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Obstetrics and Gynecology International
Volume 2009, Article ID 718981, 8 pages
http://dx.doi.org/10.1155/2009/718981
Review Article

Central Neuraxial Blockade-Assisted External Cephalic Version in Reducing Caesarean Section Rate: Systematic Review and Meta-Analysis

1Family Services Division, Department of Obstetrics and Gynaecology, Hull York Medical School (HYMS), Diana Princess of Wales Hospital, Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, Scartho Road, Grimsby DN33 2BA, UK
2Clinical Research Fellow, Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Imperial College, Hammersmith Campus, Du cane Road, London W120NN, UK

Received 14 September 2009; Accepted 18 November 2009

Academic Editor: Anthony O. Odibo

Copyright © 2009 Ibrahim Bolaji and Lillian Alabi-Isama. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We review the medical literature on the success, safety and economic value of central neuraxial blockade-assisted (CNB) external cephalic version from randomized controlled studies identified from 1951 to 2009. The result showed that more women had successful ECV with regional anaesthesia with corresponding reduction in caesarean section rate. They were 1.5 times more likely than women not receiving anaesthesia to have a successful ECV. The number to treat is six women needed to receive anaesthesia for 1 baby to be turned from breech to cephalic presentation. Feto-maternal morbidity was not increased in the CNB-aided group consisting of only transient bradycardia. Although the appropriate amount of force for safe version has not been quantified, there was no report of uterine rupture despite removal of these patients from “excessive force-pain biofeedback loop” induced through motor nerve blockade. We can attribute 30% of cost savings amounting to £42,150.00 directly to CNB using the most up to date Health Resource Group Code (HRG4). The initial results are encouraging but until the benefits and safety of CNB-aided ECV are substantiated by large randomized, blinded controlled trials, this practice cannot be universally recommended.