S. Gagnon’s research while affiliated with Mount Sinai Hospital, Toronto and other places

Introduction: Breech presentation is now an indication for cesarean delivery, however external cephalic version (ECV) maneuvers are proven therapy to reduce this event. 1 Meta-analysis review of regional anesthesia for has demonstrated a benefit of anesthesia for ECV success and maternal satisfaction. 2 However, regional anesthesia has complications and potentially IV analgesia might provide similar benefits. The objective of this study was to compare the incidence of success ECV between women receiving remifentanil intravenous (IV) analgesia and women receiving placebo.

This study was undertaken to systematically review the medical literature to determine whether anesthesia facilitates the external cephalic version maneuver (ECV) for breech presentations. Study design A meta-analytic review of medical databases for randomized clinical trials comparing anesthesia with no anesthesia given for ECV attempts. The primary outcome was the immediate success of the ECV attempt. The literature search revealed only 4 articles that met inclusion criteria. Four hundred eighty women participated in the studies and the use of anesthesia increased the success of ECV attempts (119/238 with anesthesia; 82/242 without anesthesia). The relative risk for this beneficial effect was 1.5 (95% CI 1.12-1.98) and number needed to treat was 7 (95% CI 4-14). Further study is required to assess maternal and neonatal safety with anesthesia administered for ECV maneuvers.