Abstract:

Objective To investigate the success rate of external cephalic version under intrathecal analgesia for breech position singleton pregnant women and analyze the complications of external cephalic version. Methods A total of 60 pregnant women who have undergone regular prenatal examinations and delivered normally were randomly divided into epidural anesthesia group (EA group, n=30) and combined spinal-epidural anesthesia group (CSEA group, n=30). Another 30 pregnant women who have delivered without analgesia were selected as controls. The pain scores of pregnant women of three groups when conducting the external cephalic version were compared by visual analogue scales. The proportion of head position, rate of cesarean section, and rate of adverse reactions of three groups were compared. Results After intrathecal analgesia was performed, the pain scores of EA group and CSEA group were 1.87±2.94 and 1.73±2.71, respectively, which were significantly lower than that of control group (6.84±3.08)(P=0.031 and P=0.027). The success rate of external cephalic version of EA group was 78.3%, which was higher than that of CSEA group (51.7%) and control group (48.3%)(P=0.023 and P=0.041). The difference between CSEA group and control group was not statistically significant. Compared with CSEA group and control group, both the rate of cesarean section and the rate of cesarean section with breech position as the first indication of EA group were lower and the differences were statistically significant (P=0.037 and P=0.029). The incidences of hypotension, nausea and vomiting, and decreased fetal heart rate of CSEA group were remarkably higher than those of control group and the differences were statistically significant (P=0.021, P=0.042, P=0.033). The placental abruption did not occur during the external cephalic version among pregnant women of three groups. The differences of incidences of preterm birth and umbilical cord around neck of three groups after external cephalic version were not statistically significant. Conclusion For breech position singleton pregnant women, the external cephalic version after epidural analgesia can effectively correct the fetal position and decrease the rate of cesarean section. But whether combined spinal-epidural analgesia can improve the success rate of instantaneous external cephalic version remains unclear.

Key words: epidural anesthesia, combined spinal-epidural anesthesia, breech presentation, external cephalic version