Sedation with Propofol plus Paracetamol in External Cephalic Version: An Observational Study

Javier Sánchez-Romero,Fernando Araico-Rodríguez,Luis Falcón-Araña,Aníbal Nieto-Díaz,José Eliseo Blanco-Carnero,Ana Belén Flores-Muñoz,Jesús López-Pérez,María Josefa Méndez-Martínez,Jaime Mendiola-Olivares,María Luisa Sánchez-Ferrer

doi:10.3390/jcm11030489

Abstract

Although the influence of neuraxial anesthesia or sedation with remifentanil in external cephalic version (ECV) is widely known, ECV results using propofol have not been previously analyzed. This study aimed to evaluate ECV outcomes when propofol was used. An observational analysis of ECV was performed between 1 January 2018 and 31 December 2020. ECV was accomplished with tocolysis and propofol. One hundred and thirty-one pregnant women were recruited. The propofol mean dose was 156.1 mg (SD 6.1). A cephalic presentation was achieved in 61.1% (80/131) of the pregnant women. In total, 56.7% (38/67) of pregnant women with cephalic presentation at labor had a spontaneous delivery, 26.9% (18/67) had an operative delivery, and an intrapartum urgent cesarean section was performed in 16.4% (11/67). In total, 46 pregnant women (35.9%) were scheduled for an elective cesarean section due to non-cephalic presentation. The emergency cesarean section rate during the following 24 h was 10.7% (14/131). A major ECV complication arose in 15 cases (11.5%). ECV outcomes when propofol was used seems to be similar to those with other anesthetic adjunct, so sedation with propofol could be an adequate option for ECV. More studies are needed to compare its effectiveness with neuraxial techniques.

Highlights

Breech presentation affects 3–4% of singleton term pregnancies [1,2]
The main objective of this study was to analyze External cephalic version (ECV) outcomes when propofol was used as anesthetic adjunct for the procedure
We described the delivery mode when propofol was used in ECV

Summary

Introduction

Breech presentation affects 3–4% of singleton term pregnancies [1,2]. External cephalic version (ECV) is a procedure for modifying the fetal position and achieving a cephalic presentation. The objective of the ECV is to offer an opportunity for cephalic delivery to occur which, as widely known, is safer than breech vaginal delivery or cesarean section [1]. The use of an external cephalic version in breech presentation, according to the WHO [2], certainly reduces the incidence of cesarean section, which is of special interest in those units where vaginal breech delivery is not a common practice. ECV is usually performed before the active labor period begins. Factors associated with a higher ECV success rate include the following [3–6]: multiparity, a transverse presentation, black race, posterior placenta, and amniotic fluid index higher than 10 cm

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Discussion

Conclusion