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This presentation will detail the design, implementation, and operation of ERDA, which is a collection of external version-controlled research datasets, of multiple synchronized deployments of the data, of a growing set of minimal examples using the datasets from various deployments, of stand-alone tools to create, maintain, and deploy new datasets, and of documentation targeting different audiences (users, maintainers, developers).ERDA was designed with the following principles in mind: Provide clear data provenance and ensure long-term availability, minimize effort for adding data and make all contents available to all users immediately, ensure unambiguous referencing and develop transparent versioning conventions, embrace mobility of scientists and target independence from the infrastructure of specific institutions.The talk will show how the data management is done with Git-LFS, demonstrate how data repositories are rendered from human-readable data, and give an overview of the versioning scheme that is applied.

Modelling and version control both play key roles in industrial-scale software development, yet their integration has proved difficult. Significant effort has been expended on improving file-based merging of modellers’ work, but empirical research shows the results of that approach still leave much to be desired in practice. Approaches based on multi-user modelling databases have often foundered by locking too broadly, thus preventing work on different elements in the same model, or by handling versioning themselves, leading to a silo. This article presents an approach to combining multi-user modelling with any external version control system, with no merging and no lock-outs.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 38 - N° 8S1 - p. 114-121

External cephalic version (ECV) is the manipulation of the fetus, through the maternal abdomen, to a cephalic presentation. The incidence of caesarean section for breech presentation has increased markedly in the last 20 years. External version has become more popular in the past 10 years because of the increasing evidence of risks from vaginal breech delivery, increasing demand on the reduction of caesarean sections, a strong safety record, and high success rate of ECV of up to 80%. The use of external cephalic version can produce considerable cost savings in the management of the breech presentation at term; however, there is a wide variation in the success rate, with a range between 30-80%. The ECV technique has remained unchanged for many generations without any modification. This paper provides the outcome of a small prospective study implementing a modified technique for ECV, which has a high success rate.

BACKGROUND External cephalic version is an alternative to both vaginal breech delivery and to caesarean section. The objective of this study was to summarize potential complications of external cephalic version. Which means are available for early detection and treatment of these complications? CASE REPORT A 28-year-old 1/0 with breech presentation was considered for external cephalic version at the 38th week of gestation. As three version attempts failed, the patient was discharged after normal fetal heart tone (FHT) registration and normal ultrasonographic findings on the next day. Caesarean section was planned six days later. On the day of admission, FHT registration revealed a decreased beat-to-beat variability and a sinusoidal baseline. Doppler-flow indices of the A. umbilicalis and A. cerebri media were normal, although middle cerebral artery peak systolic velocity was increased. Rapid caesarean section was performed, and an anemic baby (hemoglobin 3.4 g/dl) was born. After transfusion of 100 ml red blood cells, further development of the newborn was normal. DISCUSSION AND CONCLUSION Fetomaternal macrotransfusion may be a rare complication of external cephalic version, occurring even several days after the mechanical manipulation. FHT registrations and ultrasonographic doppler flow measurements performed periodically unit birth are necessary to detect such complications early. The Kleihauer-Betke test is the method of choice to diagnose fetomaternal macrotransfusion.

UNLABELLED The aim of this study was to evaluate the frequency and type of hip-joint instability and the frequency of hip dislocation requiring treatment in neonates who had been lying in the breech presentation and were delivered vaginally after an external version or by caesarean section, and to compare them with neonates who were naturally in the vertex presentation. Breech presentations without ongoing labour were subjected to an attempted external version and, in cases where this proved unsuccessful or where labour had started, to deliver by caesarean section. None of the breech presentations was vaginally delivered. The anterior-dynamic ultrasound method was used to assess the hip-joint status of the neonates. Out of 6,571 foetuses, 257 were in breech presentation after 36 wk of pregnancy. Sixty-two were vaginally delivered following an external version to vertex presentation and 195 were delivered by caesarean section, 75 of these following unsuccessful attempts to perform a version. Treatment for congenital hip-joint dislocation was performed on 0.2%. Out of the breech presentations, 1.0% of those delivered by caesarean section were treated, while in those with vaginal delivery following an external version the treatment frequency was 3.2%. No case of late diagnosed hip dislocation was recorded. Significant differences in frequency of hip-joint instability and treatment were found between (i) neonates delivered in breech presentation and those delivered with vertex presentation, (ii) infants delivered in vertex presentation, naturally or after successful version, and (iii) those delivered by caesarean section with or without attempted external version and those delivered with vortex presentation. CONCLUSION Breech presentation predisposes to increased hip instability. The instability is present prior to delivery and is certainly not a primary result of delivery forces. Both breech and vertex presentations following an external or spontaneous version should be considered as risk factors for neonatal hip instability.

Stich and Ravenscroft (1994) distinguish between internal and external accounts of folk psychology and argue that this distinction makes a significant difference to the debate over eliminative materialism. I argue that their views about the implications of the internal/external distinction for the debate over eliminativism are mistaken. First, I demonstrate that the first of their two external versions of folk psychology is either not a possible target of eliminativist critique, or not a target distinct from their second version of externalism. Second, I show that whether or not the second of their two external version of folk psychology is open to eliminativist critique depends on ‘internal’ factors. Finally, I argue that they are wrong to claim that eliminativists might, by attacking external versions of folk psychology, escape being put out of business if the simulation theory is correct.

The value of external cephalic version in breech presentation has been described and the results of prophylactically performed version by a single individual in 706 patients presented and assessed. The reasons for external version falling into disrepute have been discussed and means suggested for overcoming this situation. Also considered is the possibility of breech presentation being itself responsible for the onset of premature labor and its possible relation to the incidence of mental retardation.

Objectives: We hypothesize that the success rate of external cephalic version may be increased by performing a repeat attempt with the patient under epidural anesthesia. Study Design: One hundred eight women with term singleton pregnancies in breech presentation underwent attempted external version. When external version failed, we offered them the option of a later attempt under epidural anesthesia. All fetuses who remained in breech position were delivered by elective cesarean section. Results: Fifty (60%) of the 83 attempted external versions performed without anesthesia were successful. Seventeen of the 33 women whose versions were unsuccessful underwent elective cesarean delivery, and 16 elected to undergo repeat version attempts under epidural. Nine (56%) of these 16 procedures were successful, and 7 of these 9 women were delivered vaginally. The overall success rate was 71%, similar to the success rate of versions attempted on 25 women under epidural anesthesia. Conclusions: When an attempted external version fails, a repeat attempt under epidural anesthesia will usually be successful, resulting in a lower cesarean delivery rate. (Am J Obstet Gynecol 1998;179:1136-9.)

A six day old male neonate, born after attempted external version (ECV) and vaginal breech birth, was evaluated for pain during diaper changes. US of the leg showed a small subperiosteal fluid collection at the distal right femur. Conventional radiographs demonstrated the presence of a classic metaphyseal corner fracture (CML). This case is to our knowledge the first to report a CML after ECV and vaginal delivery.

The purpose of this study is to examine the incidence of cesarean section and fetal distress complicating the delivery of the second twin in vertex-nonvertex twin gestations in which the second twin underwent either breech extraction or external version. The intrapartum courses of 510 twin gestations delivered at a community hospital over a 10-year period were retrospectively analyzed. All vertex-nonvertex twin gestations were identified in which the second twin underwent attempted breech extraction or external version. Exclusion criteria included birthweight < or = 1,500 g, fetal anomaly, intrauterine demise, and monoamniotic twins. Of the 76 twin sets that met inclusion criteria, 33 underwent external version and 43 underwent primary breech extraction. The two groups had similar demographic characteristics. External version compared to breech extraction was associated with a significantly greater incidence of cesarean section (8/33 vs. 1/43, P = .008) and fetal distress (8/33 vs. 1/43, P = .008). There was no difference between groups in neonatal outcome for the second twin as measured by length of stay, 5-minute Apgar < 7, intensive care unit admissions, hyaline membrane disease, intraventricular hemorrhage, and traumatic birth injury. In conclusion, the increased incidence of cesarean section and fetal distress in patients undergoing attempted external version suggests that breech extraction may be the preferable route of delivery for the nonvertex second twin weighing more than 1,500 g.

The intrapartum management of multiple gestation continues to challenge the obstetric profession. In general, attempted vaginal delivery is appropriate for vertex-vertex twins. The options of external version, breech delivery, and cesarean delivery are analyzed for vertex-nonvertex twins. Special considerations in the intrapartum management of multiple gestation include monoamniotic twins, conjoined twins, and triplet pregnancies.

In contrast to cephalic presentations, breech presentations has a higher mortality and morbidity due to the associated incidence of prematurity, congenital malformations or intrapartum asphyxia. Thus, many efforts have been made in order to establish the best performance regarding the birth type: either vaginal delivery (in those women selected after evaluating different fetal and pelvic parameters) or the elective caesarian. On the other hand, the external version can be also considered. (American College Obstetricians and gynecologist [ACOG], 2001). It aims to avoid the vaginal delivery or caesarian complications by turning a breech presentation into a cephalic presentation.

Background. External cephalic version is attempted prior to the onset of labor. Women who present in labor with footling breech presentation are usually delivered by cesarean section. We present our experience of external version in women in labor.Material and methods. External cephalic version was attempted in thirteen patients in labor with footling breech presentation with the breech out of the pelvis.Results. The procedure was successful in twelve of the thirteen patients. Ten of them delivered vaginally. There were no maternal or neonatal complications.Conclusions. It may be reasonable to attempt external cephalic version in patients in labor prior to performing a cesarean section.

We report a case of fetal distress following external cephalic version at term, which resulted in delivery by emergency cesarean section of an anemic, acidemic infant. The characteristics of the fetal heart rate tracing, the clinical findings, and a positive Kleihauer-Betke test after delivery suggest that fetomaternal hemorrhage or placental abruption was the most likely cause of the fetal distress. We review the incidence of the reported fetal complications after external version.

OBJECTIVE: To evaluate prognostic factors of the external cephalic version. MATERIAL AND METHODS: A retrospective study of 439 external versions between January 1, 1996 and June 30, 2007 in a level III maternity in Brussels. RESULTS: The success rate of external cephalic version in this series was 37.6%. No major fetal complication was observed. Multiparity, newborn weight over 3000 g, fetal position with the back on the right, medical expertise and maternal weight gain during pregnancy less or equal to 9 kg are good prognostic factors. According to this success rate and the caesarean section rate for breech presentation during this period, we can estimate that one caesarean would be avoided for every five to six attempts of versions. CONCLUSION: External version in case of breech presentation at term deserves to be tempted. This technique appears to be well-tolerated by fetuses and reduces the number of caesarean sections. Success rate will be higher when the patient presents one or more good prognostic factors described above.

Pregnant women with a third trimester breech presentation are almost invariably offered Caesarean section as the mode of delivery of first choice, especially when external version has failed to turn the fetus to cephalic. However, increasingly women are resorting to alternatives, to avoid either operative delivery or manipulative intervention in late pregnancy. This paper reviews some of the options for women with breech presentation, focusing especially on integrating these options into conventional maternity care.

This study investigates the HBS effect in a panel of nine CEECs during 1993:Q1-2003:Q4 (unbalanced panel). Prior to estimating the model, we analyze several key assumptions of the model (e.g. wage equalisation, PPP and sectoral division) and elaborate on possible consequences of their failure to hold. In the empirical part of the paper, we check the level of integration of the variables in our panel using the Pedroni panel-stationarity tests. We then investigate the internal and external version of the HBS effect with the Pedroni panel-cointegration tests as well as by means of group-mean FMOLS and PMGE estimations to conclude that there is a strong evidence in support of the internal HBS and ambiguous evidence regarding the external HBS. Our estimates of the size of inflation and real appreciation consistent with the HBS effect turned out generally within the range of previous estimates in the literature (0-3 % per annum). However, we warn against drawing automatic policy conclusions based on these figures due to very strong assumptions on which they rest (which may not be met in near future). Finally, following the hypotheses put forward in the literature, we elaborate and attempt to evaluate empirically the potential impact of exchange rate regimes on the magnitude of the HBS effect.

Several options exist to effect vaginal delivery of a second, nonvertex twin. In the case presented, breech extraction and external version with subsequent labor were both inadequate to achieve timely delivery before the onset of fetal distress. A case of vacuum extraction of an unengaged second twin converted to vertex is described and discussed.

Objective To assess the efficacy, tolerance, and cost of external version under epidural anaesthesia and beta-mimetic tocolysis after the failure of an initial attempt with tocolysis alone. Design Prospective open study. Participants Sixty-eight women with breech presentation at around 36 weeks of gestation and an attempted external cephalic version under salbutamol that failed, who consented to try a second attempt under epidural anaesthesia. Results The overall success rate under epidural anaesthesia was 39.7% (27/68), and complications occurred in two cases. The total cost of attempting external version was higher than the cost of expectant management. Conclusions The efficacy of external cephalic version under epidural reduces the rate of caesarean sections associated with breech presentation, but its relative safety remains in question. Moreover, our economic analysis discourages the hope of lowered costs suggested by earlier reports that this technique is more expensive than expectant management, except in institutions with a policy of systematic caesarean sections when version fails.

The objective of this study was to determine the impact of undetected breech presentation on an external cephalic version program. We performed a retrospective analysis of all external cephalic versions attempted over a 1-year interval. We then analyzed all cesarean operations performed for the indication of breech presentation over the same interval. Cases involving twin gestations and premature births were excluded. We found that 21% of term breech presentations were not detected before the onset of labor and an additional 15% were not detected until after 38 weeks' gestation. Increased third-trimester screening for breech presentation could potentially decrease the need for cesarean delivery.

The morbidity and perinatal deaths associated with vaginal breech delivery have prompted an alternative approach: external cephalic version (ECV). Although ECV is safe and cost-effective, many clinicians and patients avoid the procedure because of fear of complications as well as a lack of experience. In this prospective observational study, the pressure applied during ECV was quantified using gloves that incorporate ultrathin pressure-force sensors. Participants were 92 women presenting at or after 36 weeks gestation with breech presentation, all of whom lacked contraindications to ECV. The degree of force applied for each attempt at version, or pressure-time integral (PTI-A), was estimated in relation to numerous patient-related and ultrasound factors. ECV succeeded in nearly three fourths (73%) of women entered into the study. The number of attempts at version for each patient ranged from one to 6. The sum of pressure-time integral of all attempts at version (PTI-ECV) was lowest in women having a single attempt. Those having 2 attempts had PTI-ECV figures that were twice those of the single-attempt group, and values were highest for women having 3 or more attempts. No significant differences were noted among women having 3 to 6 attempts at version. The median PTI-A of successful attempts in women who completed version after one or 2 attempts was significantly lower than that for women who needed 3 or more attempts for version to succeed. For individual women, there was no difference in PTI-A between the successful attempt and the preceding failed attempt. This suggests that failures may reflect inefficient application of force rather than insufficient force. The only clinical variable that correlated significantly with the degree of applied force was uterine tone; a more tense uterus was associated with greater applied force. The 2 operators who attempted version in these cases applied comparable degrees of force. The degree of force required for successful ECV in this study was quite variable. The investigators believe that failed version most often results not from inadequate force, but from less-than-efficient force application and that greater emphasis on ECV skill may improve the results.

Persistent fetal transverse lie at term is uncommon. A case of benign polypoid adenomyoma, found during Caesarean section, as a cause of abnormal lie in a primigravida is reported. A clear distinction as shown can be drawn between breech presentation and transverse lie at term, and between transverse lie in multiparous and nulliparous women. Prophylactic external version was not performed in this case and the reasons are discussed. Careful search for the cause of transverse lie especially in a primigravida is recommended.

Objective To describe currently accepted methods for managing the term breech pregnancy, and to predict the delivery outcomes and costs of each method. Methods Literature review was used to derive four options for the peripartum management of the term breech pregnancy. Using decision-analysis techniques, we calculated the predicted delivery outcomes and costs associated with each option. Results Applying external cephalic version to all term breech pregnancies without contraindications to labor or version, and allowing a trial of labor for eligible women who fail version, results in a 25% cesarean rate, at a cost of $8071 per case. Delivering unsuccessful versions by scheduled cesarean results in a 32% cesarean rate, at a cost of $8276 per case. In contrast, a strategy not using external version but allowing a trial of labor for those mothers who meet eligibility criteria results in a 63% cesarean rate, at a cost of $8755 per case. Routinely scheduling a cesarean when a breech is identified at term results in an 89% cesarean rate, at a cost of $9544 per case. Conclusions Although the liberal use of vaginal delivery for term breech pregnancies has been suggested as one way of lowering the cesarean rate, the addition of routine external cephalic version to the management strategy will result in more vaginal deliveries and lower costs than strategies that allow vaginal delivery but do not include an attempted cephalic version. Routine cesarean without attempted external cephalic version results in excessive operative deliveries.

We encountered two cases of cardiac asystole for one and three minutes respectively following external cephalic version. We describe the two cases and discuss the necessity for one to be aware of such an event and the possible advantage of performing a fetal heart rate (FHR) recording prior to the procedure and observation of the FHR during the version.

After delivery of twin A, external cephalic version was attempted on 30 malpositioned second twins (12 transverse and 18 breech). Version was successful and resulted in subsequent vertex vaginal delivery for 11 of the 12 transverse presentations and 16 of 18 breech presentations. Successful version was not associated with parity or with birth weight. Among the 30 attempted versions, only one infant had a 1-minute Apgar score below 7. There were not enough cases to determine an association of delivery interval between twins and poor neonatal outcome. External cephalic version in selected twin gestations is useful for management of the second twin with abnormal presentation. Technique refinement and greater experience may improve the overall success rate with external version of the second twin. Although external cephalic version cannot yet be recommended as the method of choice, the procedure seems safe, and routine cesarean delivery may not always be indicated.(Obstet Gynecol 1992;79:421-3)

The use of external cephalic version in the patient with ruptured membranes is examined and the first successful reported case is described. No difficulties or complications were encountered. We conclude that use of this procedure in the presence of ruptured membranes has been unjustly slighted and that external version may offer an important alternative to the patient with ruptured membranes, adequate amniotic fluid, and malpresentation. We caution that this should only be attempted under continuous monitoring, in patients with adequate amniotic fluid, and in facilities where immediate cesarean section is available. We believe that a larger trial is warranted, and we encourage that this be done.

Summary: The incidence of fetomaternal haemorrhage after external cephalic version was 1.8% in 167 patients. The occurrence of this complication was not found to be associated with difficult or unsuccessful version, or with any adverse perinatal outcome. We conclude that routine assessment of fetomaternal haemorrhage after external version is not necessary, except in rhesus negative women to detect the 2% in whom the routine dose of 500 iu (100 μg) of anti-D immunoglobulin is inadequate.

External version was performed three times in a patient at term because of spontaneous reversion to breech presentation. She was then delivered vaginally. Spontaneous reversion to breech presentation can be managed with additional external cephalic version procedures.

Fifty eight gravidas near-term underwent external cephalic version using tocolytic treatment and continuous fetal monitoring by cardiotocograph and real-time ultrasound. No unfavorable maternal or fetal effects were recorded. Fetal heart rates showed a significant decline at 10 and 30 min after the procedure with complete recovery at 1 h after external version, but no pathologic tracing was recorded. No uniform heart rate patterns due to external cephalic version could be found.

External version with the use of tocolysis is cost-effective and leads to lower perinatal morbidity and a lower cesarean section rate. A study was undertaken to see if version was being practiced in a nonteaching community hospital. One hundred twenty-one breech presentations occurring at 36 or more completed weeks of gestation were reviewed from July 1, 1985 to June 30, 1986. Successful version occurred in 60% of 65 patients; 77% of patients with a successful version delivered vaginally. Six of the remaining 56 patients, who did not undergo attempted version, delivered vaginally with breech presentation. At least 21 patients who delivered by elective cesarean section would have been candidates for external version with tocolysis. Seventeen patients had a cesarean section because a breech presentation was diagnosed in labor.

Six hundred eighty-two consecutive twin deliveries were reviewed. Included in the study were 136 sets of vertex-nonvertex twins with birth weights greater than 1500 gm. A primary attempt at delivery of the second twin by external version was performed on 41 twins, 55 twins underwent attempted breech extraction, and 40 patients had a primary cesarean section solely because of physician preference. There were no differences in the incidence of neonatal morbidity or mortality among the modes of delivery. External version was associated with a higher failure rate than primary breech extraction (p less than 0.01). External version was associated with complications (fetal distress, cord prolapse, and compound presentation) that were not seen in the other two groups. Primary breech extraction of the second nonvertex twin weighing greater than 1500 gm appears to be a reasonable alternative to either cesarean section or external version.