Clinical outcomes after external cephalic version with spinal anesthesia after failure of a first attempt without anesthesia.

OBJECTIVE: To determine whether repeat external cephalic version (ECV) with spinal anesthesia affects clinical outcomes and cesarean delivery rates. METHODS: A retrospective study was conducted using data collected at one hospital in Israel between January 1, 2009, and December 31, 2015. Women with non-vertex singleton pregnancies (≥37 weeks) who had a failed ECV attempt without spinal anesthesia were included in the analysis. All women were offered a repeat ECV with spinal anesthesia. Outcomes assessed were rates of vertex presentation at delivery, successful repeat ECV, and cesarean delivery. RESULTS: Overall, 145 of 213 ECV attempts without spinal anesthesia were successful. Of the 68 women with a failed attempt, 5 (7%) experienced spontaneous version and 18 (26%) delivered at another institution or went into spontaneous labor. Among the remaining 45 women, 28 (62%) agreed to a repeat ECV with spinal anesthesia; 11 (39%) of these procedures were successful. All 11 women experienced vertex presentation at delivery versus none of the 17 women who refused repeat ECV (P=0.003). The cesarean delivery rate was 64% (18/28) versus 100% (17/17), respectively (P=0.007). CONCLUSION: Repeat ECV with spinal anesthesia after a failed first attempt without spinal anesthesia increased vertex presentation at birth and decreased the rate of cesarean delivery.

The association of umbilical cord hemangioma with fetal vascular birthmarks.

OBJECTIVE: To report a rare case of umbilical cord hemangioma and to discuss its association with vascular birthmarks. METHODS: A case of umbilical cord hemangioma diagnosed by ultrasound at 28 weeks of gestation is reported. After labor induction at 38 weeks of gestation, a male infant was born. Examination of the newborn showed disseminated port wine flat skin lesions covering a significant part of his body. Reviewing the scientific literature revealed the association between umbilical cord hemangioma and fetal mortality and morbidity, in particular, vascular malformations. RESULTS: A total of 24 umbilical cord hemangioma cases were reported in detail. Of them, 37.5% were associated with perinatal mortality and 29.2% ended in the delivery of a normal healthy infant. Fetal morbidity was recognized in 33.3%. CONCLUSION: This case illustrates the importance of prenatal diagnosis of umbilical cord hemangioma for prenatal counseling.