Editorial Views  |   October 2017
Not Too Little, Not Too Much: Finding the Goldilocks Zone for Spinal Anesthesia to Facilitate External Cephalic Version
Author Notes
  • From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California (B.C.); and Department of Anesthesiology, Perioperative and Pain Medicine and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts (B.T.B.).
  • Corresponding article on page 625.
    Corresponding article on page 625.×
  • Accepted for publication July 18, 2017.
    Accepted for publication July 18, 2017.×
  • Address correspondence to Dr. Carvalho: bcarvalho@stanford.edu
Article Information
Editorial Views / Obstetric Anesthesia / Regional Anesthesia
Editorial Views   |   October 2017
Not Too Little, Not Too Much: Finding the Goldilocks Zone for Spinal Anesthesia to Facilitate External Cephalic Version
Anesthesiology 10 2017, Vol.127, 596-598. doi:10.1097/ALN.0000000000001839
Anesthesiology 10 2017, Vol.127, 596-598. doi:10.1097/ALN.0000000000001839
APPROXIMATELY one third of all births in the United States are by cesarean delivery, and in most high-income countries the cesarean delivery rate also exceeds that recommended by the World Health Organization for optimal maternal and neonatal outcomes.1  This is concerning, because cesarean delivery, and particularly high-order repeat cesarean delivery, is associated with an increase in maternal morbidity and cost compared with vaginal delivery. Consequently, there is considerable interest in the obstetric community in identifying and applying strategies to reduce the need for cesarean delivery. Particular attention has been given to preventing the first cesarean delivery, because if a woman undergoes a primary cesarean delivery, there is a 91% likelihood of cesarean delivery in subsequent pregnancies.2  One strategy that has been the focus of renewed interest in this regard is the use of external cephalic version, which is a procedure to rotate a breech presentation fetus to a vertex position before the onset of labor to facilitate vaginal delivery. Breech vaginal delivery is no longer generally offered based on data showing that this technique is associated with poorer neonatal outcomes compared with cesarean delivery.3  Thus external cephalic version, when successful, can reduce the need for cesarean delivery, and its use in appropriate patients is encouraged by obstetric professional organizations.3 
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