The Effect of Combined Spinal-Epidural Analgesia on the Success of External Cephalic Version (ECV) for Breech Position

NCT ID: NCT00565383

Last Updated: 2013-06-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

101 participants

Study Classification

INTERVENTIONAL

Study Start Date

2002-08-31

Study Completion Date

2006-06-30

Brief Summary

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We aim to answer the clinical question: Does combined spinal-epidural analgesia improve the success rate of external cephalic version? We hypothesize that neuraxial analgesia (spinal or epidural analgesia) during version for breech presentation increases successful fetal rotation and decreases the incidence of Cesarean delivery for malpresentation.

Detailed Description

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At term 2 to 3% of singleton pregnancies are in breech presentation. Many of these deliveries are managed by cesarean delivery due to higher neonatal morbidity associated with vaginal breech delivery. Cesarean delivery, the safer option for the baby, however, is associated with a higher incidence of maternal complications for both the current and subsequent pregnancies. External cephalic version is a procedure commonly used to attempt to manually rotate the fetus into vertex position. This facilitates vaginal delivery and thus avoids higher maternal and/or neonatal complications.

Obstetricians perform versions after 36 weeks gestational age with a reportable success rate of 30-80%. The most common technique involves external manipulation of the fetal position preceded by pharmacologic uterine relaxation. Pain relief is most commonly provided in the form of intravenous opioids such as fentanyl. A more efficacious form of analgesia is the use of neuraxial opioids and local anesthetics (neuraxial analgesia), a technique commonly used for labor and delivery analgesia.

Although the use of neuraxial analgesia and anesthesia techniques improve maternal pain and satisfaction, there is conflicting evidence if they improve the success rate of version procedures. The American College of Obstetricians and Gynecologists (ACOG) has stated, "Currently there is not enough evidence to make a recommendation favoring or opposing anesthesia during ECV (external cephalic version) attempts."

We propose to conduct a prospective, single blinded, randomized clinical trial to assess the impact of combined spinal-epidural analgesia on the success rate of external version for breech fetal position and the subsequent incidence of vaginal vs. Cesarean delivery as a secondary outcome.

Conditions

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Pregnancy Breech Presentation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Intravenous fentanyl analgesia

Intravenous fentanyl (50 mcg) analgesia

Group Type ACTIVE_COMPARATOR

Intravenous fentanyl (50mcg)

Intervention Type PROCEDURE

Intravenous fentanyl

Combined spinal-epidural analgesia

Combined spinal-epidural analgesia (intrathecal fentanyl 2.5 mg plus bupivacaine 2.5 mg) single administration

Group Type EXPERIMENTAL

Combined spinal-epidural analgesia

Intervention Type PROCEDURE

Combined spinal-epidural

Interventions

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Combined spinal-epidural analgesia

Combined spinal-epidural

Intervention Type PROCEDURE

Intravenous fentanyl (50mcg)

Intravenous fentanyl

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* 18-55 years of age
* Female
* Pregnant
* Breech Presentation
* Greater than 36 Weeks gestation
* Version Procedure

Exclusion Criteria

* Under 18 or over 55 years of age
Minimum Eligible Age

18 Years

Maximum Eligible Age

55 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Northwestern University

OTHER

Sponsor Role lead

Responsible Party

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John Sullivan

John T. Sullivan M.D.

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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John T Sullivan, M.D.

Role: PRINCIPAL_INVESTIGATOR

Northwestern University Feinberg School of Medicine

Locations

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Prentice Women's Hospital

Chicago, Illinois, United States

Site Status

Countries

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United States

References

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Fortunato SJ, Mercer LJ, Guzick DS. External cephalic version with tocolysis: factors associated with success. Obstet Gynecol. 1988 Jul;72(1):59-62.

Reference Type BACKGROUND
PMID: 3288930 (View on PubMed)

Zhang J, Bowes WA Jr, Fortney JA. Efficacy of external cephalic version: a review. Obstet Gynecol. 1993 Aug;82(2):306-12.

Reference Type BACKGROUND
PMID: 8336883 (View on PubMed)

Carlan SJ, Dent JM, Huckaby T, Whittington EC, Shaefer D. The effect of epidural anesthesia on safety and success of external cephalic version at term. Anesth Analg. 1994 Sep;79(3):525-8. doi: 10.1213/00000539-199409000-00021.

Reference Type BACKGROUND
PMID: 8067558 (View on PubMed)

Birnbach DJ, Matut J, Stein DJ, Campagnuolo J, Drimbarean C, Grunebaum A, Kuroda MM, Thys DM. The effect of intrathecal analgesia on the success of external cephalic version. Anesth Analg. 2001 Aug;93(2):410-3, 4th contents page. doi: 10.1097/00000539-200108000-00035.

Reference Type BACKGROUND
PMID: 11473871 (View on PubMed)

Other Identifiers

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Sullivan 002

Identifier Type: OTHER

Identifier Source: secondary_id

0897-002

Identifier Type: -

Identifier Source: org_study_id

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