Table 1 Characteristics of the included trials
Study | Study location | Sample size (anesthesia/control) | Maternal age (anesthesia vs control) | Analgesia type | Control group | Primary outcome | Other outcomes |
|---|---|---|---|---|---|---|---|
Schorr et al, 1997 [27] | Mississippi, USA | 69 (35/34) | 27.7±6.1 vs 25.8±6.6 | Epidural: 2% lidocaine with 1:200,000 epinephrine | No anesthetic intervention | Successful ECV | Patient discomfort, epidural complication, discharge (after ECV), reverted to breech, cesarean delivery, vaginal delivery, hospital stays. |
Dugoff et al, 1999 [9] | Colorado, USA | 102 (50/52) | 24.3±0.9 vs 26.8±0.9 | Spinal: 10 mg sufentanil and 1 mL of 0.25% bupivacaine | No anesthetic intervention | Successful ECV | Vaginal delivery rate, cesarean delivery rate, transient bradycardia, hypotension, abruption, patient discomfort. |
Mancuso et al, 2000 [8] | Hawaii, USA | 108 (54/54) | 28.5±4.8 vs 28.2± 4.8 | Epidural: 2% lidocaine with 1:200,000 epinephrine and 100 ug of fentanyl | No anesthetic intervention | Successful ECV | Vaginal delivery rate, cesarean delivery rate, transient bradycardia, cephalic presentation after version attempt, cephalic presentation at delivery. |
Weiniger et al, 2007 [28] | Israel | 70 (36/34) | 24.6±3.8 vs 28.1±4.1 | Spinal:7.5 mg bupivacaine | No anesthetic intervention | Successful ECV | Uterine tone relaxed, easy palpation of fetal head, further analgesia offered for ECV due to pain, VAS pain score (0–10). |
Weiniger et al, 2010 [29] | Israel | 64 (31/33) | 28.5[21,–40] vs 28.6[20,–36] | Spinal: 7.5 mg bupivacaine | No anesthetic intervention | Successful ECV | Vaginal delivery rate, cesarean delivery rate, transient bradycardia before/after ECV, uterine tone relaxed, easy palpation of fetal head, V AS pain score (0 –10), maternal hypotension. |
Burgos et al, 2013 [11] | Biscay, Spain | 450 (300/150) | In both cohorts, the mean age was 33 years. | Inhaled N2O in a 50:50 mix with oxygen | No anesthetic intervention | Successful ECV | Emergency cesarean section rate after ECV, complications, cesarean delivery, umbilical cord pH < 7.00, rate of admission to neonatal unit, median and interquartile range of pain score after the ECV. |
Munoz et al, 2014 [12] | Spain | 60 (31/29) | 32.9±4.9 vs 32.5±5.7 | Intravenous injection: 100 ml remifentanil 0.01 mg/ml | Saline placebo | Maternal pain | Number of PCA demands, successful ECV, vaginal delivery rate, cesarean delivery rate, transient bradycardia, adverse effects. |
Khaw et al, 2015 [10] | China | three groups: 189 (63/63/63) | group 1 vs group 2 vs group 3: 32[23–42] vs 32[23–42] vs 31[20–39] | Group 1: Spinal, 9 mg bupivacaine and 15 ug remifentanil Group 2: Intravenous anesthesia | No anesthetic intervention | Successful ECV | No of ECV attempts, duration of ECV, Vaginal delivery rate, cesarean delivery rate, visual Pain Score (0–100), visual Sedation Score (0–100). |
Liu et al, 2016 [14] | China | 152(76/76) | 34.1±4.2 vs 33.8±3.9 | Intravenous injection: paracetamol 1 g in 100 mL saline + remifentanil (infused at 0.1 ug/kg/min + demand boluses of 0.1 ug/kg) | Saline placebo | Maternal pain | Successful ECV, vaginal delivery rate, cesarean delivery rate, transient bradycardia. |
Wang et al, 2017 [30] | China | 144(72/72) | 33.2±4.6) vs 32.9±5.1 | Intravenous paracetamol 1 g in 100 mL saline 5 minutes before ECV. Subsequently, they received a patient-controlled analgesia at 0.1 ug/kg/min for 3 minutes and then rescue boluses on demand of 0.1 ug/kg and a lockout period of 4 minutes. | Saline placebo | Maternal pain | Successful ECV, vaginal delivery rate, cesarean delivery rate, transient bradycardia, number of PCA demands, satisfaction score, adverse events. |
Yang et al, 2019 [31] | China | 46 (25/21) | 27.15±2.73 vs 25.48±3.67 | Epidural anesthesia | No anesthetic intervention | Successful ECV | Vaginal delivery rate, cesarean delivery rate, placental abruption, postpartum hemorrhage neonatal asphyxia (mild). |
Dochez et al, 2020 [15] | France | 150(74/76) | 32.9±5.6 vs 31.0± 4.6 | Inhaled nitrous oxide in a 50:50 mix with oxygen | Medical air | Successful ECV | Vaginal delivery rate, cesarean delivery rate, transient bradycardia, degree of pain with VAS, emergency cesarean before labor, emergency cesarean in labor, admission to neonatalology unit. |
Zhang et al, 2020 [32] | China | 80(40/40) | 28.91±2.90 vs 28.76±2.88 | Spinal anesthesia: receive low concentration of ropivacaine combined with low dose fentanyl, where the concentration of ropivacaine is 0.25% and the dose of fentanyl is 15 g. | No anesthetic intervention | Successful ECV | cesarean delivery rate |
Han et al, 2020 [33] | China | 104 (63/41) | 28.3±3.1 vs 28.2±3.0 | Spinal anesthesia: low concentration ropivacaine (0.25%) combined with low dose fentanyl (15 ug) | No anesthetic intervention | Successful ECV | Vaginal delivery rate, cesarean delivery rate, number of cases of obstructed labor and stillbirth, premature rupture of membranes, postpartum hemorrhage, neonatal asphyxia, premature birth, umbilical cord wrap, neonatal birth injuries, maternal pain. |
Straube et al, 2021 [34] | North Carolina | 48 (23/25) | 32.5±4.7 vs 31.8±4.3 | Inhaled 50:50 mixture of N2O and oxygen | 100% oxygen | Maternal pain | Successful ECV, cesarean delivery rate, anxiety, satisfaction, eventual delivery mode, procedural difficulty, and ECV complication rates. |
Yang et al, 2023 [35] | China | 201 (67/134) | 30.04 ± 4.22 vs 31.22 ± 4.18 | Injection of 0.25 mg subcutaneous terbutaline and 7.5 mg of intrathecal ropivacaine in the left side lying position. | No anesthetic intervention | Successful ECV | Clinical outcomes, such as placenta abruption, cord prolapse, hemorrhage and Apgar score. |