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Survey of Anesthesia Practices to Facilitate External Cephalic Version
Abstract Number: F-12
Abstract Type: Original Research
Background: External cephalic version (ECV) is used for breech presentation in order to enable attempted vaginal delivery (1). Neuraxial block may increase ECV success rates (2) and is cost-effective (3), however the extent to which neuraxial anesthesia is used to facilitate ECV has not been assessed in the United States. The purpose of this survey study was to assess the frequency and characteristics of neuraxial blockade used to facilitate ECV.
Methods: We surveyed Society of Obstetric Anesthesiology and Perinatology (SOAP) members regarding their institutional ECV practice. An 18-question survey was developed by 3 obstetric anesthesiologists and tested for face validity on a cohort of practicing anesthesiologists. The survey was emailed on Jan 16th 2014 to the 1,056 SOAP members. We present descriptive statistics of the initial responses.
Results: The initial survey request was completed by 188/1,056 (18%) of the members. Of the respondents, 88% practice in the United States, and 73% of responders work in academic institutions. The frequency of ECV performance for breech presentation is <50% in 67% institutions, =>50% in 28% institutions and 3% of institutions do not perform ECV. External cephalic version neuraxial block practice and ECV adjuncts are summarized in the Table.
Conclusions: Our interim analysis shows that neuraxial blocks are not universally offered to facilitate ECV, despite evidence for improved ECV success with neuraxial anesthesia. There is clear variability in neuraxial block technique and dosing to obtain anesthesia or analgesia levels. Initial results suggest that education of both obstetrician and anesthesiologist is necessary to remove barriers to care before widespread neuraxial use for ECV is realized.
1. de Hundt M. Obstet Gynecol 2014;123:1327-34.
2. Sultan P. Int J Obstet Anesth 2011;20:299-306.
3. Carvalo B. Anesth Analg 2013;117:155-9.