Prediction of Success in External Cephalic Version for Breech Presentation at Term

Abstract

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.

Experiences with High Success Rate of External Cephalic Version and Comparisons of Different Tocolysis for Risk-effective version based on a bayesian network meta-analysis

“…Firstly, in our opinion, proper selection of the candidates was the most important, including the condition of the mothers and fetuses. Variables such as parity, age, body mass index and uterine tension of the mothers, type of breech, placental location, amniotic uid index, estimated fetal weight, cord rounds and palpation of the fetal head of the fetuses were reported to be associated with the success rate of ECV [13]. Among all the observational factors, higher AFI was found to be associated with higher success rate of ECV with our data, no matter through single or multi-factor analysis.…”

“…Besides, it has been estimated that ECV trial is cost-effective when compared to a scheduled CS for breech presentation if provided the probability of successful ECV is more than 32% [11]. For decades, ECV has been carried out in many medical institutions domastic and overseas, and the reported success rates of ECV ranged from 35-86% [8,9,12,13]. In the present study, a retrospective experiences analysis with high ECV success rate of 90.58% in a tertiary hospital in Northest China was recorded and the variables associated with the success rate of ECV were detailedly analyzed.…”

Current Approach for External Cephalic Version in Germany

“…Keines der Modelle ist ausreichend validiert [20]. Beispielhaft kam eine aktuelle Studie zu höherer Erfolgsrate (65 %), die Body-Mass-Index, fetale Schädelgröße und Parität als unabhängige Determinanten identifizierte [27].…”

Prediction model of success for external cephalic version. Complications and perinatal outcomes after a successful version

“…Some authors have postulated that having a model for predicting success in clinical practice can improve decision‐making in some women who initially reject ECV 18,19 . Models for predicting success of ECV based on the presence of certain variables provide the pregnant woman with a personalized probability of success.…”

“…Different models have been published. Some include a scoring system 19–21 that generates a score indicative of the probability of success, similar to the Bishop test, and others include a mathematical formula that includes the presence or absence of certain variables 18,22–26 . Furthermore, different models consider very different variables, both clinical and ultrasound.…”