Epidural analgesia for cephalic version: a randomized trial.
OBJECTIVE
To determine if epidural analgesia improves the success rate of external cephalic version.


METHODS
Women with singleton fetuses in breech or transverse presentation of at least 37 weeks' gestation were offered enrollment in a randomized trial. Inclusion criteria included maternal age of 18 years or older, nonvertex presentation confirmed by ultrasound, intact membranes, reactive fetal nonstress test, and estimated fetal weight (EFW) between 2000 and 4000 g. Women in the epidural group had lumbar epidural catheters inserted, through which 2% lidocaine and 100 microg of fentanyl were infused. External cephalic version attempts were done with ultrasound guidance in a standard fashion for both groups. The primary outcome variable was the successful version of the fetus to a cephalic presentation.


RESULTS
There were no statistically significant differences between groups in gestation at time of procedure, placental location, fetal lie, gravity, parity, EFW, or amniotic fluid index. External cephalic version was successful in 32 of 54 women (59%) with epidural anesthesia compared with 18 of 54 (33%) with no anesthesia (relative risk [RR] 1.8, 95% confidence interval [CI] 1.2, 2.8, P <.05). Vaginal delivery occurred in 29 of 54 women (54%) in the epidural group and 16 of 54 women (30%) in the control group (RR 1.9, 95% CI 1.2, 2.9, P <.05).


CONCLUSIONS
Epidural analgesia increased the success rate of external cephalic version and the likelihood of subsequent vaginal delivery.
Mancuso
K M
KM
Department of Obstetrics and Gynecology, Tripler Army Medical Center, Honolulu, Hawaii, USA.
Yancey
M K
MK
Murphy
J A
JA
Markenson
G R
GR
D000328:Adult; D015360:Analgesia, Epidural; D001946:Breech Presentation; D005260:Female; D006801:Humans; D011247:Pregnancy; D016896:Treatment Outcome; D014710:Version, Fetal / Q000379:methods