Randomized controlled trial of external cephalic version in term multiparae with or without spinal analgesia

Area of Science:

• Obstetrics and Gynecology
• Anesthesiology
• Perinatal Medicine

Background:

• Neuraxial analgesia is known to improve external cephalic version (ECV) success rates in nulliparous women.
• The efficacy of spinal analgesia for ECV in multiparous women remains less understood.

Purpose of the Study:

• To compare the success rates of external cephalic version (ECV) in multiparous women receiving spinal analgesia versus those receiving no analgesia.
• To evaluate the impact of spinal analgesia on patient comfort and adverse outcomes during ECV.

Main Methods:

• A prospective randomized controlled trial was conducted over six years.
• Healthy multiparous women at term with breech presentation underwent ECV, randomized to receive spinal analgesia or no analgesia.
• Primary outcome was successful ECV conversion; secondary outcomes included pain scores and adverse events.

Main Results:

• ECV success was significantly higher in the spinal analgesia group (87.1%) compared to the no-analgesia group (57.5%) (P=0.009).
• Spinal analgesia markedly reduced pain scores (1.7 vs 5.5, P<0.0001) and improved patient comfort.
• Maternal hypotension occurred in 32% of the spinal analgesia group but was easily managed without adverse outcomes; no ECV complications were reported.

Conclusions:

• Spinal analgesia significantly increases ECV success rates in multiparous women.
• The administration of spinal analgesia enhances patient comfort during ECV procedures.
• Spinal analgesia is a safe and effective adjunct for ECV in multiparous women.