CSE Minimally Benefits External Cephalic Version


HOLLYWOOD, FLA. — Combined spinal-epidural analgesia did not significantly improve the rate of successful external cephalic version, compared with systemic opioid analgesia for breech presentation, but it did improve maternal pain and satisfaction, Dr. John T. Sullivan reported at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

A total of 86 women with singleton breech presentation were randomized to receive combined spinal-epidural (CSE)analgesia (2.5-mg intrathecal bupivacaine) plus 15-mcg fentanyl, followed by a 45-mg lidocaine and 15-mcg epinephrine epidural test dose, or 50 mcg of IV fentanyl.

Patients received analgesic intervention and terbutaline timed to provide peak analgesic and uterine relaxant effect at the time of external cephalic version, said Dr. Sullivan of Northwestern University, Chicago.

The success rate of external cephalic version was 43% in the CSE group and 33% in the systemic analgesia group. Vaginal deliveries occurred in 36% of those in the CSE group and 24% of those in the systemic analgesia group. The differences were not statistically significant.

However, pain scores were significantly lower in the CSE group (mean visual analog scale score of 11 vs. 36), and patient satisfaction with analgesic technique was higher in that group (median verbal rating of satisfaction score of 10 vs. 7).

Higher parity, greater estimated gestational age, and shorter procedure duration were significantly associated with version success, Dr. Sullivan noted.

Data regarding the impact of neuraxial anesthesia on the success rate of external cephalic version have been conflicting, and because improved success with external cephalic version has been suggested as a means for lowering cesarean section rates, further study is warranted, he said, noting that additional cases will be randomized for this study in an attempt to improve its power.

Next Article: