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Effect of Regional Anesthesia on the Success Rate of External Cephalic Version: A Systematic Review and Meta-Analysis

Goetzinger, Katherine R. MD; Harper, Lorie M. MD, MSCI; Tuuli, Methodius G. MD, MPH; Macones, George A. MD, MSCE; Colditz, Graham A. MD, DrPH

doi: 10.1097/AOG.0b013e3182324583
Reviews

OBJECTIVE: To estimate whether the use of regional anesthesia is associated with increased success of external cephalic version.

DATA SOURCES: We searched MEDLINE, EMBASE, the Cochrane Library, and clinical trial registries.

METHODS OF STUDY SELECTION: Electronic databases were searched from 1966 through April 2011 for published, randomized controlled trials in the English language comparing regional anesthesia with no regional anesthesia for external cephalic version. The primary outcome was external cephalic version success. Secondary outcomes included cesarean delivery, maternal discomfort, and adverse events. Pooled risk ratios (relative risk) were calculated using a random-effects model. Heterogeneity was assessed using the Cochran's Q statistic and quantified using the I2 method.

TABULATION, INTEGRATION, AND RESULTS: Six randomized controlled trials met criteria for study inclusion. Regional anesthesia was associated with a higher external cephalic version success rate compared with intravenous or no analgesia (59.7% compared with 37.6%; pooled relative risk 1.58; 95% confidence interval [CI] 1.29–1.93). This significant association persisted when the data were stratified by type of regional anesthesia (spinal compared with epidural). The number needed to treat with regional anesthesia to achieve one additional successful external cephalic version was five. There was no evidence of statistical heterogeneity (P=.32, I2=14.9%) or publication bias (Harbord test P=.78). There was no statistically significant difference in the risk of cesarean delivery comparing regional anesthesia with intravenous or no analgesia (48.4% compared with 59.3%; pooled relative risk 0.80; 95% CI 0.55–1.17). Adverse events were rare and not significantly different between the two groups.

CONCLUSION: Regional anesthesia is associated with a higher success rate of external cephalic version.

Regional anesthesia is associated with increased success of external cephalic version.

From the Departments of Obstetrics & Gynecology and Surgery, Washington University in St Louis, St Louis, Missouri.

Drs. Goetzinger and Harper are supported by a training grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (5 T32 HD055172-02) and from a National Institutes of Health (NIH)/National Center for Research Resources (NCRR) Washington University ICTS grant (UL1 RR024992).

The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR or the NIH.

Corresponding author: Katherine R. Goetzinger, MD, Department of Obstetrics and Gynecology, Washington University School of Medicine, 4911 Barnes-Jewish Hospital Plaza, Campus Box 8064, St Louis, MO 63110; e-mail: goetzingerk@wudosis.wustl.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.