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ECV Anaesthesia — FRCA Final MCQ

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ModerateObstetric AnaesthesiaECV AnaesthesiaFRCA Final

A 28-year-old woman (ASA I, 58 kg) at 36 weeks gestation presents for external cephalic version (ECV) for breech presentation. What is the recommended anaesthetic technique to improve ECV success?

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Correct answer: E — Spinal anaesthesia with a low dose (e.g., bupivacaine 7.5 mg)

Evidence suggests that neuraxial anaesthesia improves ECV success rates compared to no anaesthesia (RR 1.44 for success). A low-dose spinal anaesthetic (e.g., heavy bupivacaine 7.5 mg ± fentanyl 15 mcg) provides adequate abdominal wall relaxation and pain relief while maintaining maternal blood pressure and avoiding the risks of a full surgical block. RCOG recommends offering regional anaesthesia for ECV, particularly after a previous failed attempt.

Reference: RCOG – 2017 – GTG 20a ECV; OAA – 2024 – Quick Reference Handbook