Comparative effectiveness of intravenous remifentanil, epidural anesthesia, and a 2-step analgesic approach for external cephalic version: a large prospective single-center cohort study.
Epidural anesthesia gave higher external cephalic version success than remifentanil or stepwise approach
Comparative effectiveness of intravenous remifentanil, epidural anesthesia, and a 2-step analgesic approach for external cephalic version: a large prospective single-center cohort study.
Among the analgesic strategies used during external cephalic version, neuraxial anesthesia is the only approach that has consistently demonstrated higher vaginal delivery rates.
This study aimed to compare the success of external cephalic version, modes of delivery, maternal pain, and complications using 3 strategies: intravenous analgesia with remifentanil, epidural anesthesia, and a stepwise approach in which epidural anesthesia was administered only if intravenous analgesia was unsuccessful.
We conducted a single-center, consecutive 3-phase cohort study including 1963 singleton pregnancies undergoing an external cephalic version: 558 with intravenous remifentanil (Group 1, 2012-2015), 665 with intravenous remifentanil followed by epidural anesthesia 2 to 3 days later if unsuccessful (Group 2, 2016-2019), and 730 under epidural anesthesia (Group 3, 2020-2024), yielding 2218 procedures, 1233 with intravenous remifentanil and 985 with epidural anesthesia.
epidural gave the highest success rate for turning the baby head-down
Adverse effects of anesthesia were generally uncommon and clinically mild, but higher with epidural anesthesia (P<.001).
Abnormal fetal heart rate patterns were more frequent with epidural (3.6%, 35/985) than with remifentanil (1%, 12/1233) (P<.001).
Procedure-related hospital admissions were uncommon and similar (3.6%, 35/985 vs 3.6%, 45/1233).
Procedure-related deliveries and urgent cesareans were rare, but higher with epidural (1.4%, 15/985) than with remifentanil (0.5%, 6/1233) (P=.021).
In this study, a single attempt with epidural anesthesia was the most effective strategy for external cephalic version, achieving the highest success and vaginal delivery rates while providing superior maternal pain control, but with higher complications.
These findings may help support more informed counseling and shared decision-making when discussing analgesic options for external cephalic version.