title: Neuraxial blockade for external cephalic version: a systematic review.
abstract: BACKGROUND
  The desire to decrease the number of cesarean deliveries has renewed interest in external cephalic version. The rationale for using neuraxial blockade to facilitate external cephalic version is to provide abdominal muscular relaxation and reduce patient discomfort during the procedure, so permitting successful repositioning of the fetus to a cephalic presentation. This review systematically examined the current evidence to determine the safety and efficacy of neuraxial anesthesia or analgesia when used for external cephalic version.
  
  
  METHODS
  A systematic literature review of studies that examined success rates of external cephalic version with neuraxial anesthesia was performed. Published articles written in English between 1945 and 2010 were identified using the Medline, Cochrane, EMBASE and Web of Sciences databases.
  
  
  RESULTS
  Six, randomized controlled studies were identified. Neuraxial blockade significantly improved the success rate in four of these six studies. A further six non-randomized studies were identified, of which four studies with control groups found that neuraxial blockade increased the success rate of external cephalic version. Despite over 850 patients being included in the 12 studies reviewed, placental abruption was reported in only one patient with a neuraxial block, compared with two in the control groups. The incidence of non-reassuring fetal heart rate requiring cesarean delivery in the anesthesia groups was 0.44% (95% CI 0.15-1.32).
  
  
  CONCLUSIONS
  Neuraxial blockade improved the likelihood of success during external cephalic version, although the dosing regimen that provides optimal conditions for successful version is unclear. Anesthetic rather than analgesic doses of local anesthetics may improve success. The findings suggest that neuraxial blockade does not compromise maternal or fetal safety during external cephalic version.
authors.affiliation: Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA 94305, USA. p.sultan@doctors.org.uk
authors.forename: P
authors.initials: P
authors.lastname: Sultan
authors.forename: B
authors.initials: B
authors.lastname: Carvalho
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical / Q000379:methods*; D005260:Female; D006801:Humans; D009407:Nerve Block / Q000379:methods*; D011247:Pregnancy; D014710:Version, Fetal