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Does Regional Anesthesia for External Cephalic Version Increase the Risk of Emergent Cesarean Delivery? [8C]

Ainsworth, Alessandra, MD; Tolcher, Mary C., MD; Weaver, Amy, MS; Holman, Michelle, MD; Sviggum, Hans, MD; Arendt, Katherine, MD

Obstetrics & Gynecology: May 2016 - Volume 127 - Issue - p 28S
doi: 10.1097/01.AOG.0000483357.01712.4b
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INTRODUCTION: Previous studies have shown improved success without additional complications when external cephalic version (ECV) is performed with neuraxial anesthesia (NA). The purpose of this study was to evaluate the effect of NA at the time of ECV on emergent cesarean delivery (CD), procedure success, and subsequent vaginal delivery.

METHODS: Women who underwent ECV at Mayo Clinic between January 1, 2010 and December 31, 2014 with and without NA were retrospectively studied. The primary outcome was the rate of emergency CD (delivery within 4 hours of ECV). Secondary outcomes were ECV success and ultimate mode of delivery. Outcomes were compared using the chi-square test.

RESULTS: A total of 135 patients underwent 144 ECV procedures with NA use in 65 (45.1%) procedures. Increased rates of emergent CD were found with NA compared to procedures without NA (6 [9.2%] versus 0 [0%], P=.006). ECV success was unaffected by NA (36 [55.4%] successful ECV with NA versus 38 [48.1%] without NA, P=.38). Successful ECV led to subsequent vaginal delivery in only 55 (38.2%) women.

CONCLUSION: NA for ECV increased the risk of emergent CD without impacting ECV success. These findings differ from previous randomized controlled trials (RCTs). The increased risk and decreased success of our ECVs compared to ECVs performed in the context of RCTs could be explained by patient selection, variation in operator experience or technique, or variation in anesthetic management. Future studies should further evaluate the risk of NA for ECV in true practice scenarios outside of RCTs.

Mayo Clinic, Rochester, MN

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

© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.