Results support the need for interventions to increase timely diagnosis of breech presentation as well as improved patient counseling and use of experienced providers for external cephalic version.

(Birth. 2017;44(3):222–229) Breech presentation accounts for 10% to 15% of cesarean deliveries in the United States. Cesarean delivery presents maternal risks and risk for future pregnancies. External cephalic version has a 60% success rate and is effective in decreasing cesarean deliveries. Optimal timing for external cephalic version is 36 to 37 weeks. At a later gestational age, advanced labor or rupture of membranes may prevent external cephalic version. This study investigated the connection between gestational age when breech presentation is diagnosed and the likelihood of a vaginal delivery, hypothesizing that the likelihood of vaginal delivery and external cephalic version would decrease if there was a failure to diagnose breech presentation before 38 weeks’ gestation.

eat four large oranges ; at 1, P.M., 1 dined on a small quantity of roast beef, and whortleberry and green-currant pie. At 7, P.M., the urine passed was of straw color, specific gravity 1036. After standing thirty minutes, a sediment was thrown down, consisting mainly of oxalate of lime in very large beautiful crystals. I think I never saw a specimen of urine in which it existed in greater abundance, or in which the crystals were larger. It also contained urate of ammonia and an excess of urea. I placed some of it in a watch-glass, and added strong nitric acid ; in a few moments it was almost a solid mass from the crystals of nitrate of urea. The urine passed next morning at 7 o'clock had a specific gravity of 1030, and contained an excess of urea and uric acid and epithelial scales. At 11, P.M., the urine was normal. I then eat four more large oranges, and went to bed. The urine passed at 7 o'clock the next morning was loaded with the oxalates. These two experiments, one upon the urine of food, and the other upon the urine of blood, seem to me to indicate :

INTRODUCTION: To compare perinatal outcomes following a failed external cephalic version (ECV) to a successful ECV and a planned cesarean delivery METHODS: This was a retrospective cohort study from January 2012 to June 2015. We included singleton, nonanamolous live births delivered after 36 weeks. We performed a comparison of perinatal outcomes between women who had an unsuccessful ECV, a successful ECV and a planned cesarean delivery. The primary outcome was a composite of neonatal outcomes, which included APGAR <7 at 5 minutes, NICU or intermediate care nursery admission, need for respiratory support and hypoglycemia. A secondary outcome was final mode of delivery among women attempting ECV. RESULTS: We identified 236 pregnancies meeting inclusion criteria, 126 (53.3%) of which attempted ECV with 110 (46.7%) undergoing planned cesarean delivery. The success rate of external cephalic version (ECV) was 50.7% (n=64). Among women who had successful ECV, the rate of cesarean section was 25% (n=16). Among women with failed ECV, the rate of the primary outcome was 6.8% (n=4), versus 12.9% (n=7) in the successful group and 10.9% (n=12) in the planned cesarean group (p=0.59). There was no difference in the rates of Apgar score <7 at 5 minutes, NICU or intermediate care nursery admission, need for respiratory support or hypoglycemia. CONCLUSION: ECV was not associated with an absolute risk increase in the primary composite outcome compared to planned cesarean for fetal malpresentation. This evidence provides support for ECV as a safe alternative for women with fetal malpresentation who desire a vaginal delivery regardless of outcome.