Randomized trial of anaesthetic interventions in external cephalic version for breech presentation

Area of Science:

• Obstetrics and Gynecology
• Anesthesiology
• Fetal Medicine

Background:

• External cephalic version (ECV) is crucial for reducing Cesarean sections in breech presentations.
• Comparing anesthetic techniques for ECV is essential for optimizing outcomes.

Purpose of the Study:

• To compare the success rates of ECV using spinal anaesthesia (SA), intravenous analgesia (IVA) with remifentanil, and no anaesthetic intervention.
• To evaluate the effectiveness of SA and IVA for ECV re-attempts.

Main Methods:

• A double-phased, randomized controlled trial involving 189 patients.
• Patients were allocated to SA, IVA (remifentanil), or Control groups for ECV.
• Phase 2 involved re-attempts with SA or IVA for patients in the Control group with failed initial ECV.

Main Results:

• ECV success rates were highest with SA (83%), compared to IVA (64%) and Control (64%) (P=0.027).
• SA significantly reduced pain scores (0/100) compared to IVA (35/100) and Control (50/100) (P<0.001).
• Re-attempts were successful in 78% with SA versus 0% with IVA (P=0.0007); fetal bradycardia and emergency CS rates were similar across groups.

Conclusions:

• Spinal anaesthesia is superior to IV analgesia or no intervention for improving ECV success rates and reducing pain.
• SA facilitates ECV re-attempts, likely due to improved abdominal muscle relaxation.
• Anesthetic interventions for ECV do not significantly increase fetal risks like bradycardia or emergency Cesarean section.