External cephalic version with epidural anaesthesia alter failure of a first trial with beta-mimetics

Objective To assess the efficacy, tolerance, and cost of ext external versi on under epidural anaesthesia and beta-mimetic tocolysis after the failure of an initial attempt with tocolysis alone. Design Prospective open study. Participants Sixty-eight women with breech presentation at around 36 weeks of gestation and an attempted external cephalic version under salbutamol th at failed, who consented to try a second attempt under epidural anaesthesia . Results The overall success rate under epidural anaesthesia was 39.7% (27/6 8), and complications occurred in two cases. The total cost of attempting e xternal version was higher than the cost of expectant management. Conclusions The efficacy of external cephalic version under epidural reduce s the rate of caesarean sections associated with breech presentation, but i ts relative safety remains in question. Moreover, our economic analysis dis courages the hope of lowered costs suggested by earlier reports Char this t echnique is more expensive than expectant management, except in institution s with a policy of systematic caesarean sections when version fails.