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Use of a Piglet Model for the Study of Anesthetic-induced Developmental Neurotoxicity AIDN: A Translational Neuroscience Approach

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Anesthetic approaches for malpresentation and multiple gestation.

Oscar F C van den Bosch¹, Feline F J A Ter Bruggen¹, Erica M Johnson²

¹Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.

Current Opinion in Anaesthesiology

|February 12, 2026

Summary

Anesthesiologists should be prepared for external cephalic version (ECV) and labor analgesia in malpresentation and multiple gestation. Cesarean delivery in multiple gestations increases postpartum hemorrhage risk, requiring vigilant care.

Keywords:

breech malpresentation multiple gestation obstetric anesthesia

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Area of Science:

Obstetrics and Anesthesiology
Maternal-Fetal Medicine

Background:

Malpresentation and multiple gestation present unique anesthetic challenges.
Current anesthetic practices require updates based on recent evidence.

Purpose of the Study:

To review anesthetic considerations for malpresentation and multiple gestation.
To cover analgesia for external cephalic version (ECV), labor, and cesarean delivery.
To discuss postpartum hemorrhage risk management.

Main Methods:

Literature review of anesthetic management in malpresentation and multiple gestation.
Analysis of recent findings on neuraxial analgesia and cesarean delivery risks.

Main Results:

Neuraxial analgesia enhances ECV success and maternal comfort.
Neuraxial labor analgesia improves safety in multiple gestation vaginal deliveries.
Cesarean delivery in multiple gestations has a higher risk of uterine atony and increased oxytocin needs.

Conclusions:

Anesthesiologists must be vigilant for malpresentation and multiple gestation cases.
Gaps between evidence and practice necessitate implementation studies and guidelines.