Repeated external cephalic version
Volume 167 Number 2
second versions were done for the patient's benefaction in view of the higher complication rate of cesarean sections. It seemed prudent to induce labor after the second version, because the fetus quickly reverted to a breech position after the first external cephalic version. When induction failed, the patient was offered a cesarean section, but she declined. Because there was no immediate danger to either mother or fetus, the patient's request for expectant management with careful surveillance was honored according to the principle of patient autonomy. This patient had been carefully counseled on multiple occasions by several physicians regarding her options, risks, and benefits, and she made fully informed decisions. The third external cephalic version was done at the patient's request to employ reasonable options to avoid a cesarean delivery or breech vaginal birth.
We believe that patients who require a second version usually should have labor induced. This case suggests that when induction of labor is unsuccessful, expectant management rather than cesarean section is a reasonable option. It demonstrates that a fetus may spontaneously revert to a breech position twice at term and that external cephalic version may be done three times successfully and safely in selected cases to avoid unnecessary cesarean delivery.
REFERENCES 1. Stine LE, Phelan JP, Wallace R, Eglinton GS, Van Dorsten JP, Schifrin BS. Update on external cephalic version performed at term. Obstet Gynecol 1985;65:642-6. 2. Dyson DC, Ferguson JE II, Hensleigh P. Antepartum external cephalic version under tocolysis. Obstet Gynecol 1986;67:63-8.
Congenital deficiency of o-feroprotein Frank Greenberg, MD,a Andrew Faucett, MS,a Esmie Rose, PhD," Lisa Bancalari, MS,c Nataline B. Kardon, MD,c Gerald Mizejewski, PhD/ James E. Haddow, MD: and Elliot Alpert, MD b Houston, Texas, Flushing and Albany, New York, and Scarborough, Maine Although a-fetoprotein may playa role in fetal immune function or in maintenance of osmotic pressure, its exact function is unknown. We report two infants documented to have congenital deficiency of a-fetoprotein. One infant had cord blood levels
Volume 167 Number 2
second versions were done for the patient's benefaction in view of the higher complication rate of cesarean sections. It seemed prudent to induce labor after the second version, because the fetus quickly reverted to a breech position after the first external cephalic version. When induction failed, the patient was offered a cesarean section, but she declined. Because there was no immediate danger to either mother or fetus, the patient's request for expectant management with careful surveillance was honored according to the principle of patient autonomy. This patient had been carefully counseled on multiple occasions by several physicians regarding her options, risks, and benefits, and she made fully informed decisions. The third external cephalic version was done at the patient's request to employ reasonable options to avoid a cesarean delivery or breech vaginal birth.
We believe that patients who require a second version usually should have labor induced. This case suggests that when induction of labor is unsuccessful, expectant management rather than cesarean section is a reasonable option. It demonstrates that a fetus may spontaneously revert to a breech position twice at term and that external cephalic version may be done three times successfully and safely in selected cases to avoid unnecessary cesarean delivery.
REFERENCES 1. Stine LE, Phelan JP, Wallace R, Eglinton GS, Van Dorsten JP, Schifrin BS. Update on external cephalic version performed at term. Obstet Gynecol 1985;65:642-6. 2. Dyson DC, Ferguson JE II, Hensleigh P. Antepartum external cephalic version under tocolysis. Obstet Gynecol 1986;67:63-8.
Congenital deficiency of o-feroprotein Frank Greenberg, MD,a Andrew Faucett, MS,a Esmie Rose, PhD," Lisa Bancalari, MS,c Nataline B. Kardon, MD,c Gerald Mizejewski, PhD/ James E. Haddow, MD: and Elliot Alpert, MD b Houston, Texas, Flushing and Albany, New York, and Scarborough, Maine Although a-fetoprotein may playa role in fetal immune function or in maintenance of osmotic pressure, its exact function is unknown. We report two infants documented to have congenital deficiency of a-fetoprotein. One infant had cord blood levels
