title: Central neuraxial blockade promotes external cephalic version success after a failed attempt.
abstract: External cephalic version (ECV) has been successfully used to decrease the fetal and maternal morbidity and costs of cesarean delivery. As there are limited data regarding the use of central neuraxial blockade in the setting of previously failed ECV attempts, we sought to evaluate the efficacy and safety of spinal and epidural anesthesia in this setting. A retrospective review of all ECV attempts performed by a single experienced obstetrician between 1995 and 1999 was conducted. Standardized tocolytic and anesthetic regimens were used. A total of 77 patients underwent ECV attempts; of these, 37 (48%) were unsuccessful, 15 of which consented to further attempts with anesthesia. Neuraxial anesthesia was associated with frequent ECV success in both multiparous 4/4 (100%) and nulliparous 9/11 (82%) parturients. Overall 5/6 (83%) and 8/9 (89%) (P = NS) ECV attempts were successful with spinal and epidural anesthesia, respectively, with 2/5 (40%) and 6/8 (75%) (P = NS) resulting in vaginal deliveries. One successful ECV in the epidural group had an urgent cesarean delivery for persistent fetal bradycardia with good neonatal and maternal outcomes. We conclude central neuraxial anesthesia promotes successful ECV after previously failed ECV attempts.
  
  
  CONCLUSIONS
  Our retrospective analysis of central neuraxial techniques, both epidural and spinal anesthesia, noted a significant success rate in the setting of previously failed external cephalic version attempts.
authors.affiliation: Department of Anesthesiology, Harvard Medical School, Brigham and Women's Hospital, CWN-L1, Boston, MA 02115, USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: Cherayil
authors.forename: Bruce
authors.initials: B
authors.lastname: Feinberg
authors.forename: Julian
authors.initials: J
authors.lastname: Robinson
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: Tsen
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D001946:Breech Presentation; D002585:Cesarean Section; D005260:Female; D006801:Humans; D009407:Nerve Block; D005996:Nitroglycerin / Q000494:pharmacology; D011247:Pregnancy; D012189:Retrospective Studies; D015145:Tocolysis; D014665:Vasodilator Agents / Q000494:pharmacology; D014710:Version, Fetal
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin