The effect of epidural anesthesia on safety and success of external cephalic version at term

Abstract

The purpose of this study was to assess the effect of epidural anesthesia on the success and safety of external cephalic version (ECV) performed at term. A retrospective record review of all pregnant women > 36 wk gestation who had attempts at ECV at Arnold Palmer Hospital for Children and Women between April 2, 1992, and April 30, 1993, was performed. The standard contraindications to ECVs were observed, and the use of tocolytics and lumbar epidural anesthesia was based on personal preference of the patient's physician. Sixty-one patients underwent 69 attempts, with eight patients having two attempts. There were 37 attempts without epidural and 32 with epidural. Four (10%) and 11 (34%) of the no epidural and epidural groups, respectively, were either in labor or had a cervical dilation > 3 cm at the time of the attempt. The other major patient variables likely to affect the success of ECV were not different between the groups, with the exception of a higher percentage of attempts by the housestaff in the epidural group. The success rate was 59% and 24% for the epidural group and no epidural group, respectively (P < 0.05). The incidence of abruptio placentae, fetal bradycardia, low Apgar scores, and low umbilical artery pH was similar. In our patient population, regional anesthesia increased the success rate of ECV and decreased the cesarean delivery rate with no apparent ill effect on perinatal or maternal morbidity or mortality.