Systematic review of the effectiveness of remifentanil in term breech pregnancies undergoing external cephalic version.
Int J Obstet Anesth
; 54: 103649, 2023 05.
Article
in En
| MEDLINE
| ID: mdl-36989876
ABSTRACT
BACKGROUND:
External cephalic version (ECV) is a moderately painful procedure used to turn a fetus from a non-vertex to cephalic position. This systematic review and meta-analysis compared intravenous remifentanil with other analgesia or no analgesia or placebo on the success rate and associated pain of ECV.METHODS:
Systematic searches for randomised controlled trials using remifentanil during ECV for non-cephalic term singleton pregnancies were conducted in EMBASE, MEDLINE and the Cochrane Library to October 2021. The primary outcomes were successful ECV and maternal pain; secondary outcomes included mode of delivery and adverse effects. The Cochrane Risk of Bias tool was used and meta-analysis undertaken if there were ≥2 comparable studies.RESULTS:
Four trials were identified, three placebo-controlled and one vs no analgesia, totalling 482 participants. Comparisons against nitrous oxide or neuraxial anaesthesia were not analysed. Two studies had a low overall risk of bias, and two had some concern for bias. Remifentanil compared with placebo increased the success of ECV by 43% (risk ratio [RR] 1.43; 95% confidence interval [CI] 1.14 to 1.78). Pain scores (0-10) were lower (mean difference -1.97; 95% CI -2.49 to -1.46) whilst there was no impact on caesarean delivery rate (RR 0.97; 95% CI 0.81 to 1.17). Adverse events were rare, with fetal bradycardia observed less often with remifentanil than placebo.CONCLUSIONS:
Remifentanil increases the procedural success of ECV and reduces pain compared with placebo. Trials were at low risk of bias and contained a sufficient number of participants to have reasonable confidence in this finding.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Version, Fetal
/
Breech Presentation
Type of study:
Clinical_trials
/
Etiology_studies
/
Prognostic_studies
/
Systematic_reviews
Limits:
Female
/
Humans
/
Pregnancy
Language:
En
Journal:
Int J Obstet Anesth
Journal subject:
ANESTESIOLOGIA
/
OBSTETRICIA
Year:
2023
Document type:
Article
Affiliation country: