Extradural Analgesia in Labour When the Breech Presents

Abstract

Summary A retrospective study was made of the course and outcome of labour in 226 patients in whom a singleton fetus presented by the breech. Patients with macerated stillbirths or who were delivered before the 28th week of gestation had been excluded. Of the 226 patients, 101 received extradural analgesia, 79 received parenteral analgesia and 46 underwent elective Caesarean section. There was no difference in the incidence of breech extraction or emergency Caesarean section in the first two groups of patients. The length of both first and second stages of labour in multiparae was prolonged in the extradural group, but not markedly so. The Apgar scores of the infants delivered vaginally were not significantly different at one minute in both groups but the five minute Apgar score in the infants of primiparae was significantly higher in the extradural group. The Apgar score at one minute in the group delivered by emergency Caesarean section was significantly lower after extradural block but the difference was not significant at five minutes. This study suggests that the management and outcome of labour when the breech presents is not adversely affected by the provision of extradural analgesia.

Intrapartum Cesarean Section and Perinatal Outcomes after Epidural Analgesia or Remifentanil-PCA in Breech and Twin Deliveries

“…EA for vaginal breech delivery was reported to be associated with favorable Apgar scores and maternal outcomes and may be considered the preferred analgesic modality for this type of delivery [ 52 , 53 ]. Similar to our finding, Darby et al reported no differences in emergency CS rates in patients with EA or parenteral analgesia in singleton breech deliveries [ 54 ]. However, contrary to our results, they reported that while the one-minute Apgar scores of the neonates in the EA and parenteral analgesia groups did not differ significantly, the Apgar scores of the neonates of primiparae were significantly higher in the EA group at five minutes.…”

Balancing the risks of planned cesarean section and trial of vaginal delivery for the mature, selected, singleton breech presentation

“…Breech delivery should be preceded by a detailed anomaly scan as a severe or lethal defect may affect the subsequent management. Our findings confirm those of others which have shown that the second stage is prolonged in patients who receive epidural analgesia [6,11,13]. Of course, this is a potentially biased finding as patients with poor progress are more likely to require epidural analgesia.…”

Breech delivery and epidural analgesia

“…This observation contrasts with some previous reports (Bowen–Simpkins & Ferguson 1974; Crawford & Weaver 1982; Rudick et al 1983) which found no increase in caesarean deliveries in women of mixed parity. Indeed, one report (Darby et al 1976) commented on a 50% reduction in emergency caesarean sections among women, also of mixed parity, who had epidural analgesia. Our study highlights the important difference in outcome in primiparae and multiparae.…”