Epidural analgesia for cephalic version: A randomized trial

Objective: To determine if epidural analgesia improves the success rate of external cephalic version. Methods: Women with singleton fetuses in breech or transverse presentation of at least 37 weeks' gestation were offered enrollment in a randomized tri al. Inclusion criteria included maternal age of 18 years or older, nonverte x presentation confirmed by ultrasound, intact membranes, reactive fetal no nstress test, and estimated fetal weight (EFW) between 2000 and 4000 g. Wom en in the epidural group had lumbar epidural catheters inserted, through wh ich 2% lidocaine and 100 mu g of fentanyl were infused. External cephalic v ersion attempts were done with ultrasound guidance in a standard fashion fo r both groups. The primary outcome variable was the successful version of t he fetus to a cephalic presentation. Results: There were no statistically significant differences between groups in gestation at time of procedure, placental location, fetal lie, gravity, parity, EFW, or amniotic fluid index. External cephalic version was succes sful in 32 of 54 women (59%) with epidural anesthesia compared with 18 of 5 4 (33%) with no anesthesia (relative risk [RR] 1.8, 95% confidence interval [CI] 1.2, 2.8, P <.05). Vaginal delivery occurred in 29 of 54 women (54%) in the epidural group and 16 of 54 women (30%) in the control group (RR 1.9 , 95% CT 1.2, 2.9, P<.05). Conclusion: Epidural analgesia increased the success rate of external cepha lic version and the likelihood of subsequent vaginal delivery. (Obstet Gyne col 2000;95:638-51.).