Spinal pain control helps rotate breech babies

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - The results of a new study conducted in women who'd never given birth before suggests that a commonly used technique to rotate a fetus from a feet-first "breech" position into the normal head-first "cephalic" position is more likely to be successful if pain control drugs are injected into the spinal canal first.

The researchers are hopeful that these data will help reduce c-section rates in these women, according to the report in the journal Obstetrics and Gynecology.

External cephalic version, or ECV, is a standard manipulatory technique used to move the fetus from a breech position to a cephalic one. Success rates of up to 100 percent have been achieved in women who've given birth before (multiparous), but the rates reported in women who've never given birth (nulliparous) are much lower, ranging from 30 to 63 percent.

Previous studies have investigated whether spinal pain control can improve ECV success rates in nulliparous women, but the answer remains unclear.

Past studies have not differentiated between the results with multiparous and nulliparous pregnancies, lead author Dr. Carolyn F. Weiniger, from Hadassah-Hebrew University Medical Center in Jerusalem, told Reuters Health. "This may account for the conflicting evidence regarding the effect of spinal analgesia on the success of ECV."

She pointed out that the current study included only nulliparous pregnancies, and "we found that these women have a twofold increased chance of success of ECV when using spinal (pain control) for the ECV."

The study involved 70 women with a fetus in the breech position who were randomly assigned to receive spinal or no analgesia prior to ECV.

ECV was successful in 66.7 percent of women given spinal analgesia compared with 32.4 percent of women who received no analgesia. Spinal analgesia was also associated with reduced pain scores on a standard test.

No serious obstetrical complications were seen in either group, the report indicates.

"I hope that this study raises the awareness that cesarean section need not be the automatic option for nulliparous women with a breech presentation," Weiniger said. "I hope women will consider ECV, which with spinal analgesia has a higher chance of success and will not be painful. Many women fear the pain of ECV and others worry about the failure."

SOURCE: Obstetrics and Gynecology, December 2007.