Cherayil Gerald, Feinberg Bruce, Robinson Julian, Tsen Lawrence C
Department of Anesthesiology, Harvard Medical School, Brigham and Women's Hospital, CWN-L1, Boston, MA 02115, USA.
Anesth Analg. 2002 Jun;94(6):1589-92, table of contents. doi: 10.1097/00000539-200206000-00041.
External cephalic version (ECV) has been successfully used to decrease the fetal and maternal morbidity and costs of cesarean delivery. As there are limited data regarding the use of central neuraxial blockade in the setting of previously failed ECV attempts, we sought to evaluate the efficacy and safety of spinal and epidural anesthesia in this setting. A retrospective review of all ECV attempts performed by a single experienced obstetrician between 1995 and 1999 was conducted. Standardized tocolytic and anesthetic regimens were used. A total of 77 patients underwent ECV attempts; of these, 37 (48%) were unsuccessful, 15 of which consented to further attempts with anesthesia. Neuraxial anesthesia was associated with frequent ECV success in both multiparous 4/4 (100%) and nulliparous 9/11 (82%) parturients. Overall 5/6 (83%) and 8/9 (89%) (P = NS) ECV attempts were successful with spinal and epidural anesthesia, respectively, with 2/5 (40%) and 6/8 (75%) (P = NS) resulting in vaginal deliveries. One successful ECV in the epidural group had an urgent cesarean delivery for persistent fetal bradycardia with good neonatal and maternal outcomes. We conclude central neuraxial anesthesia promotes successful ECV after previously failed ECV attempts.
Our retrospective analysis of central neuraxial techniques, both epidural and spinal anesthesia, noted a significant success rate in the setting of previously failed external cephalic version attempts.
外倒转术（ECV）已成功用于降低剖宫产的胎儿和产妇发病率及费用。由于关于在先前ECV尝试失败的情况下使用中枢神经阻滞的数据有限，我们试图评估在这种情况下脊髓麻醉和硬膜外麻醉的有效性和安全性。对1995年至1999年间由一位经验丰富的产科医生进行的所有ECV尝试进行了回顾性分析。采用了标准化的宫缩抑制剂和麻醉方案。共有77例患者接受了ECV尝试；其中37例（48%）未成功，其中15例同意在麻醉下进一步尝试。在经产妇4/4（100%）和初产妇9/11（82%）中，神经轴麻醉与频繁的ECV成功相关。总体而言，脊髓麻醉和硬膜外麻醉的ECV尝试分别有5/6（83%）和8/9（89%）（P=无显著性差异）成功，其中2/5（40%）和6/8（75%）（P=无显著性差异）导致阴道分娩。硬膜外组有一例成功的ECV因持续性胎儿心动过缓紧急剖宫产，母婴结局良好。我们得出结论，在先前ECV尝试失败后，中枢神经轴麻醉可促进ECV成功。
我们对硬膜外和脊髓麻醉这两种中枢神经轴技术的回顾性分析表明，在先前外倒转术尝试失败的情况下成功率显著。
