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Regional anesthesia improves success of external cephalic version

Clinical Question:
Does the use of regional anesthesia during external cephalic version for breech presentation improve the success rate of the procedure?

Bottom Line:
The use of regional anesthesia during external cephalic version for breech presentation significantly improves the success rate. Further studies are needed to determine whether regional anesthesia during cephalic version reduces the cesarean delivery rate. (LOE = 1a)

Reference:
Goetzinger KR, Harper LM, Tuuli MG, Macones GA, Colditz GA. Effect of regional anesthesia on the success rate of external cephalic version. Obstet Gynecol 2011;118(5):1137-1144.  [PMID:22015882]

Study Design:
Meta-analysis (randomized controlled trials)

Funding:
Foundation

Setting:
Various (meta-analysis)

Synopsis:
This meta-analysis of randomized controlled trials of regional anesthesia versus intravenous analgesia or no treatment during external cephalic version for breech presentation at term pregnancy included 6 studies with 508 women. Term pregnancy was defined as at least 36 weeks' gestation. Successful version was defined as manipulation of the fetus from breech to cephalic presentation confirmed by ultrasonography. All women received tocolysis. Data were analyzed for publication bias and none was found. Women in the regional anesthesia groups were more likely to have successful procedures (60% vs 38%; relative risk [RR] = 1.58; 95% CI, 1.29-1.93; number needed to treat [NNT] = 5). Subgroup analysis by type of regional anesthesia suggested that epidural anesthesia was more beneficial than spinal anesthesia, but with largely overlapping confidence intervals (RR =1.91; 1.29-1.93 vs 1.46; 1.14-1.87). In 5 of the 6 studies, cesarean delivery rates after successful cephalic version was reported: 105/217 (48%) patients in the regional anesthesia groups versus 131/221 (59%) in the control groups, which was not statistically significant (RR = 0.80; 0.55-1.17). This difference would be clinically important if true, which would require a larger sample size to determine.

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