Anesthetic approaches for malpresentation and multiple gestation.

PURPOSE OF REVIEW: This review provides an updated overview of anesthetic considerations for malpresentation and multiple gestation. Key topics include analgesia for external cephalic version (ECV), labor analgesia for vaginal delivery in malpresentation and multiple gestation, anesthetic considerations for cesarean delivery in these scenarios, and management of postpartum hemorrhage risk.

RECENT FINDINGS: Neuraxial analgesia improves both maternal comfort and procedural success during ECV for malpresentation. Neuraxial labor analgesia facilitates safer vaginal delivery in multiple gestation pregnancies. Cesarean delivery for multiple gestation carries an increased risk of uterine atony, with higher oxytocin requirements (ED 90  > 4 IU) compared with singleton pregnancies.

SUMMARY: Anesthesiologists should maintain vigilance and readiness for rapid intervention when caring for patients with malpresentation and/or multiple gestation. Persistent gaps exist between recent evidence and routine clinical practice; therefore, implementation studies and multidisciplinary consensus guidelines are warranted.