Impact of Analgesia on Success of External Version: Comparison of Spinal Anesthesia Versus Sedation

Impact of Analgesia on Success of External Version: Comparison of Spinal Anesthesia Versus Sedation; Prospective, Controlled, Randomized Study

At the time of birth, nearly 5% of children are in breech presentation. This type of presentation requires a medical environment and leads to more frequent use of Caesarean sections. This is why the external version can be proposed, usually from the 36th week. Its success rate is 40%, and is usually performed under simple sedation. One of the causes of failure is the lack of relaxation of the uterus, which could be higher in case of deeper anesthesia, as is the case in spinal anesthesia. The study project is to demonstrate superiority of spinal anesthesia compared to the usual protocol sedation in terms of primary and secondary objectives.

Inclusion Criteria:

• age ≥ 18 years
• patient with 36 weeks of amenorrhea (SA) a fetus breech or transverse presentation
• covered by a an insurance system
• signed contentment

Exclusion Criteria:

Obstetric contraindications:

• placenta previa
• 3rd trimester bleeding
• suspicion of fetal anoxia
• patient has already received more than one caesarean section
• multi-fetal pregnancy
• HIV +
• anticoagulant therapy

Anesthesiologic contraindications:

• infection at the puncture site, systemic infection or severe sepsis
• intracranial hypertension
• uncompensated heart failure
• constitute or acquired coagulation abnormalities, including anticoagulant therapy with curative intent
• neuropathy with demyelination of nerve fibers in thrust or unstabilized during recovery
• syringomyelia