[Unusual obstetrical situations: role of locoregional anesthesia].

Breech or twin delivery is a difficult obstetric situation in which both maternal and neonatal risks are increased and where the incidence of caesarean section and instrumental extraction is high. Epidural anaesthesia may worsen the obstetric situation especially if high doses of local anaesthetics are used resulting in a dense motor blockade. If, on the contrary, effective analgesia is obtained by the epidural injection of low concentrations of local anaesthetics especially with opiates, epidural anaesthesia may increase neither the duration of the second stage nor the incidence of caesarean delivery or forceps extraction and may rather improve neonatal outcome. Extension of the sensory block may be rapid, allowing obstetric intervention while maintaining maternal safety and comfort. For similar reasons and by using low dose techniques, epidural anaesthesia should not be anymore considered contra-indicated in the trial of labor after previous caesarean section.