Background Several adjuvant interventions have been evaluated for improving the success rate of external cephalic version (ECV) and reduce the rate of cesarean delivery (CD). Evidence regarding the effect of Nitrous oxide (NO) is limited with inconsistent results on pain score and success rate. Objective To examine the effect of inhaled NO on the success rate and pain score for women undergoing ECV. Search strategy MEDLINE, EMBASE, PubMed, Ovid Medline, ClinicalTrials.gov, the Cochrane Library and Google Scholars from inception till June 2020. Selection criteria Peer-review studies that examined the success rate of inhaled NO use during ECV attempt compared with or without the use of other analgesic agents were eligible for inclusion. Data collection and analysis All ascertained records were screened independently for eligibility by two authors. The study quality scores were evaluated as a source of heterogeneity by fitting meta-regression models to the individual study effect sizes. Results Of the 186 records, two randomized trials and one prospective cohort study (434 in the NO group and 286 in the controls) were deemed adequate for meta-analysis. ECV success rate did not differ significantly between the NO and the controls group (p=0.825; OR 1.036; 95% CI, 0.756-1.419). In addition, the use of NO did not affect pain scores (p=0.457; OR 0.759; 95% CI, -1.240-2.759) and there was no difference in the incidence of CD (p=0.943; OR 1.013; 95% CI, 0.703-1.46). Conclusion Use of NO during ECV is not associated with increase in ECV success rate and does not affect pain score.

Objective: To examine the impact of “natural” cesarean deliveries (NCD) on peripartum maternal blood loss. Design: Randomized controlled trial. Setting: Single academic hospital in Afula, Israel, between August 2016 and February 2019. Population or Sample: Term singleton gestations scheduled for a planned CD under spinal anesthesia. Methods: Women were randomized at a ratio of 1:1 to NCD (study group) or traditional CD (control group). Women in the study group watched fetal extraction, had early skin to skin contact, and breastfed until the end of surgery. Neonates in the control group were presented to the mother without direct contact. Blood samples were drawn from all women to determine oxytocin levels using an ELISA kit. Main Outcome Measures: Postpartum hemoglobin (Hb) levels. Results: 214 women randomized, 23 were excluded. There were no significant differences in demographic and obstetric variables between the groups. Postpartum Hb levels were 10.1±1.1 and 10.3±1.3 g/dL in the study and control groups, respectively (P = .19). There were no significant differences in estimated blood loss, and rates of PPH and blood transfusion. Maternal pain scores, satisfaction, and exclusive breastfeeding rate at discharge, were similar. Maternal oxytocin blood levels were 389.5±183.7 and 408.5±233.6 pg/mL in the study and control groups, respectively (P = .96). Rate of composite neonatal morbidity that comprised neonatal hypothermia, hypoglycemia, jaundice, and neonatal intensive care unit admission was higher in the study group. Conclusions: NCD does not affect maternal blood loss. Maternal oxytocin blood levels in NCD and traditional CD are similar.