title: A prospective randomized trial of the use of epidural anesthesia during external cephalic version.
abstract: Objective: To determine if the use of epidural anesthesia improves the success rate of external cephalic version (ECV).Design: Women identified with a singleton fetus in a breech or transverse presentation at a gestational age of >/=37 weeks gestation were offered enrollment in this prospective randomized trial. Inclusion criteria included maternal age of 18 years or older, a non-vertex presentation confirmed by ultrasound, a reactive fetal non-stress test, and an estimated fetal weight of 2,000-4,000 g. A 1:1 randomization was accomplished through a computer-generated random numbers table with group assignments sealed in sequentially numbered opaque envelopes. Women in the epidural ECV group had a lumbar epidural catheter inserted through which 2% lidocaine and 100 µg of fentanyl were infused.Results: There were no statistically significant differences between the two groups in gestational age at ECV, placental location, fetal lie, gravidity or parity, estimated fetal weight, or amniotic fluid index. The ECV was successful in 26 of 45 (58%) women with epidural anesthesia compared to 16 of 48 (33%) with no anesthesia (relative risk 1.7, 95% confidence interval 1.1-2.8, P <.05). Fetal bradycardia resulting in discontinuation of the version efforts occurred in two patients in the epidural group and three women in the control population, a non-statistically significant difference. There were no maternal complications noted in the study population related to the epidural anesthesia.Conclusions: The use of epidural anesthesia increases the success rate of external cephalic version.
authors.affiliation: Department of Obstetrics and Gynecology, Tripler Army Medical Center, Hawaii, Honolulu, USA
authors.initials: K
authors.lastname: Mancuso
authors.initials: MK
authors.lastname: Yancey
authors.initials: JA
authors.lastname: Murphy
authors.initials: D
authors.lastname: Daniels
authors.initials: G
authors.lastname: Markenson