Repeat External Cephalic Version Under Regional Anesthesia: Is it Worth the Attempt? [22I]

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Abstract

INTRODUCTION:

Breech presentation occurs in 4% of term pregnancies with high cesarean delivery rate for persistent breech. External cephalic version (ECV) is a technique used to reduce incidence of cesarean due to malpresentation. Regional anesthesia increases ECV success rates in the first attempt. We assessed the effects of regional anesthesia in repeat ECV.

METHODS:

Retrospective cohort analysis of term ECVs between 2012-2017. Women failing initial ECV were offered repeat ECVs with or without regional anesthesia, depending on preference. Primary outcome was successful cephalic version and secondary outcome was vaginal delivery. The impact of BMI, maternal age, gestational age, parity, and birthweight were examined in multivariable model.

RESULTS:

304 women underwent initial ECV without regional anesthesia, 91 (30%) converted to cephalic, resulting in 69 vaginal deliveries (22%). Among 213 women with unsuccessful ECV, 81 underwent repeat ECV: 52 without spinal, 10 converted to cephalic (19%) and 9 delivered vaginally (17%); 29 with spinal anesthesia, 9 converted to cephalic (31%) and 7 delivered vaginally (24%). In unadjusted analysis, OR for successful version with spinal anesthesia was 2.74 (95% CI 1.05–7.15). This did not retain statistical significance after controlling for confounders (OR 2.55, 95% CI: 0.92-7.05). There was no statistically significant difference in maternal age, gestational age, or birth weight between the two groups.

CONCLUSION:

Offering repeat ECV to women who fail first attempt is a reasonable option and has a success rate comparable to the first attempt. In this study, regional anesthesia did not have statistically significant effect on the success rate of repeat ECV.

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