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has been reviewed by the Editorial Board and by special expert referees. Although it is judged not acceptable for publication in Obstetrics & Gynecology in its present form, we would be willing to give further consideration to a revised version.If you wish to consider revising your manuscript, you will first need to study carefully the enclosed reports submitted by the referees and editors. Each point raised requires a response, by either revising your manuscript or making a clear and convincing argument as to why no revision is needed. To facilitate our review, we prefer that the cover letter include the comments made by the reviewers and the editor followed by your response. The revised manuscript should indicate the position of all changes made. We suggest that you use the "track changes" feature in your word processing software to do so (rather than strikethrough or underline formatting). Your paper will be maintained in active status for 21 days from the date of this letter. If we have not heard from you by Jan 10, 2019, we will assume you wish to withdraw the manuscript from further consideration. REVIEWER COMMENTS:Reviewer #1: This is a retrospective study using clinical information to predict success rate after ECV in 250 women at 36-41 week' gestation. All procedures were performed by the same experienced physician. After using creative Condition inference classification tree analysis , they found that parity , BMI , and fore bag size in cm are the best predictors for success. They found that fore bag size, BMI, and parity are the best predictors for ECV success. I have few comments 1. Despite the impressive results , the findings are not generalizable to clinical practice since all procedures were performed by one experienced provider.2. What are the years of the study? the authors should include the time period.3. The authors provide data on mean BMi. Do they have data on number of those with AFI< 5 or deepest vertical pocket < 2 cm.? how do they compare to the fore bag data.? 4. Data relating to parity and BMI are not surprising , and data on fore bag size is a proxy for lack of engagement. 5. The average BMI for the patient population is way different than that in the US. I am interested to see how the Fore bag size will predict ECV in those with BMI > 40.6. The authors should provide more data on obstetric outcomes other than admission to NICU. It is surprising that no complications are included.Reviewer #2: This is a retrospective cohort study designed to develop a prediction model to predict success after external cephalic version for breech presentation at term. The study identified 3 independent predictors including: fore-bag size, BMI and prior vaginal birth.

BackgroundPreeclampsia is among the most common medical complications of pregnancy. The clinical utility of invasive hemodynamic monitoring in preeclampsia (e.g., Swan-Ganz catheter) is controversial. Thoracic impedance cardiography (TIC) and Doppler echocardiography are noninvasive techniques but they both have important limitations. NICaS™ (NI Medical, PetachTikva, Israel) is a noninvasive cardiac system for determining cardiac output (CO) that utilizes regional impedance cardiography (RIC) by noninvasively measuring the impedance signal in the periphery. It outperformed any other impedance cardiographic technology and was twice as accurate as TIC.MethodsWe used the NICaS™ system to compare the hemodynamic parameters of women with severe preeclampsia (PET group, n = 17) to a cohort of healthy normotensive pregnant women with a singleton pregnancy at term (control group, n = 62) (1/2015–6/2015). Heart rate (HR), stroke volume (SV), CO, total peripheral resistance (TPR) and mean arterial pressure (MAP) were measured 15–30 min before CS initiation, immediately after administering spinal anesthesia, immediately after delivery of the fetus and placenta, at the abdominal fascia closure and within 24–36 and 48–72 h postpartum.ResultsThe COs before and during the CS were significantly higher in the control group compared to the PET group (P < .05), but reached equivalent values within 24–36 h postpartum. CO peaked at delivery of the newborn and the placenta and started to decline afterwards in both groups. The MAP and TPR values were significantly higher in the PET group at all points of assessment except at 48–72 h postpartum when it was still significantly higher for MAP while the TPR only exhibited a higher trend but not statistically significant. The NICaS™ device noninvasively demonstrated low CO and high TPR profiles in the PET group compared to controls.ConclusionsThe immediate postpartum period is accompanied by the most dramatic hemodynamic changes and fluid shifts, during which the parturient should be closely monitored. The NICaS™ device may help the clinician to customize the most optimal management for individual parturients. Our findings require validation by further studies on larger samples.

Significant hemodynamic changes (reduction of TPR and increase of CO) take place at the time of delivery of fetus and placenta. Knowledge of normal hemodynamic values using a reliable noninvasive technique during various stages of pregnancy and the postpartum period is feasible, and might assist clinicians in assessing the level of patient deviation from expected cardiac performance, especially in high-risk women.

PurposeWe sought to assess long-term changes in the flow parameters of retrobulbar vessels in diabetic patients.MethodsThe retrobulbar circulation of 138 eyes was evaluated between 1994 and 1995 and 36 eyes were reevaluated between 2004 and 2008 (study group). They were divided into four groups: eyes of diabetic patients without diabetic retinopathy (DR), eyes with nonproliferative DR, eyes with proliferative DR, and eyes of nondiabetic patients (controls). Color Doppler imaging was used to assess the flow velocities in the major retrobulbar vessels. The resistive index (RI) was calculated and compared among the groups and between the two time periods.ResultsRI values of the central retinal artery and posterior ciliary artery had increased in the two non-DR groups and in the nonproliferative DR group, with a surprising decrease measured in eyes with proliferative DR (P= nonsignificant [NS]). Combining the nonproliferative DR and proliferative DR groups resulted in a milder increase of the RI of the posterior ciliary artery (P= NS) and the central retinal artery (P=0.02) in the DR group compared to the other groups.ConclusionOur results demonstrate that an increase of the resistance in the retrobulbar vessels, as a part of DR, can lessen over time and may even be reversed.

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The present study employed a think‐aloud method to explore the origin of centrality deficit (i.e., poor recall of central ideas) in individuals with Attention Deficit Hyperactivity Disorder (ADHD). Moreover, utilizing the diverse think‐aloud responses, we examined the overall quality of text processing employed by individuals with ADHD during reading, in order to shed more light on text‐level deficiencies underlying their poor comprehension after reading. To address these goals, adolescents with and without ADHD were asked to state aloud whatever comes to their minds during the reading of two expository texts. After reading, the participants freely recalled text ideas and answered multiple‐choice questions on the texts. Compared to controls, participants with ADHD generated fewer responses that reflect deep, efficient text processing, and reinstated fewer prior text ideas, particularly central ones, during reading. Moreover, the proportions of deep processing responses positively associated with participants’ performance on recall and comprehension tasks. These findings suggest that individuals with ADHD exhibit poor text comprehension and memory, particularly of central ideas, because they construct a low‐quality, less‐connected text representation during reading, and produce fewer, less‐elaborated retrieval cues for subsequent tasks after reading.

Hemodynamic parameters immediately before, during and shortly after CS in singleton and twin pregnancies are equivalent. Further evaluations of the value of NICaS™ in assessing cardiovascular-related pregnancy complications are warranted.