presentation in 24 weeks

Mammary Glands
Fallopian Tubes
Supporting Ligaments
Reproductive System
Gametogenesis
Placental Development
Maternal Adaptations
Menstrual Cycle
Antenatal Care
Small for Gestational Age
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RBC Isoimmunisation
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Multiple Pregnancy
Miscarriage
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Gestational Trophoblastic Disease
Breech Presentation
Abnormal lie, Malpresentation and Malposition
Oligohydramnios
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Headaches in Pregnancy
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Thyroid Disease in Pregnancy
Epilepsy in Pregnancy
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Cervical Intraepithelial Neoplasia + Cervical Screening
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Urinary Incontinence
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Bartholin's Cyst
Lichen Sclerosus
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Introduction to Infertility
Female Factor Infertility
Male Factor Infertility
Female Genital Mutilation
Barrier Contraception
Combined Hormonal
Progesterone Only Hormonal
Intrauterine System & Device
Emergency Contraception
Pelvic Inflammatory Disease
Genital Warts
Genital Herpes
Trichomonas Vaginalis
Bacterial Vaginosis
Vulvovaginal Candidiasis
Obstetric History
Gynaecological History
Sexual History

Obstetric Examination

Speculum Examination
Bimanual Examination
Amniocentesis
Chorionic Villus Sampling
Hysterectomy
Endometrial Ablation
Tension-Free Vaginal Tape
Contraceptive Implant
Fitting an IUS or IUD

Original Author(s): Minesh Mistry Last updated: 12th November 2018 Revisions: 7

1 Introduction
2 Preparation
3 General Inspection
4 Abdominal Inspection
5.1 Fundal Height
5.3 Presentation
5.4 Liquor Volume
5.5 Engagement
6 Fetal Auscultation
7 Completing the Examination

The obstetric examination is a type of abdominal examination performed in pregnancy.

It is unique in the fact that the clinician is simultaneously trying to assess the health of two individuals – the mother and the fetus.

In this article, we shall look at how to perform an obstetric examination in an OSCE-style setting.

Introduction

Introduce yourself to the patient
Wash your hands
Explain to the patient what the examination involves and why it is necessary
Obtain verbal consent

Preparation

In the UK, this is performed at the booking appointment, and is not routinely recommended at subsequent visits
Patient should have an empty bladder
Cover above and below where appropriate
Ask the patient to lie in the supine position with the head of the bed raised to 15 degrees
Prepare your equipment: measuring tape, pinnard stethoscope or doppler transducer, ultrasound gel

General Inspection

General wellbeing – at ease or distressed by physical pain.
Hands – palpate the radial pulse.
Head and neck – melasma, conjunctival pallor, jaundice, oedema.
Legs and feet – calf swelling, oedema and varicose veins.

Abdominal Inspection

In the obstetric examination, inspect the abdomen for:

Distension compatible with pregnancy
Fetal movement (>24 weeks)
Surgical scars – previous Caesarean section, laproscopic port scars
Skin changes indicative of pregnancy – linea nigra (dark vertical line from umbilicus to the pubis), striae gravidarum (‘stretch marks’), striae albicans (old, silvery-white striae)

Fig 1 – Skin changes in pregnancy. A) Linea nigra. B) Striae gravidarum and albicans.

Ask the patient to comment on any tenderness and observe her facial and verbal responses throughout. Note any guarding.

Fundal Height

Use the medial edge of the left hand to press down at the xiphisternum, working downwards to locate the fundus.
Measure from here to the pubic symphysis in both cm and inches. Turn the measuring tape so that the numbers face the abdomen (to avoid bias in your measurements).
Uterus should be palpable after 12 weeks, near the umbilicus at 20 weeks and near the xiphisternum at 36 weeks (these measurements are often slightly different if the woman is tall or short).
The distance should be similar to gestational age in weeks (+/- 2 cm).
Facing the patient’s head, place hands on either side of the top of the uterus and gently apply pressure
Move the hands and palpate down the abdomen
One side will feel fuller and firmer – this is the back. Fetal limbs may be palpable on the opposing side

Fig 2 – Assessing fetal lie and presentation.

Presentation

Palpate the lower uterus (below the umbilicus) to find the presenting part.
Firm and round signifies cephalic, soft and/or non-round suggests breech. If breech presentation is suspected, the fetal head can be often be palpated in the upper uterus.
Ballot head by pushing it gently from one side to the other.

Liquor Volume

Palpate and ballot fluid to approximate volume to determine if there is oligohydraminos/polyhydramnios
When assessing the lie, only feeling fetal parts on deep palpation suggests large amounts of fluid
Fetal engagement refers to whether the presenting part has entered the bony pelvis
Note how much of the head is palpable – if the entire head is palpable, the fetus is unengaged.
Engagement is measured in 1/5s

Fig 3 – Assessing fetal engagement.

Fetal Auscultation

Hand-held Doppler machine >16 weeks (trying before this gestation often leads to anxiety if the heart cannot be auscultated).
Pinard stethoscope over the anterior shoulder >28 weeks
Feel the mother’s pulse at the same time
Should be 110-160bpm (>24 weeks)

Completing the Examination

Palpate the ankles for oedema and test for hyperreflexia (pre-eclampsia)
Thank the patient and allow them to dress in private
Summarise findings
Blood pressure
Urine dipstick
Hands - palpate the radial pulse.
Skin changes indicative of pregnancy - linea nigra (dark vertical line from umbilicus to the pubis), striae gravidarum ('stretch marks'), striae albicans (old, silvery-white striae)
One side will feel fuller and firmer - this is the back. Fetal limbs may be palpable on the opposing side

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24 weeks pregnant: fetal development

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Where to go next

24 Weeks Pregnant

Your baby is the size of an

ear of corn

When you're 24 weeks pregnant, your baby bump and those little movements inside you are becoming more pronounced as your little one gets bigger and stronger. In this article, we’ll look at some of the things that you may be dealing with at 24 weeks pregnant, from your growing baby to your changing body. We'll also discuss what you can do to stay healthy and comfortable during this time.

Highlights at 24 Weeks Pregnant

At 24 weeks pregnant, your baby is now about the size of a full ear of corn.

They’re growing stronger, meaning you might feel more of their movements right now!

Now might be the time to start thinking about your birth plan—it’s always good to be prepared!

Your baby is getting bigger, and it’s healthy and normal to gain pregnancy weight at around 24 weeks. You might consider wearing some stretchy pants and roomy tops for more comfort. Your healthcare provider will help you stay on track with your weight, but you can also try out our Pregnancy Weight Gain Calculator below:

Pregnancy Weight Gain Calculator

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24 Weeks Pregnant: Your Baby’s Development

Your little one is continuing to develop at 24 weeks pregnant and is getting ready for the outside world. Here are some of the fetal developments taking place at 24 weeks:

What is normal fetal movement at 24 weeks? When you’re 24 weeks pregnant, those fetal movements may feel a little stronger and more noticeable, with pokes and kicks becoming more frequent. Your little one is gaining muscle control and strength.

By 24 weeks, your baby’s inner ear is fully developed. This organ controls their sense of balance and helps your baby know if they’re right side up or facing down in the womb.

Although your baby’s lungs are formed by this week, they won’t be ready to function normally in the outside world until after they start producing a substance called surfactant. This will start in the upcoming weeks—often around 26 weeks .

By 24 weeks pregnant, you may be sensing times when your fetus’s movement levels seem to increase, such as before bedtime, and other times when they seem to move less, which could occur when your baby is sleeping.

Your healthcare provider can advise you on whether you should be monitoring your baby’s movements. If your provider gives you the go-ahead, this downloadable fetal movement tracker can help you keep a record of the increased or decreased movements at 24 weeks and beyond.

If you’re 24 weeks pregnant with twins, learn more about your babies in our twin pregnancy week-by-week guide .

How Many Months Is 24 Weeks Pregnant?

It’s common to wonder how far along you are at 24 weeks pregnant and what that is in months. Well, at 24 weeks, it’s likely you’re in your sixth month of pregnancy, though there are various ways of grouping the 40 weeks of pregnancy into months. So, don’t be alarmed if your healthcare provider refers to something different!

Baby's Size at 24 Weeks Pregnant

You may be asking yourself, “How big is a baby at 24 weeks?” At 24 weeks pregnant, your baby is about the size of a full ear of corn, their weight is more than 1 1/3 pounds, and they’re about 8 inches long from crown to rump.

Your Baby: What Does 24 Weeks Pregnant Look Like?

To answer the question, “What does a fetus look like at 24 weeks pregnant,” take a peek at our visual below:

Your Body at 24 Weeks Pregnant

At 24 weeks pregnant, you’re wrapping up the second trimester, which ends at 27 weeks.

It’s natural and healthy to gain pregnancy baby weight, and by 24 weeks pregnant, you may have gained about 10 to 15 pounds. Eating a nutritious diet and getting regular exercise will help you feel better both physically and emotionally during pregnancy. Plus, staying fit during pregnancy will make it easier to lose the weight you’ve gained later on, after your baby is born.

24 Weeks Pregnant: Your Symptoms

At 24 weeks pregnant, here are some of the symptoms you may be experiencing:

Skin changes. You might start to see darker patches of skin on your body and face due to hormonal changes. This happens because the pigment-bearing cells called melanin are stimulated.

The brown patches on your face are called chloasma, and the dark line down your abdomen is called the linea nigra. These pigmented areas usually fade after your baby is born. Experts say that avoiding heavy sun exposure and using sunscreen can help reduce chloasma.

Stretch marks. As your body grows, you might also notice red streaks where the skin stretches. Stretch marks during pregnancy are most likely to occur on areas like your belly, buttocks, and breasts. Stretch marks can’t be prevented, but they can fade over time after the birth of your baby. You might also experience itchiness as your skin stretches; applying moisturizer may help reduce the itchy feeling.

Round ligament pain. It's possible that you’ll experience pain on one or both sides of your abdomen or hip area. This could be round ligament pain, which is quite common during pregnancy. It happens because the ligaments holding your uterus in place are becoming strained and stretched. Gently stretching and changing positions may help reduce the pain. If the pain ever gets too intense at 24 weeks pregnant (or any other week); if it’s accompanied by other symptoms, such as fever, bleeding, or diarrhea; or if you’re at all worried, contact your healthcare provider.

Trouble sleeping. The size of your belly bump at 24 weeks pregnant might make it difficult to find a comfortable sleeping position. If you can’t sleep at 24 weeks pregnant, some well-placed pillows can help! Try sleeping on your side with your knees bent and with one pillow between your legs and another one under your belly for support. Read more in our guide to sleeping while pregnant .

Loss of balance and dizziness. Your growing belly affects how your weight is distributed, making it a little easier to feel off balance. On top of this, changes in circulation can make you feel dizzy or light-headed. It may help to move slowly (particularly when you get up or change positions), drink lots of water, and stay cool. If you do feel dizzy, lie down on your side, if you can. If you’re concerned, ask your healthcare provider for advice.

Leg cramps. Have you been experiencing painful calf or foot muscle contractions lately? It’s not unusual to feel the symptom of cramping at 24 weeks pregnant. In fact, you might encounter this symptom from time to time right up until the day your baby is born. Although experts don’t know the exact cause of leg cramps during pregnancy, they do agree on what to do about them:

Stretch your calf muscles before you go to sleep at night, stay physically fit through regular exercise during pregnancy , and drink plenty of water to help reduce cramping.

How Big Is a Pregnant Belly at 24 Weeks?

By 24 weeks pregnant, you may have gained about 10 or 15 pounds, and your belly bump is still growing in size day by day. Around this time, your fundal height in centimeters will usually match the number of weeks you’re pregnant. So, at 24 weeks, the distance from your pubic bone to the top of your uterus will be around 24 centimeters (plus or minus 2 centimeters).

As your belly grows, you might want to try wearing a maternity belt or belly band to keep your abdomen well supported when you exercise.

What Does 24 Weeks Pregnant Look Like?

To envision what your belly might look like when you're around 24 weeks pregnant, check out the image below.

24 Weeks Pregnant: Things to Consider

At 24 weeks pregnant, take some time to consider the following:

As your belly grows, you and your partner may be wondering whether sex is still safe. If your pregnancy is progressing normally, having sex is probably safe, but if you are experiencing pregnancy complications, your healthcare provider may recommend you abstain. Because everyone’s situation is unique, your provider is the best person to ask. Read up on sex during pregnancy for more information, and discuss your feelings with your partner, too.

A glucose screening test is usually done between 24 and 28 weeks of pregnancy. The test will help your healthcare provider assess your risk of gestational diabetes . Your provider will advise you if you need this test; to learn more, see our article on glucose screening and testing .

As your belly gets larger, you'll need to adjust your daily routine, such as the way you fasten your seatbelt to safely protect you and your baby. The lap strap of the seatbelt should go under your belly and rest snugly against your hip bones. Put the shoulder strap across the center of your chest rather than under your arm. Never cross any part of the seatbelt over your belly.

Staying hydrated is important, but many people struggle to drink enough each day. As a parent-to-be, you need plenty of water to stay healthy and to support your growing baby. Experts recommend you drink about 10 cups of fluid a day, the bulk of it water. If you tend to forget to drink during your busy day, set a phone reminder that prompts you to drink a glass of water every few hours; download a hydration app that tracks your intake and reminds you if you fall behind; or set out full bottles of water at the start of each day to prompt you to get through all of them.

It might be a good idea to start discussing your preferences for childbirth with your healthcare provider and birth partner. Your birth partner could be your partner or another trusted friend or loved one. The more your birth partner and your provider know about your personal preferences and the kind of birth you’d like to have, the better they can support you when the time comes. Your birth partner can support you by helping with certain labor comfort measures like massages and by offering encouragement and emotional support. There’s still lots of time to have these discussions and to write a birth plan if you’d like to, but now is a good time to start having these conversations.

Although your baby’s arrival is still a few months away, the second trimester is still a great time to start babyproofing. You may have some extra energy now, and once your baby has arrived you will have lots of other things on your plate. Check out our tips on how to baby-proof your home . Know that while you can get some things out of the way now (like securing electric cables and adding child-proof locks to low cupboards), baby proofing is an ongoing task, and you’ll need to revisit it before your little one can crawl.

You may be experiencing some strange things that you can’t quite place. Perhaps you’re having strange dreams, or maybe you’re struggling to stay focused when normally you’re super on top of things. Read our articles on vivid pregnancy dreams and “pregnancy brain” to separate fact from fiction and find out why this may be happening.

24 Weeks Pregnant: Questions for Your Healthcare Provider

Throughout your pregnancy, you always have the opportunity to consult with your healthcare provider about any questions and concerns you may have. Here are a few common questions at 24 weeks pregnant:

Are there any pregnancy screenings or tests I need to schedule during the rest of this trimester?

Do I need to drink filtered tap water?

Are there any foods I should eat more of? Any I need to avoid?

Are there any vaccinations I need to get while I’m pregnant? When is the best time to have them, to ensure the best protection for me and my little one?

What help is available if I’m feeling down while pregnant?

What are the signs of preterm labor? (Contact your healthcare provider at 24 weeks pregnant if you notice pelvic pain, lower abdominal pressure, abdominal cramps, frequent contractions [8 times an hour], or if your water breaks.)

24 Weeks Pregnant: Your Checklist

At 24 weeks pregnant and in the coming weeks, consider the following to-dos to guide you on your way:

□ Feeling stressed? Pamper yourself with a prenatal massage. Find a massage therapist who is specially trained to treat pregnant people.

□ The next few weeks could be a good opportunity to travel before your baby is born. After about 28 weeks of pregnancy, it’s typically more difficult to travel, because walking a lot can be tiring and sitting for long periods can be extremely uncomfortable. o If you’ve been thinking about a getaway, start organizing a last-minute vacation. It’s not a bad idea to discuss your travel plans with your healthcare provider. You can also read our article on traveling and flying while pregnant .

□ Have some fun! Take this quiz to find out your ideal babymoon destination .

□ In the third trimester you’ll have a lot on your plate, so take the time now to get a few things done, such as stocking up on baby essentials before your little one arrives.

How We Wrote This Article The information in this article is based on the expert advice found in trusted medical and government sources, such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. You can find a full list of sources used for this article below. The content on this page should not replace professional medical advice. Always consult medical professionals for full diagnosis and treatment.

American College of Obstetricians and Gynecologists. Your Pregnancy and Childbirth: Month to Month, 6th ed. (Washington, DC: American College of Obstetricians and Gynecologists, 2015).
American College of Obstetricians and Gynecologists. Your Pregnancy and Childbirth: Month to Month, 7th ed. (Washington, DC: American College of Obstetricians and Gynecologists, 2021).
Mayo Clinic. Guide to a Healthy Pregnancy, 2nd ed. (Rochester, MN: Mayo Clinic Press, 2018).
Cleveland Clinic. “Fetal development Stages of Growth.”
Cleveland Clinic. “Fundal Height.”
Cleveland Clinic. “Having a Healthy Pregnancy.”
Kids Health. “Week 24.”
March of Dimes. “Making Healthy Choices For You and Your Baby.”
Mayo Clinic. “Pregnancy Week by Week.”
Medline Plus. “Skin and Hair Changes During Pregnancy.”
Women’s Health. “Staying Healthy and Safe.”

Review this article:

What to know if your baby is breech

Find out what breech position means, how to turn a breech baby, and what having a breech baby means for your labor and delivery.

What does it mean when a baby is breech?

Signs of a breech baby, why are some babies breech, how to turn a breech baby: is it possible, will i need a c-section if my baby is breech, how to turn a breech baby naturally.

Breech is a term used to describe your baby's position in the womb. Breech position means your baby is bottom-down instead of head-down.

Babies are often active in early pregnancy, moving into different positions. But by around 8 months, there's not much room in the uterus. Most babies maximize their cramped quarters by settling in head down, in what's known as a cephalic or vertex presentation. But if you have a breech baby, it means they're poised to come out buttocks and/or feet first. At 28 weeks or less, about a quarter of babies are breech, and at 32 weeks, 7 percent are breech. By the end of pregnancy, only 3 to 4 percent of babies are in breech position. At term, a baby in breech position is unlikely to turn on their own.

There are several types of breech presentations:

Frank breech (bottom first with feet up near the head)
Complete breech (bottom first with legs crossed)
Incomplete or footling breech (one or both feet are poised to come out first)

(In rare cases, a baby will be sideways in the uterus with their shoulder, back, or arm presenting first – this is called a transverse lie.)

See what these breech presentations look like .

If your baby is in breech position, you may feel them kicking in your lower belly. Or you may feel pressure under your ribcage, from their head.

By the beginning of your third trimester , your practitioner may be able to tell what position your baby is in by feeling your abdomen and locating the baby's head, back, and bottom.

If your baby's position isn't clear during an abdominal exam at 36 weeks, your caregiver may do an internal exam to try to feel what part of the baby is in your pelvis. In some cases, they may use ultrasound to confirm the baby's position.

We don't usually know why some babies are breech – in most cases it seems to be chance. While sometimes a baby with certain birth defects may not turn to a head-down position, most babies in breech position are perfectly fine. Here are some things that might increase the risk of a breech presentation:

You're carrying multiples
You've been pregnant before
You've had a breech presentation before
There's too much amniotic fluid or not enough amniotic fluid
You have placenta previa (the placenta is covering all of part of the opening of the uterus)
Your baby is preterm
Your uterus is shaped abnormally or has growths, such as fibroids
The umbilical cord is short
You were a breech delivery, or your sibling or parent was a breech delivery
Advanced maternal age (especially age 45 and older)
Your baby is a low weight at delivery
You're having a girl

There is a procedure for turning a breech baby. It's called an external cephalic version (ECV). An ob/gyn turns your baby by applying pressure to your abdomen and manually manipulating the baby into a head-down position. Some women find it very uncomfortable or even painful.

An EVC has about a 58 percent success rate, and it's more likely to work if this isn't your first baby. It's not for everyone – you can't have the procedure if you're carrying multiples or if you have too little amniotic fluid or placental abruption , for example. Your provider also won't attempt to turn your breech baby if your baby has any health problems.

The procedure is done after 36 weeks and in the hospital, where your baby can be monitored and where you'll be near a delivery room should any complications arise.

It depends, and it's something you'll want to talk with your caregiver about ahead of time. Discuss your preferences, the advantages and risks of each option ( vaginal and cesarean delivery of a breech presentation), and their experience. The biggest risk of a breech delivery is when the body delivers but the head stays entrapped within the cervix.

In the United States, most breech babies are delivered via cesarean. You may wind up having a vaginal breech delivery if your labor is so rapid that you arrive at the hospital just about to deliver. Another scenario is if you have a twin pregnancy where the first baby is in the head-first position and the second baby is not. A baby who delivers head-first will make room for the breech baby.

However, the vast majority of babies who remain breech arrive by c-section. If a c-section is planned, it will usually be scheduled at 39 weeks. To make sure your baby hasn't changed position in the meantime, you'll have an ultrasound at the hospital to confirm their position just before the surgery.

If you go into labor or your water will break s before your planned c-section, be sure to call your provider right away and head for the hospital.

In rare circumstances, if you're at low risk of complications and your caregiver is experienced delivering breech babies vaginally, you may choose to have what is called a "trial of vaginal birth." This means that you can attempt to deliver vaginally but should be prepared to have a cesarean delivery if labor isn't progressing well. You and your baby will be closely monitored during labor.

In addition to ECV, there are some alternative, natural ways to try to turn your baby. There's no proof that any of them work – or that all of them are safe. Consult your practitioner before trying them.

There's no conclusive proof that the mother's position has any effect on the baby's position, but the idea is to employ gravity to help your baby somersault into a head-down position. A few tips:

Get into one of the following positions twice a day, starting at around 32 weeks.
Be sure to do these moves on an empty stomach, lest your lunch comes back up.
Make sure there's someone around to help you get up if you start feeling lightheaded.
If you find these positions uncomfortable, stop doing them.

Position 1: Lie flat on your back and raise your pelvis so that it's 9 to 12 inches off the floor. Support your hips with a pillow and stay in this position for five to 15 minutes. Position 2: Kneel down, with your forearms on the floor in front of you, so that your bottom sticks up in the air. Stay in this position for five to 15 minutes. Sleeping position

Many women wonder if there are sleeping positions to turn a breech baby. But the positions you use to try to coax your baby head down for a short time shouldn't be used while you're sleeping. (It's not safe to sleep flat on your back in late pregnancy, for example, because the weight of your baby may compress the blood vessels that provide oxygen and nutrients to them.)

The best position for sleeping during pregnancy is on your side. Placing a pillow between your legs in this position may help open your pelvis, giving your baby room to move more easily. Support your back with plenty of pillows, too. Again, there's no proof that this works, but since it's the best sleeping position for you and your baby, you may as well give it a try.

Moxibustion

This ancient Chinese technique burns herbs to stimulate key acupressure points. To help turn a breech baby, an acupuncturist or other practitioner burns mugwort near the acupressure point of your pinky toes. According to Chinese medicine, this should stimulate your baby's activity enough that they may change position on their own. Some studies show that moxibustion in combination with acupuncture and/or positioning methods may be of some benefit. Others show moxibustion to provide no help in coaxing a baby into cephalic position. If you've discussed it with your caregiver and want to give it a try, contact your state acupuncture or Chinese medicine association and ask for the names of licensed practitioners.

One small study found that women who are regularly hypnotized into a state of deep relaxation at 37 to 40 weeks are more likely to have their baby turn than other women. If you're willing to try this technique, look for a licensed hypnotherapist with experience working with pregnant women.

Chiropractic care

There's a technique – called The Webster Breech Technique – that aims to reduce stress on the pelvis by relaxing the uterus and surrounding ligaments. The idea is that a breech baby can turn more naturally in a relaxed uterus, but research is limited as to the risks and benefits of this technique. If you're interested, talk with your provider about working with a chiropractor who's experienced with the technique.

This is a safe – and again, unproven – method based on the fact that your baby can hear sounds outside the womb. Simply play music close to the lower part of your abdomen (some women use headphones) to encourage your baby to move in the direction of the sound.

Learn more:

C-section recovery
Third trimester pregnancy guide and checklist
Hospital bag checklist

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Breech, posterior, transverse lie: What position is my baby in?

woman with hand on belly at medical office

Raspberry leaf tea during pregnancy

Too much amniotic fluid (polyhydramnios)

C-section recovery: Timeline, aftercare tips, and expectations

Mom laying with c-section scar laying down with baby

BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies .

ACOG. 2019. If your baby is breech. FAQ. The American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/if-your-baby-is-breech Opens a new window [Accessed November 2021]

ACOG. 2018. Mode of term singleton breech delivery. Committee opinion number 745. The American College of Obstetricians and Gynecologists. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/08/mode-of-term-singleton-breech-delivery Opens a new window [Accessed November 2021]

Brici P et al. 2019. Turning foetal breech presentation at 32-35 weeks of gestational age by acupuncture and moxibustion. Evidence-based Complementary and Alternative Medicine https://www.hindawi.com/journals/ecam/2019/8950924/ Opens a new window [Accessed November 2021]

Ekeus C et al. 2019. Vaginal breech delivery at term and neonatal morbidity and mortality — a population-based cohort study in Sweden. Journal of Maternal Fetal Neonatal Medicine 32(2):265. https://pubmed.ncbi.nlm.nih.gov/28889774/ Opens a new window [Accessed November 2021]

Fruscalzo A et al 2014. New and old predictive factors for breech presentation: our experience in 14433 singleton pregnancies and a literature review. Journal of Maternal Fetal Neonatal Medicine 27(2): 167-72. https://pubmed.ncbi.nlm.nih.gov/23688372/ Opens a new window [Accessed November 2021]

Garcia MM et al. 2019 Effectiveness and safety of acupuncture and moxibustion in pregnant women with noncephalic presentation: An overview of systematic reviews. Evidence Based Complementary Alternative Medicine 7036914. https://pubmed.ncbi.nlm.nih.gov/31885661/ Opens a new window [Accessed November 2021]

Gray C. 2021. Breech presentation. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK448063/ Opens a new window [Accessed November 2021]

Meaghan M et al. 2021. External cephalic version. NCBI StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK482475/ Opens a new window [Accessed November 2021]

MedlinePlus. 2020. Breech - series - Types of breech presentation. https://medlineplus.gov/ency/presentations/100193_3.htm Opens a new window [Accessed November 2020]

Noli SA et al. 2019. Preterm birth, low gestational age, low birth weight, parity, and other determinants of breech presentation: Results from a large retrospective population-based study. Biomed Research International https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6766171/ Opens a new window [Accessed November 2021]

Pistolese RA. 2002. The Webster Technique: A chiropractic technique with obstetric implications. Journal of Manipulative and Physiological Therapeutics 25(6): E1-9. https://pubmed.ncbi.nlm.nih.gov/12183701/ Opens a new window [Accessed November 2021]

Where to go next

several pieces of clothes, accessories and other necessities woman needs to bring to a hospital

Breech Position: What It Means if Your Baby Is Breech

Medical review policy, latest update:.

Medically reviewed for accuracy.

What does it mean if a baby is breech?

What are the different types of breech positions, what causes a baby to be breech, recommended reading, how can you tell if your baby is in a breech position, what does it mean to turn a breech baby, how can you turn a breech baby, how does labor usually start with a breech baby.

If your cervix dilates too slowly, if your baby doesn’t move down the birth canal steadily or if other problems arise, you’ll likely have a C-section. Talk your options over with your practitioner now to be prepared. Remember that though you may feel disappointed things didn’t turn out exactly as you envisioned, these feelings will melt away once your bundle of joy safely enters the world.

Updates history

Jump to your week of pregnancy, trending on what to expect, signs of labor, pregnancy calculator, ⚠️ you can't see this cool content because you have ad block enabled., top 1,000 baby girl names in the u.s., top 1,000 baby boy names in the u.s., braxton hicks contractions and false labor.

When is Breech an Issue?

The later in pregnancy a baby is breech , the more difficult it is for the baby to flip head down. The baby’s size grows in relation to the uterus and there is a smaller percentage of amniotic fluid for the baby to move freely. The more complicated past births were due to fetal position, the earlier I suggest starting to get your muscles unwound and your pelvis aligned. If a previous baby remained either breech or posterior until birth, I suggest bodywork throughout the pregnancy.

In time, the breech baby’s head becomes heavy enough (between 5-7 months) for gravity to bring the head down in a symmetrical womb. The baby will move head down if there is room or if there is tone in the support to the uterus to direct the baby head down.

Common issues with breech:

Health of the baby overall
Safety of the birth
Safety for the mother facing surgical birth
Emotions of the birthing parent(s)
Belly Mapping® Breech
Flip a Breech
When Baby Flips Head Down
Breech & Bicornuate Uterus
Breech for Providers
What if My Breech Baby Doesn't Turn?
Belly Mapping ®️ Method

After Baby Turns

Head Down is Not Enough
Sideways/Transverse
Asynclitism
Oblique Lie
Left Occiput Transverse
Right Occiput Anterior
Right Occiput Posterior
Right Occiput Transverse
Face Presentation
Left Occiput Anterior
OP Truths & Myths
Anterior Placenta
Body Balancing

When should I be concerned about a breech position?

During the month before 30 weeks, about 15% of babies are breech. Since breech baby’s spine is vertical, the womb is “stretched” upwards. We expect babies to turn head down by 28-32 weeks.

Breech may not be an issue until 32-34 weeks. If you know your womb has an unusual limitation in shape or size, such as a bicornate uterus then begin body balancing before pregnancy and once 15 weeks in pregnancy. In this case, the baby needs to be head down much earlier so that the uterus still has the room for baby to turn. Every unique womb is unique so these dates are theoretical, not absolute.

The timeline for breech

This is a timeline of what to do and when to do it in order to help a breech baby move head down:

Before 24-26 weeks, most babies lie diagonally or sideways in the Transverse Lie position .
Between 24-29 weeks, most babies turn vertical and some will be breech.
By 30-32 weeks, most babies flip head down and bottom-up.
By 34 weeks pregnant, the provider expects the baby to be head down.
Between 36-37 weeks, a provider may suggest an external cephalic version .
Full term is from 37-42 weeks gestation, and about 3-4% of term babies are breech.

The medical model of care addresses the breech position between 36-37 weeks, when baby’s survival outside the womb won’t include special nursery care to breathe or suck. Physicians Oxorn and Foote, however, recommend helping babies turn head down at 34 weeks. Some home birth midwives suggest interacting with a baby at 30-34 weeks to encourage a head-down position (vertex).

Women who have had difficult previous births due to posterior, asynclitism , or a labor that didn’t progress, may want to begin bodywork and the Forward-leaning Inversion as soon as the second trimester of pregnancy (after morning sickness is gone and extra things like fetal positioning activities can be thought about).

Here is a general guideline for the average pregnancy:

10-24 weeks gestation

This is the time when fetal position is generally determined, even though the baby’s final position isn’t typically set before 34 weeks gestation. How can this be? The body has a habit, so to speak, of how the soft tissues, ligaments, muscles, and alignment of the pelvis and whole body is set. The baby simply follows this basic pattern. By adding body balancing now, the baby has an increased chance of ideal positioning for labor at 34 weeks and beyond.

24-30 weeks

Routine good posture with walking and exercise will help most babies be head down as the third trimester gets underway. A 30-second inversion is good practice for everyone. Unless you have a medical reason not to, please consider the Forward-leaning Inversion. If you have a history of car accidents, falls, uncomfortable pregnancies, hormonal imbalance, or a previous breech or posterior baby, then begin the inversion and body work before or during early pregnancy.

30-34 weeks

After 30 weeks, you can start following our 6-day program for Helping Your Breech Baby Turn . By 32-34 weeks, chiropractic adjustments are suggested. We recommend consulting with one of our Spinning Babies ® Aware Practitioners . The best time to flip a breech is now.

Oxorn and Foote recommend external version at 34 weeks, but most doctors want to wait for the baby’s lungs and suck reflex to be more developed in case the maneuver goes wrong and starts labor or pulls the placenta off the uterine wall. There is often enough amniotic fluid for an easy flip before 35 weeks.

Dad's the hero in this "over the top" support to help his mate do a Breech Tilt in the comfort of bed!

Dad’s the hero in this “over the top” support to help his mate do a Breech Tilt in the comfort of a bed!

Breech Tilt: Follow the FLI with the Breech Tilt for 10-20 minutes. This allows you to tuck your chin while upside down on a similar slanted surface. Use an ironing board against the couch, for instance.
Open-knee Chest: Open-knee Chest has been studied and shown to help breeches flip. I like inversion positions that allow the mother to tuck her own chin. Myofascial workers tell me this relaxes her pelvis, whereas extending the chin tightens the pelvis.
Professional bodywork: Acupuncture and Moxibustion both have good statistics for flipping breeches. Find out if there’s a Spinning Babies ® Aware Practitioner in your area.
Therapeutic massage: There are muscle/fascia attachments at the base of the skull, respiratory diaphragm, inguinal ligament, and even the hip sockets! We are whole organisms, not machines with reproductive parts.
Chiropractic or Osteopathic: Spinal adjustmentsof the neck do improve pelvic alignment, especially if accompanied by fascial release. Not all chiropractors are trained in soft tissue body work, however. And not all soft tissue work is equal. This is why we promote our Aware Practitioner Workshops for bodyworkers.

Should manual external cephalic version be done earlier?

A few midwives recommend version (manually turning the breech baby to head down) at 30 –31 weeks. Anne Frye, author of Holistic Midwifery, reported a very low incidence of breech at term when her midwifery group manually rotated babies during this gestational age.

Attempting to turn the baby now is over a month before the medical model of turning breeches. Utmost gentleness must be the protective factor. If forcing a baby to turn harms the baby or placenta, the baby is too young to be cared for outside of the Neonatal Intensive Care Unit.

Midwives who turn babies now believe there is less chance of hurting a baby and proceed very carefully, stopping at once if there is resistance. Typically, there is less resistance from the uterus because there is more fluid and the baby is still very small.

Body work is suggested before attempting this, especially for first-time moms or women who had a difficult time with their first birth. There are risks to a manual version, so the baby should be monitored closely in between each 10-30 degrees of rotation.

35-36 weeks

If your baby is breech during this time your doctor or midwife will begin to talk about how to help the baby flip head down, and possibly about scheduling a manual version for 36-37 weeks. Getting body work and having acupuncture or homeopathy may help soften the ligaments and a tense uterus to either help the baby flip spontaneously or to allow more success in an attempt at a version.

Moxibustion has its highest success rate this week.

36-37 weeks.

During this time, you can continue with the suggestions in the “Professional Help” page. Also, an obstetrician may suggest manually flipping the baby to a head down position at this time. A few midwives will also offer this, perhaps even earlier, at 30-34 weeks.

NOTE: Don’t let someone manually flip your baby without using careful monitoring of the baby’s heartbeat. Accidents can occur, even when there is good intention. The baby must be listened to and the version stopped immediately if the heart rate drops.

External cephalic version near the end of pregnancy

You may also agree to go through with a cephalic version at this time. The baby is in the womb with the cord and placenta and there is a small risk in turning the baby manually. This maneuver should be done with monitoring by experienced professionals, in a setting ready for a cesarean if needed.

There is about a 40-50% chance this will be successful. Sometimes the baby moves easily and sometimes the procedure is painful. I believe it’s important who performs it, and that ligament tightness would make this more uncomfortable. I suggest getting chiropractic, myofascial, acupuncture, homeopathy, or moxibustion (or all of these) before and after the version.

Doing the Three Sisters of Balance SM (or following the Turning Your Breech Baby guidelines) daily beforehand and just before the procedure would be relaxing and helpful. More birth professionals are using our approach in the hours or the week before the procedure and report that fewer procedures are necessary and those that are seem to be easier than average to do when the baby is able to be turned.

38-40 weeks

Sometimes a woman and her caregiver don’t know the baby is breech until this point or until labor. Rarely does a baby flip to breech this late in pregnancy but they can. Parents and providers may learn that baby is breech during a routine bio-physical ultrasound exam during this time or later in pregnancy.

An external cephalic version may yet be successful, depending on the fluid level and the flexibility of the uterus, the baby’s head position and location, a uterine septum, where the placenta is, etc.

It is still possible that the baby flips doing body balancing activities or even labor itself (contractions might be the very action that turns baby in about 1% of breeches). You may find turning easier if you keep doing the activities listed above.

40-41 weeks

Though many breeches are born about 37-39 weeks gestation, some will happily go to 41 or 42 weeks. For a head down baby, 41 weeks and 1 to 3 days is a common time for labor to begin on its own. SStarting labor at this gestation can certainly be normal for a healthy breechling, too.

If the pregnant person has a tendency to be somewhat overweight or lower energy, which can indicate low thyroid function, a longer pregnancy may be more likely. This tendency deserves looking after. Well-nourished and peppy women may also go a full pregnancy length, of course.

Going into labor and then having a planned cesarean is recommend by Dr. Michel Odent in his book, Cesarean. Going into labor spontaneously is safer for the breech vaginal birth, as well. Women who are trying to flip their baby often find it necessary to slow down the efforts and come to terms with a breech birth.

When facing a cesarean, it can be nurturing to you and your baby to plan a cesarean with skin-to-skin, delayed cord clamping, and breastfeeding on the operating room table or in the recovery room. Give yourself some time and compassion to feel your feelings and explore your options to adapt to the options you have available to you.

Postdates (after your due date) with a breech

With a breech, going all the way to 42 weeks may or may not be more of an issue. Some providers will have to end any plans for a vaginal birth by now. Midwifery statutes often limit midwifery care out of the hospital to 37-42 weeks (or 36-43, depending on where you live).

After 42 weeks, the baby’s skull bones are setting up more firmly and a vaginal birth is less favorable. I’ve been to a few breech births after 42 weeks gestation and everything went very well. But, I do sometimes wonder why labor isn’t starting and if metabolism is a reason, especially when there’s been regular bodywork for weeks.

For a person carrying a breech baby who does show signs of low thyroid function or otherwise a “sloshy” metabolism, I am inclined to transfer care to a kind hospital provider at 41.5 weeks. Intelligent and experienced monitoring may rule out issues that arise post dates that may complicate labor. With slow metabolism postdates issues with breech position may need extra attention before 42 weeks.

Continue body balancing and daily stretching but stop inversions for three days. Walk with a stride. See more at https://www.spinningbabies.com/pregnancy-birth/baby-position/breech/when-baby-flips-head-down/

If Baby Does Not Turn

Not every breech baby will turn on their own. Not every attempt at an External Cephalic Version works (It’s often 50-50). Adding body balancing has abundant anecdotal reporting to show success. But this balancing should be individualized if the pregnant person has followed general guidelines closely for 1-2 weeks without success.

Be compassionate to you and your baby. You are both doing the best you can with the resources you have.

Choose your path. Sometimes it may feel like you don’t have a choice. Consider why it feels that way. Perhaps your choice is safety over manner of birth? That’s totally valid. Just because a vaginal birth might be available to some doesn’t mean it is your first choice, too.

Sometimes babies choose, too. The labor goes too fast to do surgery for the birth. Or, the baby doesn’t come into the pelvis and surgical birth is necessary. (Remember reaching in and pulling out the baby is not reasonable if a cesarean is available in the region unless this is a second twin (subsequent triplet) or travel is impossible due to weather, war, or whatever reason. Life is real. Babies don’t follow a script. Be real with your own experience.

Inducing a breech

Inducing a breech is not recommended in out of hospital settings. Even in the hospital, the risk rises. In some areas where breech is common, Pitocin/Syntocin inductions are done with outcomes that are good enough to keep the options open. Induction by herbs is also considered out of scope for breech.

We need to respect the breech and not stress the baby, especially in settings where we don’t have the rescue setup to solve any potential problems. Try body balancing and see if labor begins on its own. That would be a non-invasive, non-manipulating approach.

The Breech Turned During Labor

It is a rare possibility that the baby flips to head down during labor. I once assisted a midwife who’s laboring mother’s water had released. Her labor was mild and not picking up, so after 24 hours we transferred and found that the baby had flipped. The doctor thought we’d misdiagnosed, but the mother’s abdomen was so thin we could feel the baby’s knuckles and elbow and found the baby in the opposite direction after entering the hospital!

Another mother had Dynamic Body Balancing in early labor with one of Dr. Carol Phillips students who was also a midwife. Her breech baby turned head down during transition phase of labor!

Laboring With a Breech Before The Cesarean

If the plan is to have a cesarean once labor begins, call the hospital and alert them of labor immediately. Go to the hospital right away. Breech births can go quite quickly and you want to be where people are ready to help you. If you plan to have a vaginal birth, don’t delay in getting to your birth location or getting your birth team to you.

While it can be totally normal to have a 24-hour or longer breech birth, many breech labors are quite short. Because the softer bottom is first, it may take you by surprise that you are progressing with such little pain (though some breech births are as painful as head down births). Just don’t base your decision to get to the hospital on your pain level!

A cesarean can be more complicated if the baby is wedged low in the pelvis. That is why there is a recommendation to have the cesarean in early labor. But cesareans are done everyday with head down babies low in the pelvis. Sometimes it’s how it is.

Starting labor in and of itself doesn’t make the surgery more dangerous. Rushing around and doing things in a hurry might. Alert your hospital before labor and again once you start labor. Be firm that you know what you are about and that they need to get the Operating Room ready while you are on your way.

Mostly, a leisurely transition into the hospital can be sustained with a sense of humor and practicality. There can be a sense of calm while you and the staff take the steps to welcome your baby. This is your birth. Be present with how your experience unfolds.

After the birth

While the concern about breech position is during the birthing, when the baby is breech for most of the third trimester, their skull bones become shaped by the inside of the upper womb (the fundus). This isn’t typically an issue but can be noticed.

Craniosacral therapy can gently (and without using force) reshape the baby’s head, ideally during the month or two after birth. Surgery on baby’s skull is seldom necessary after 3-6 sessions with a Craniosacral therapist. For most breech babies, this issue is not present. I list is here because I have heard some assumptions that can be dispelled.

A question about breech

Email from Wed, Feb 11, 2009:

…I’m 30 weeks and the baby is what I’d describe as oblique breech – his head is on my right side next to my belly button, his hips/butt are in my pelvis on the lower left side (my left) and his feet are in front of his face. I think he’s facing forward – towards my belly button. I’ve known this for weeks just because his big head is so hard I always bump that spot on accident. …. my first son was 9 lbs and born posterior, so I’m really hoping this baby is in the ideal position for delivery… so both of these things make me nervous that he won’t move. He has been in this position for a few weeks now. … Anyway, just wondering if I should worry and what, if anything, I can do to help him move now. My Midwife suggested a Chiropractor that can do some adjustments. I’d like to do the couch inversion too. Would it help for me to walk more? Also, should I sleep more on one side than the other? Thanks for your help! Great site!

Gail’s reply:

Hi…. now is a good time to take action, not so much that your baby is breech, but because your first baby was OP . You see, a pelvic misalignment and/or round ligament spasms (they often go together) can result in either a breech or a posterior fetal position . So, a breech will often flip to a posterior position and may stay that way unless you resolve the underlying issue. Maternal positioning is often not enough by itself to correct a posterior fetal position when there is a history of previous posterior or breech babies. While certainly most breech babies flip head down, it’s beneficial to help correct the symmetry of your uterine ligaments now, while the baby is still small enough to have plenty of room to flip head down once the reason for the previous posterior position is remedied. See some things a Chiropractor can do for breech and posterior by reading Professional Help .

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About epocrates

Breech presentation

Highlights & basics, diagnostic approach, risk factors, history & exam, differential diagnosis.

Tx Approach

Emerging Tx

Complications.

PATIENT RESOURCES

Patient Instructions

Breech presentation refers to the baby presenting for delivery with the buttocks or feet first rather than head.

Associated with increased morbidity and mortality for the mother in terms of emergency cesarean section and placenta previa; and for the baby in terms of preterm birth, small fetal size, congenital anomalies, and perinatal mortality.

Incidence decreases as pregnancy progresses and by term occurs in 3% to 4% of singleton term pregnancies.

Treatment options include external cephalic version to increase the likelihood of vaginal birth or a planned cesarean section, the optimal gestation being 37 and 39 weeks, respectively.

Planned cesarean section is considered the safest form of delivery for infants with a persisting breech presentation at term.

Quick Reference

Key Factors

buttocks or feet as the presenting part

Fetal head under costal margin, fetal heartbeat above the maternal umbilicus.

Other Factors

subcostal tenderness

Pelvic or bladder pain.

Diagnostics Tests

1st Tests to Order

transabdominal/transvaginal ultrasound

Treatment options.

presumptive

<37 weeks' gestation

specialist evaluation

corticosteroid

magnesium sulfate

≥37 weeks' gestation not in labor

unsuccessful ECV with persistent breech

Classifications

Types of breech presentation

Baby's buttocks lead the way into the birth canal

Hips are flexed, knees are extended, and the feet are in close proximity to the head

65% to 70% of breech babies are in this position.

Baby presents with buttocks first

Both the hips and the knees are flexed; the baby may be sitting cross-legged.

One or both of the baby's feet lie below the breech so that the foot or knee is lowermost in the birth canal

This is rare at term but relatively common with premature fetuses.

Common Vignette

Epidemiology

33% of births less than 28 weeks' gestation

14% of births at 29 to 32 weeks' gestation

9% of births at 33 to 36 weeks' gestation

6% of births at 37 to 40 weeks' gestation.

Pathophysiology

Natasha Nassar, PhD
Christine L. Roberts, MBBS, FAFPHM, DrPH
Jonathan Morris, MBChB, FRANZCOG, PhD
John W. Bachman, MD
Rhona Hughes, MBChB
Brian Peat, MD
Lelia Duley, MBChB
Justus Hofmeyr, MD

Clinical exam

Palpation of the abdomen to determine the position of the baby's head

Palpation of the abdomen to confirm the position of the fetal spine on one side and fetal extremities on the other

Palpation of the area above the symphysis pubis to locate the fetal presenting part

Palpation of the presenting part to confirm presentation, to determine how far the fetus has descended and whether the fetus is engaged.

Ultrasound examination

Premature fetus.

Prematurity is consistently associated with breech presentation. [ 6 ] [ 9 ] This may be due to the smaller size of preterm infants, who are more likely to change their in utero position.

Increasing duration of pregnancy may allow breech-presenting fetuses time to grow, turn spontaneously or by external cephalic version, and remain cephalic-presenting.

Larger fetuses may be forced into a cephalic presentation in late pregnancy due to space or alignment constraints within the uterus.

small for gestational age fetus

Low birth-weight is a risk factor for breech presentation. [ 9 ] [ 11 ] [ 12 ] [ 13 ] [ 14 ] Term breech births are associated with a smaller fetal size for gestational age, highlighting the association with low birth-weight rather than prematurity. [ 6 ]

nulliparity

Women having a first birth have increased rates of breech presentation, probably due to the increased likelihood of smaller fetal size. [ 6 ] [ 9 ]

Relaxation of the uterine wall in multiparous women may reduce the odds of breech birth and contribute to a higher spontaneous or external cephalic version rate. [ 10 ]

fetal congenital anomalies

Congenital anomalies in the fetus may result in a small fetal size or inappropriate fetal growth. [ 9 ] [ 12 ] [ 14 ] [ 15 ]

Anencephaly, hydrocephaly, Down syndrome, and fetal neuromuscular dysfunction are associated with breech presentation, the latter due to its effect on the quality of fetal movements. [ 9 ] [ 14 ]

previous breech delivery

The risk of recurrent breech delivery is 8%, the risk increasing from 4% after one breech delivery to 28% after three. [ 16 ]

The effects of recurrence may be due to recurring specific causal factors, either genetic or environmental in origin.

uterine abnormalities

Women with uterine abnormalities have a high incidence of breech presentation. [ 14 ] [ 17 ] [ 18 ] [ 19 ]

female fetus

Fifty-four percent of breech-presenting fetuses are female. [ 14 ]

abnormal amniotic fluid volume

Both oligohydramnios and polyhydramnios are associated with breech presentation. [ 1 ] [ 12 ] [ 14 ]

Low amniotic fluid volume decreases the likelihood of a fetus turning to a cephalic position; an increased amniotic fluid volume may facilitate frequent change in position.

placental abnormalities

An association between placental implantation in the cornual-fundal region and breech presentation has been reported, although some studies have not found it a risk factor. [ 8 ] [ 20 ] [ 21 ] [ 22 ] [ 10 ] [ 14 ]

The association with placenta previa is also inconsistent. [ 8 ] [ 9 ] [ 22 ] Placenta previa is associated with preterm birth and may be an indirect risk factor.

Pelvic or vaginal examination reveals the buttocks and/or feet, felt as a yielding, irregular mass, as the presenting part. [ 26 ] In cephalic presentation, a hard, round, regular fetal head can be palpated. [ 26 ]

The Leopold maneuver on examination suggests breech position by palpation of the fetal head under the costal margin. [ 26 ]

The baby's heartbeat should be auscultated using a Pinard stethoscope or a hand-held Doppler to indicate the position of the fetus. The fetal heartbeat lies above the maternal umbilicus in breech presentation. [ 1 ]

Tenderness under one or other costal margin as a result of pressure by the harder fetal head.

Pain due to fetal kicks in the maternal pelvis or bladder.

breech position

Visualizes the fetus and reveals its position.

Used to confirm a clinically suspected breech presentation. [ 28 ]

Should be performed by practitioners with appropriate skills in obstetric ultrasound.

Establishes the type of breech presentation by imaging the fetal femurs and their relationship to the distal bones.

Transverse lie

Differentiating Signs/Symptoms

Fetus lies horizontally across the uterus with the shoulder as the presenting part.

Similar predisposing factors such as placenta previa, abnormal amniotic fluid volume, and uterine anomalies, although more common in multiparity. [ 1 ] [ 2 ] [ 29 ]

Differentiating Tests

Clinical examination and fetal auscultation may be indicative.

Ultrasound confirms presentation.

Treatment Approach

Breech presentation <37 weeks' gestation.

The UK Royal College of Obstetricians and Gynaecologists (RCOG) recommends that corticosteroids should be offered to women between 24 and 34+6 weeks' gestation, in whom imminent preterm birth is anticipated. Corticosteroids should only be considered after discussion of risks/benefits at 35 to 36+6 weeks. Given within 7 days of preterm birth, corticosteroids may reduce perinatal and neonatal death and respiratory distress syndrome. [ 32 ] The American College of Obstetricians and Gynecologists (ACOG) recommends a single course of corticosteroids for pregnant women between 24 and 33+6 weeks' gestation who are at risk of preterm delivery within 7 days, including those with ruptured membranes and multiple gestations. It may also be considered for pregnant women starting at 23 weeks' gestation who are at risk of preterm delivery within 7 days. A single course of betamethasone is recommended for pregnant women between 34 and 36+6 weeks' gestation at risk of preterm birth within 7 days, and who have not received a previous course of prenatal corticosteroids. Regularly scheduled repeat courses or serial courses (more than two) are not currently recommended. A single repeat course of prenatal corticosteroids should be considered in women who are less than 34 weeks' gestation, who are at risk of preterm delivery within 7 days, and whose prior course of prenatal corticosteroids was administered more than 14 days previously. Rescue course corticosteroids could be provided as early as 7 days from the prior dose, if indicated by the clinical scenario. [ 33 ]

Magnesium sulfate given before anticipated early preterm birth reduces the risk of cerebral palsy in surviving infants. Physicians electing to use magnesium sulfate for fetal neuroprotection should develop specific guidelines regarding inclusion criteria, treatment regimens, and concurrent tocolysis. [ 34 ]

Breech presentation from 37 weeks' gestation, before labor

ECV is the initial treatment for a breech presentation at term when the patient is not in labor. It involves turning a fetus presenting by the breech to a cephalic (head-down) presentation to increase the likelihood of vaginal birth. [ 35 ] [ 36 ] Where available, it should be offered to all women in late pregnancy, by an experienced clinician, in hospitals with facilities for emergency delivery, and no contraindications to the procedure. [ 35 ] There is no upper time limit on the appropriate gestation for ECV, with success reported at 42 weeks.

There is no general consensus on contraindications to ECV. Contraindications include multiple pregnancy (except after delivery of a first twin), ruptured membranes, current or recent (<1 week) vaginal bleeding, rhesus isoimmunization, other indications for cesarean section (e.g., placenta previa or uterine malformation), or abnormal electronic fetal monitoring. [ 35 ] One systematic review of relative contraindications for ECV highlighted that most contraindications do not have clear empirical evidence. Exceptions include placental abruption, severe preeclampsia/HELLP syndrome, or signs of fetal distress (abnormal cardiotocography and/or Doppler flow). [ 36 ]

The procedure involves applying external pressure and firmly pushing or palpating the mother's abdomen to coerce the fetus to somersault (either forward or backward) into a cephalic position. [ 37 ]

The overall ECV success rate varies but, in a large series, 47% of women following an ECV attempt had a cephalic presentation at birth. [ 35 ] [ 38 ] Various factors influence the success rate. One systematic review found ECV success rates to be 68% overall, with the rate significantly higher for women from African countries (89%) compared with women from non-African countries (62%), and higher among multiparous (78%) than nulliparous women (48%). [ 39 ] Overall, the ECV success rates for nulliparous and multiparous non-African women were 43% and 73%, respectively, while for nulliparous and multiparous African women rates were 79% and 91%, respectively. Another study reported no difference in success rate or rate of cesarean section among women with previous cesarean section undergoing ECV compared with women with previous vaginal birth. However, numbers were small and further studies in this regard are required. [ 40 ]

Women's preference for vaginal delivery is a major contributing factor in their decision for ECV. However, studies suggest women with a breech presentation at term may not receive complete and/or evidence-based information about the benefits and risks of ECV. [ 41 ] [ 42 ] Although up to 60% of women reported ECV to be painful, the majority highlighted the benefits outweigh the risks (71%) and would recommend ECV to their friends or be willing to repeat for themselves (84%). [ 41 ] [ 42 ]

Cardiotocography and ultrasound should be performed before and after the procedure. Tocolysis should be used to facilitate the maneuver, and Rho(D) immune globulin should be administered to women who are Rhesus negative. [ 35 ] Tocolytic agents include adrenergic beta-2 receptor stimulants such as albuterol, terbutaline, or ritodrine (widely used with ECV in some countries, but not yet available in the US). One Cochrane review of tocolytic beta stimulants demonstrates that these are less likely to be associated with failed ECV, and are effective in increasing cephalic presentation and reducing cesarean section. [ 43 ] There is no current evidence to recommend one beta-2 adrenergic receptor agonist over another. Until these data are available, adherence to a local protocol for tocolysis is recommended. The Food and Drug Administration has issued a warning against using injectable terbutaline beyond 48 to 72 hours, or acute or prolonged treatment with oral terbutaline, in pregnant women for the prevention or prolonged treatment of preterm labor, due to potential serious maternal cardiac adverse effects and death. [ 44 ] Whether this warning applies to the subcutaneous administration of terbutaline in ECV is still unclear; however, studies currently support this use. The European Medicines Agency (EMA) recommends that injectable beta agonists should be used for up to 48 hours between the 22nd and 37th week of pregnancy only. They should be used under specialist supervision with continuous monitoring of the mother and unborn baby owing to the risk of adverse cardiovascular effects in both the mother and baby. The EMA no longer recommends oral or rectal formulations for obstetric indications. [ 45 ]

If ECV is successful, pregnancy care should continue as usual for any cephalic presentation. One systematic review assessing the mode of delivery after a successful ECV found that these women were at increased risk for cesarean section and instrumental vaginal delivery compared with women with spontaneous cephalic pregnancies. However, they still had a lower rate of cesarean section following ECV (i.e., 47%) compared with the cesarean section rate for those with a persisting breech (i.e., 85%). With a number needed to treat of three, ECV is still considered to be an effective means of preventing the need for cesarean section. [ 46 ]

Planned cesarean section should be offered as the safest mode of delivery for the baby, even though it carries a small increase in serious immediate maternal complications compared with vaginal birth. [ 24 ] [ 25 ] [ 31 ] In the US, most unsuccessful ECV with persistent breech will be delivered via cesarean section.

A vaginal mode of delivery may be considered by some clinicians as an option, particularly when maternal request is provided, senior and experienced staff are available, there is no absolute contraindication to vaginal birth (e.g., placenta previa, compromised fetal condition), and with optimal fetal growth (estimated weight above the tenth centile and up to 3800 g). Other factors that make planned vaginal birth higher risk include hyperextended neck on ultrasound and footling presentation. [ 24 ]

Breech presentation from 37 weeks' gestation, during labor

The first option should be a planned cesarean section.

There is a small increase in the risk of serious immediate maternal complications compared with vaginal birth (RR 1.29, 95% CI 1.03 to 1.61), including pulmonary embolism, infection, bleeding, damage to the bladder and bowel, slower recovery from the delivery, longer hospitalization, and delayed bonding and breast-feeding. [ 23 ] [ 31 ] [ 47 ] [ 48 ] [ 49 ] [ 50 ] [ 51 ] [ 52 ] [ 53 ] [ 54 ] [ 55 ] [ 56 ] [ 57 ] [ 58 ] Consider using antimicrobial triclosan-coated sutures for wound closure to reduce the risk of surgical site infection. [ 59 ]

Planned cesarean section is safer for babies, but is associated with increased neonatal respiratory distress. The risk is reduced when the section is performed at 39 weeks' gestation. [ 64 ] [ 65 ] [ 66 ] For women undergoing a planned cesarean section, RCOG recommends an informed discussion about the potential risks and benefits of a course of prenatal corticosteroids between 37 and 38+6 weeks' gestation. Although prenatal corticosteroids may reduce admission to the neonatal unit for respiratory morbidity, it is uncertain if there is any reduction in respiratory distress syndrome, transient tachypnea of the newborn, or neonatal unit admission overall. In addition, prenatal corticosteroids may result in harm to the neonate, including hypoglycemia and potential developmental delay. [ 32 ] ACOG does not recommend corticosteroids in women >37 weeks' gestation. [ 33 ]

Undiagnosed breech in labor generally results in cesarean section after the onset of labor, higher rates of emergency cesarean section associated with the least favorable maternal outcomes, a greater likelihood of cord prolapse, and other poor infant outcomes. [ 23 ] [ 67 ] [ 49 ] [ 68 ] [ 69 ] [ 70 ] [ 71 ]

This mode of delivery may be considered by some clinicians as an option for women who are in labor, particularly when delivery is imminent. Vaginal breech delivery may also be considered, where suitable, when delivery is not imminent, maternal request is provided, senior and experienced staff are available, there is no absolute contraindication to vaginal birth (e.g., placenta previa, compromised fetal condition), and with optimal fetal growth (estimated weight above the tenth centile and up to 3800 g). Other factors that make planned vaginal birth higher risk include hyperextended neck on ultrasound and footling presentation. [ 24 ]

Findings from one systematic review of 27 observational studies revealed that the absolute risks of perinatal mortality, fetal neurologic morbidity, birth trauma, 5-minute Apgar score <7, and neonatal asphyxia in the planned vaginal delivery group were low at 0.3%, 0.7%, 0.7%, 2.4%, and 3.3%, respectively. However, the relative risks of perinatal mortality and morbidity were 2- to 5-fold higher in the planned vaginal than in the planned cesarean delivery group. Authors recommend ongoing judicious decision-making for vaginal breech delivery for selected singleton, term breech babies. [ 72 ]

ECV may also be considered an option for women with breech presentation in early labor, when delivery is not imminent, provided that the membranes are intact.

A woman presenting with a breech presentation <37 weeks is an area of clinical controversy. Optimal mode of delivery for preterm breech has not been fully evaluated in clinical trials, and the relative risks for the preterm infant and mother remain unclear. In the absence of good evidence, if diagnosis of breech presentation prior to 37 weeks' gestation is made, prematurity and clinical circumstances should determine management and mode of delivery.

Primary Options

12 mg intramuscularly every 24 hours for 2 doses

6 mg intramuscularly every 12 hours for 4 doses

The UK Royal College of Obstetricians and Gynaecologists recommends that corticosteroids should be offered to women between 24 and 34+6 weeks' gestation, in whom imminent preterm birth is anticipated. Corticosteroids should only be considered after discussion of risks/benefits at 35 to 36+6 weeks. Given within 7 days of preterm birth, corticosteroids may reduce perinatal and neonatal death and respiratory distress syndrome. [ 32 ]

The American College of Obstetricians and Gynecologists recommends a single course of corticosteroids for pregnant women between 24 and 33+6 weeks' gestation who are at risk of preterm delivery within 7 days, including those with ruptured membranes and multiple gestations. It may also be considered for pregnant women starting at 23 weeks' gestation who are at risk of preterm delivery within 7 days. A single course of betamethasone is recommended for pregnant women between 34 and 36+6 weeks' gestation at risk of preterm birth within 7 days, and who have not received a previous course of prenatal corticosteroids. Regularly scheduled repeat courses or serial courses (more than two) are not currently recommended. A single repeat course of prenatal corticosteroids should be considered in women who are less than 34 weeks' gestation, who are at risk of preterm delivery within 7 days, and whose prior course of prenatal corticosteroids was administered more than 14 days previously. Rescue course corticosteroids could be provided as early as 7 days from the prior dose, if indicated by the clinical scenario. [ 33 ]

consult specialist for guidance on dose

external cephalic version (ECV)

There is no upper time limit on the appropriate gestation for ECV; it should be offered to all women in late pregnancy by an experienced clinician in hospitals with facilities for emergency delivery and no contraindications to the procedure. [ 35 ] [ 36 ]

ECV involves applying external pressure and firmly pushing or palpating the mother's abdomen to coerce the fetus to somersault (either forward or backward) into a cephalic position. [ 37 ]

Cardiotocography and ultrasound should be performed before and after the procedure.

If ECV is successful, pregnancy care should continue as usual for any cephalic presentation. A systematic review assessing the mode of delivery after a successful ECV found that these women were at increased risk for cesarean section and instrumental vaginal delivery compared with women with spontaneous cephalic pregnancies. However, they still had a lower rate of cesarean section following ECV (i.e., 47%) compared with the cesarean section rate for those with a persisting breech (i.e., 85%). With a number needed to treat of 3, ECV is still considered to be an effective means of preventing the need for cesarean section. [ 46 ]

tocolytic agents

see local specialist protocol for dosing guidelines

Tocolytic agents include adrenergic beta-2 receptor stimulants such as albuterol, terbutaline, or ritodrine (widely used with external cephalic version [ECV] in some countries, but not yet available in the US). They are used to delay or inhibit labor and increase the success rate of ECV. There is no current evidence to recommend one beta-2 adrenergic receptor agonist over another. Until these data are available, adherence to a local protocol for tocolysis is recommended.

The Food and Drug Administration has issued a warning against using injectable terbutaline beyond 48-72 hours, or acute or prolonged treatment with oral terbutaline, in pregnant women for the prevention or prolonged treatment of preterm labor, due to potential serious maternal cardiac adverse effects and death. [ 44 ] Whether this warning applies to the subcutaneous administration of terbutaline in ECV is still unclear; however, studies currently support this use. The European Medicines Agency (EMA) recommends that injectable beta agonists should be used for up to 48 hours between the 22nd and 37th week of pregnancy only. They should be used under specialist supervision with continuous monitoring of the mother and unborn baby owing to the risk of adverse cardiovascular effects in both the mother and baby. The EMA no longer recommends oral or rectal formulations for obstetric indications. [ 45 ]

A systematic review found there was no evidence to support the use of nifedipine for tocolysis. [ 73 ]

There is insufficient evidence to evaluate other interventions to help ECV, such as fetal acoustic stimulation in midline fetal spine positions, or epidural or spinal analgesia. [ 43 ]

Rho(D) immune globulin

300 micrograms intramuscularly as a single dose

Nonsensitized Rh-negative women should receive Rho(D) immune globulin. [ 35 ]

The indication for its administration is to prevent rhesus isoimmunization, which may affect subsequent pregnancy outcomes.

Rho(D) immune globulin needs to be given at the time of external cephalic version and should be given again postpartum to those women who give birth to an Rh-positive baby. [ 74 ]

It is best administered as soon as possible after the procedure, usually within 72 hours.

Dose depends on brand used. Dose given below pertains to most commonly used brands. Consult specialist for further guidance on dose.

elective cesarean section/vaginal breech delivery

Mode of delivery (cesarean section or vaginal breech delivery) should be based on the experience of the attending clinician, hospital policies, maternal request, and the presence or absence of complicating factors. In the US, most unsuccessful external cephalic version (ECV) with persistent breech will be delivered via cesarean section.

Cesarean section, at 39 weeks or greater, has been shown to significantly reduce perinatal mortality and neonatal morbidity compared with vaginal breech delivery (RR 0.33, 95% CI 0.19 to 0.56). [ 31 ] Although safer for these babies, there is a small increase in serious immediate maternal complications compared with vaginal birth (RR 1.29, 95% CI 1.03 to 1.61), as well as long-term risks for future pregnancies, including pulmonary embolism, bleeding, infection, damage to the bladder and bowel, slower recovery from the delivery, longer hospitalization, and delayed bonding and breast-feeding. [ 23 ] [ 31 ] [ 47 ] [ 48 ] [ 49 ] [ 50 ] [ 51 ] [ 52 ] [ 53 ] [ 54 ] [ 55 ] [ 56 ] [ 57 ] [ 58 ] Consider using antimicrobial triclosan-coated sutures for wound closure to reduce the risk of surgical site infection. [ 59 ]

Vaginal delivery may be considered by some clinicians as an option, particularly when maternal request is provided, when senior and experienced staff are available, when there is no absolute contraindication to vaginal birth (e.g., placenta previa, compromised fetal condition), and with optimal fetal growth (estimated weight above the tenth centile and up to 3800 g). Other factors that make planned vaginal birth higher risk include hyperextended neck on ultrasound and footling presentation. [ 24 ]

For women undergoing a planned cesarean section, the UK Royal College of Obstetricians and Gynaecologists recommends an informed discussion about the potential risks and benefits of a course of prenatal corticosteroids between 37 and 38+6 weeks' gestation. Although prenatal corticosteroids may reduce admission to the neonatal unit for respiratory morbidity, it is uncertain if there is any reduction in respiratory distress syndrome, transient tachypnea of the newborn, or neonatal unit admission overall. In addition, prenatal corticosteroids may result in harm to the neonate, including hypoglycemia and potential developmental delay. [ 32 ] The American College of Obstetricians and Gynecologists does not recommend corticosteroids in women >37 weeks' gestation. [ 33 ]

It is best administered as soon as possible after delivery, usually within 72 hours.

Administration of postpartum Rho (D) immune globulin should not be affected by previous routine prenatal prophylaxis or previous administration for a potentially sensitizing event. [ 74 ]

≥37 weeks' gestation in labor: no imminent delivery

planned cesarean section

For women with breech presentation in labor, planned cesarean section at 39 weeks or greater has been shown to significantly reduce perinatal mortality and neonatal morbidity compared with vaginal breech delivery (RR 0.33, 95% CI 0.19 to 0.56). [ 31 ]

Although safer for these babies, there is a small increase in serious immediate maternal complications compared with vaginal birth (RR 1.29, 95% CI 1.03 to 1.61), as well as long-term risks for future pregnancies, including pulmonary embolism, infection, bleeding, damage to the bladder and bowel, slower recovery from the delivery, longer hospitalization, and delayed bonding and breast-feeding. [ 23 ] [ 31 ] [ 47 ] [ 48 ] [ 49 ] [ 50 ] [ 51 ] [ 52 ] [ 53 ] [ 54 ] [ 55 ] [ 56 ] [ 57 ] [ 58 ] Consider using antimicrobial triclosan-coated sutures for wound closure to reduce the risk of surgical site infection. [ 59 ]

Continuous cardiotocography monitoring should continue until delivery. [ 24 ] [ 25 ]

vaginal breech delivery

This mode of delivery may be considered by some clinicians as an option, particularly when maternal request is provided, when senior and experienced staff are available, when there is no absolute contraindication to vaginal birth (e.g., placenta previa, compromised fetal condition), and with optimal fetal growth (estimated weight above the tenth centile and up to 3800 g). Other factors that make planned vaginal birth higher risk include hyperextended neck on ultrasound and footling presentation. [ 24 ]

For women with persisting breech presentation, planned cesarean section has, however, been shown to significantly reduce perinatal mortality and neonatal morbidity compared with vaginal breech delivery (RR 0.33, 95% CI 0.19 to 0.56). [ 31 ]

ECV may also be considered an option for women with breech presentation in early labor, provided that the membranes are intact.

There is no upper time limit on the appropriate gestation for ECV. [ 35 ]

Involves applying external pressure and firmly pushing or palpating the mother's abdomen to coerce the fetus to somersault (either forward or backward) into a cephalic position. [ 37 ]

Relative contraindications include placental abruption, severe preeclampsia/HELLP syndrome, and signs of fetal distress (abnormal cardiotocography and/or abnormal Doppler flow). [ 35 ] [ 36 ]

Rho(D) immune globulin needs to be given at the time of ECV and should be given again postpartum to those women who give birth to an Rh-positive baby. [ 74 ]

≥37 weeks' gestation in labor: imminent delivery

cesarean section

For women with persistent breech presentation, planned cesarean section has been shown to significantly reduce perinatal mortality and neonatal morbidity compared with vaginal breech delivery (RR 0.33, 95% CI 0.19 to 0.56). [ 31 ] Although safer for these babies, there is a small increase in serious immediate maternal complications compared with vaginal birth (RR 1.29, 95% CI 1.03 to 1.61), as well as long-term risks for future pregnancies, including pulmonary embolism, infection, bleeding, damage to the bladder and bowel, slower recovery from the delivery, longer hospitalization, and delayed bonding and breast-feeding. [ 23 ] [ 31 ] [ 47 ] [ 48 ] [ 49 ] [ 50 ] [ 51 ] [ 52 ] [ 53 ] [ 54 ] [ 55 ] [ 56 ] [ 57 ] [ 58 ] Consider using antimicrobial triclosan-coated sutures for wound closure to reduce the risk of surgical site infection. [ 59 ]

This mode of delivery may be considered by some clinicians as an option, particularly when delivery is imminent, maternal request is provided, when senior and experienced staff are available, when there is no absolute contraindication to vaginal birth (e.g., placenta previa, compromised fetal condition), and with optimal fetal growth (estimated weight above the tenth centile and up to 3800 g). Other factors that make planned vaginal birth higher risk include hyperextended neck on ultrasound and footling presentation. [ 24 ]

It is best administered as soon as possible after the delivery, usually within 72 hours.

External cephalic version before term

Moxibustion, postural management, follow-up overview, perinatal complications.

Compared with cephalic presentation, persistent breech presentation has increased frequency of cord prolapse, abruptio placentae, prelabor rupture of membranes, perinatal mortality, fetal distress (heart rate <100 bpm), preterm delivery, lower fetal weight. [ 10 ] [ 11 ] [ 67 ]

complications of cesarean section

The long-term risks include potential compromise of future obstetric performance, increased risk of repeat cesarean section, infertility, uterine rupture, placenta accreta, placental abruption, and emergency hysterectomy. [ 60 ] [ 61 ] [ 62 ] [ 63 ] The evidence suggests that using sutures, rather than staples, for wound closure after cesarean section reduces the incidence of wound dehiscence. [ 59 ]

Emergency cesarean section, compared with planned cesarean section, has demonstrated a higher risk of severe obstetric morbidity, intra-operative complications, postoperative complications, infection, blood loss >1500 mL, fever, pain, tiredness, and breast-feeding problems. [ 23 ] [ 48 ] [ 50 ] [ 70 ] [ 81 ]

Key Articles

Impey LWM, Murphy DJ, Griffiths M, et al; Royal College of Obstetricians and Gynaecologists. Management of breech presentation: green-top guideline no. 20b. BJOG. 2017 Jun;124(7):e151-77. [Full Text]

Hofmeyr GJ, Hannah M, Lawrie TA. Planned caesarean section for term breech delivery. Cochrane Database Syst Rev. 2015 Jul 21;(7):CD000166. [Abstract] [Full Text]

Royal College of Obstetricians and Gynaecologists. External cephalic version and reducing the incidence of term breech presentation. March 2017 [internet publication]. [Full Text]

Cluver C, Gyte GM, Sinclair M, et al. Interventions for helping to turn term breech babies to head first presentation when using external cephalic version. Cochrane Database Syst Rev. 2015 Feb 9;(2):CD000184. [Abstract] [Full Text]

de Hundt M, Velzel J, de Groot CJ, et al. Mode of delivery after successful external cephalic version: a systematic review and meta-analysis. Obstet Gynecol. 2014 Jun;123(6):1327-34. [Abstract]

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53. Persson J, Wolner-Hanssen P, Rydhstroem H. Obstetric risk factors for stress urinary incontinence: a population-based study. Obstet Gynecol. 2000 Sep;96(3):440-5. [Abstract]

54. MacLennan AH, Taylor AW, Wilson DH, et al. The prevalence of pelvic disorders and their relationship to gender, age, parity and mode of delivery. BJOG. 2000 Dec;107(12):1460-70. [Abstract]

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73. Wilcox C, Nassar N, Roberts C. Effectiveness of nifedipine tocolysis to facilitate external cephalic version: a systematic review. BJOG. 2011 Mar;118(4):423-8. [Abstract]

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Published by

American College of Obstetricians and Gynecologists

2016 (reaffirmed 2022)

Royal College of Obstetricians and Gynaecologists (UK)

National Institute for Health and Care Excellence (UK)

Topic last updated: 2024-03-05

Natasha Nassar , PhD

Associate Professor

Menzies Centre for Health Policy

Sydney School of Public Health

University of Sydney

Christine L. Roberts , MBBS, FAFPHM, DrPH

Research Director

Clinical and Population Health Division

Perinatal Medicine Group

Kolling Institute of Medical Research

Jonathan Morris , MBChB, FRANZCOG, PhD

Professor of Obstetrics and Gynaecology and Head of Department

Peer Reviewers

John W. Bachman , MD

Consultant in Family Medicine

Department of Family Medicine

Mayo Clinic

Rhona Hughes , MBChB

Lead Obstetrician

Lothian Simpson Centre for Reproductive Health

The Royal Infirmary

Brian Peat , MD

Director of Obstetrics

Women's and Children's Hospital

North Adelaide

South Australia

Lelia Duley , MBChB

Professor of Obstetric Epidemiology

University of Leeds

Bradford Institute of Health Research

Temple Bank House

Bradford Royal Infirmary

Justus Hofmeyr , MD

Head of the Department of Obstetrics and Gynaecology

East London Private Hospital

East London

South Africa

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v.12(2); 2020 Feb

Rescue Cervical Cerclage : Prevention of a Previable Birth

Divya pandey.

1 Obstetrics & Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND

Neha Pruthi Tandon

2 Obstetrics & Gynaecology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, IND

Rescue cervical cerclage can effectively prolong a nonviable gestation to viability, if done correctly in chosen patients after appropriate counseling. Here, we present a case study of an antenatal woman with advanced cervical changes at 24 weeks who benefited from the rescue cervical cerclage procedure to have a successful pregnancy outcome.

Introduction

The benefits of rescue cervical cerclage (also known as emergency cerclage/stitch or rescue stitch) have been controversial [ 1 ]. It is a rescue procedure to prolong pregnancy to a viable gestation in women presenting in the second trimester with cervical dilatation and bulging fetal membranes. Under emergency circumstances, when done with all aseptic precautions, it can significantly prolong pregnancy and increase the chance of viable pregnancy outcomes. However, the increased risk of infection due to exposure of the fetal membranes to vaginal bacteria has to be explained to the patient. Rescue cerclage can be offered to women without signs of infection, active vaginal bleeding and active labor [ 2 ].

This paper will discuss a case of successful cerclage done in the second trimester at 24 weeks.

Case presentation

A 26-year-old female with a previous history of one miscarriage at 22 weeks presented to the emergency at 24 weeks of gestation with heaviness in the lower abdomen. There was no history of watery discharge /bleeding per vaginam. There was no history suggestive of urinary tract infection. Her general condition was fair and vitals were stable. Fundal height corresponded to the period of gestation. On per speculum examination cervix was 4 cm dilated with membranes bulging through the external cervical os into the vagina (figure (figure1). 1 ). The patient was admitted, investigations [complete hemogram, urine routine and microscopic, C-reactive protein (CRP), cervical culture] were sent, steroid (dexamethasone) and tocolytics (isoxsuprine infusion) were started. Ultrasound showed a single live fetus corresponding to 24 weeks with fundal placenta and an effective fetal weight of 900 grams. The patient was explained all the risks and benefits of the emergency cerclage and written consent was taken for the procedure.

An external file that holds a picture, illustration, etc.
Object name is cureus-0012-00000006994-i01.jpg

Emergency cerclage was planned under spinal anesthesia. A foleys bulb inflated with 15 ml saline was used to reposit the bulging membranes. Wurm's stitch was applied (as the cervix was well effaced) using silk under aseptic conditions (figure (figure2). 2 ). Two stitches were applied at 12 o' clock and 6 o' clock position (Figure (Figure2). 2 ). In the postoperative period, the patient was administered antibiotics and tocolysis (intramuscular isoxsuprine injection, 10 mg 6 hourly for 48 hours then gradually tapered to 8 hourly injection and then switched to oral isoxsuprine tablet for one week, then stopped along with intramuscular 17-alpha hydroxyprogesterone caproate injection once a week ). The patient was followed with weekly CRP and total leucocyte counts. Report for cervical culture was negative. The patient was discharged at 26 weeks of gestation on weekly intramuscular 17-alpha hydroxyprogesterone caproate injection as per recommendation by the Society of Maternal Fetal Medicine. Routine maternofetal surveillance was followed. The pregnancy thrived well till 34+5 weeks when she developed premature rupture of membranes (PROM). Preterm fetus of 2.0 kg was delivered vaginally. The neonate stayed in Neonatal Intensive Care Unit (NICU) for two days and thereafter was discharged.

An external file that holds a picture, illustration, etc.
Object name is cureus-0012-00000006994-i02.jpg

Women presenting with painless cervical dilatation in second trimester are left with two options of management: one is expectant and the other is rescue cervical cerclage. Although there are limited randomized controlled trials and meta-analysis on expectant bed rest vs rescue cerclage to date, a few observational studies have shown that pregnancy is prolonged by 6 to 9 weeks with rescue cerclage compared to less than 4 weeks with expectant management (bed rest) [ 3 - 6 ].

Namouz et al. conducted a literature review in 2013 including 34 studies, which included majority of observational and limited randomized controlled trials. Their data suggested that rescue cerclage was associated with a longer latency period and better pregnancy outcomes when compared with bed rest [ 7 ].

Stupin et al. conducted a retrospective trial on 161 women with amniotic sac prolapse. Improved perinatal outcome-live birth rate, birth weight was seen in the cerclage group [ 4 ]. Smaller observational trials and retrospective studies have found significantly increased interval from treatment‑to‑delivery, increased mean birth weight, higher neonatal survival rates, and live birth rates with decreased NICU stay in the emergency cerclage groups [ 3 , 8 ]. In another study by Olatunbosun et al., it was found that women treated with cerclage required a significantly shorter period of antepartum hospitalization, decreased use of tocolytics, and experienced less preterm membrane ruptures compared to women in the bed rest group. There was no statistical difference in the frequencies of chorioamnionitis, maternal morbidity or cesarean section between the two groups [ 6 ].

In the present case, there was increased treatment to delivery interval by 10 weeks and an increase in weight by 1.1 Kg. This case adds to the existing data on women undergoing cerclage. Rescue cerclage is a favorable approach in women with cervical dilatation in the second trimester.

According to the Society of Obstetrics and Gynecology of Canada (SOGC) guidelines, emergency cerclage may be considered in women in whom the cervix has dilated to < 4 cm without contractions before 24 weeks of gestation [ 9 ]. Recent National Institute of Clinical Excellence (NICE) guidelines recommend that rescue cervical cerclage should be considered for women between 16 and 27 weeks with a dilated cervix and exposed unruptured fetal membranes. However, benefits of cervical cerclage are more when applied at earlier gestations [ 2 ].

Conclusions

Rescue cervical cerclage is a safe and easy surgical procedure that can prolong pregnancy to viability even with advanced cervical changes. This procedure should be undertaken in an antenatal woman with advanced cervical changes after analyzing the overall clinical picture and comprehensive counseling.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

Human Ethics

Consent was obtained by all participants in this study

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Cephalic Presentation At 24 Weeks

I am 28 year old lady, g.a by lmp is 24 week 04 days report is single live fetus in longitudinal lie with cephalic prese ....

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1- normal 2- normal 3-it is not one report which decides everything it is total picture which is important so follow advise of your obstetrician.

Name: sunita kumari 27y/f material abdomen: single live fetus. Liquor- afi (cm): 10-11 placenta: anterior foetal movemen ...

Hello. This much information is not sufficient to judge the foetal sex. It is determined by measuring the angle of genital tubercle to a horizontal line.

My sister has crossed her 40 th week of pregnancy but still ahe didn't get labour pain and we consult with gynaecologist ...

Reason is not important what should be done now is important. Depending on examination findings, medical history and reports examining doctor will decide to induce now or within few days.

Hi I am 33 weeks pregnant, in scanning I got to know tht my baby head is in down pole (cephalic presentation) so baby ch ...

Majority of the times after this time it does not change position. Exercises and walking good for health and may help in second stage of labour, though does not guarantee normal delivery.

As my pregnancy colour doppler test bpd 84. 2 mm hc 309. 4 mm ac 293. 2 mm fl 65. 0 mm weight 2222gms heart rate 124 bpm ...

The whole report is normal. Don't take tension. And make sure to be happy. It has tremendous positive effect.

My ultrasonography report says: gravid uterus contains single alive fetus. 1. Cervical length - within normal limit 2. P ...

Please understand that the usg report is not to decide if cs is needed or not. It is done to decide if the baby is well developed and positioned properly. The decision to do cs is done after a long consideration of weight and position of the baby and the presence or absence of bleeding or escape of water near term.

I am 35 weeks pregnant. Ultrasound report says placenta is in posterior low and presentation is cephalic. Is posterior l ...

Hello Lybrate-User, No it does not cause problems in normal delivery mostly. Just be careful. It may cause early delivery.

I am 25 years old married girl. I am 34 week pregnant. Scan performed at this week shows cephalic presentation with fung ...

Yes the persentation and every thing is right just the weight of the baby is bit less. Don't panic. It can be managed with proper care. You should be in constant contact with your gynecologist. And don't stress on normal delivery. There is no harm in ceasarian also.

Hi, Mera kal se 35 weeks start hua. Mera 34 weeks 4 days ultrasound report me baby cephalic presentation me hai or AFI 7 ...

Baby is in reduced amniotic fluid, take 4litres of fluids dailyandcome for private chat where I can suggest the required tests and all.

Hi, In my usgarden color droplet test I came to know that the following details 1. Single live fetus 2. Cephalic 3. 35 w ...

For normal delivery you need to have been average in all aspects .anything out of it considered risky. As in your case liqour js 6 which is worrisome. A trial for normal labour can be considered but with understanding risk also wait for a week get a repeat usg scan assess your liquor ,if it is going down .I would suggest induction of labour with limited trial trial of labour can be given with due risk.

Mar 25, 2019

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JUNGLE GEMS. 24 WEEKS. IN THE BEGINNING. Why this project How was the team selected Naming of the Super Team What has been our process. Creation of Sub–Teams First Twelve Weeks:. Marketing Pre-Admission Admission Public Relations Fulfillment.

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JUNGLE GEMS 24 WEEKS

IN THE BEGINNING • Why this project • How was the team selected • Naming of the Super Team • What has been our process

Creation of Sub–TeamsFirst Twelve Weeks: Marketing Pre-Admission Admission Public Relations Fulfillment

Creation of Sub-Teams: Second Twelve Weeks • Marketing • Fulfillment • Hidden Treasures • Public Relations • Hospitality

Marketing Goals: Develop stronger relationship with referral bases. Focusing on orthopedic practices. Develop Outcome Data Fact Sheets for customers/referral sources Increase Internal & External community awareness Organize Alumni Celebration

Pre-Admission Goals: Develop Ambassador Program Develop Phone Training for staff

Admission Goals: Develop First Impression Program Develop Weekend Admission Program

Public Relation Goals: • Increase awareness of VCC • Ensure awareness of community about changes • Increase awareness about Jungle Gems to employees and community

Fulfillment Goals: 12 week: • One Great Unit: Post-Acute • Includes huddles, 72-hour logs, new shift report process, team based assessments upon admission 24 week: • Complete new intake form • Refine admission process

HIDDEN TREASURES GOALS: Second 12 weeks: • To eliminate delays with admissions and make admissions a hoop-free process by the second 12 weeks • To say yes to 98% of Medicare admissions

HOSPITALITY GOALS: Second 12 weeks • Accept 100% of admissions through E-Hall door • JKV Transportation will code transports to E-Hall

90 Day Outcomes • Completion of all goals above. All goals will have measurable benchmarks which we will be measured against • Medicare Census will have increased to 65 patients by 2nd 12 weeks • Average Length of Stay will increaseto 32 days for the Post-Acute Unit by 2nd 12 weeks

Hakuna MaCensus!!! • Date ADC ALOS OREOE • 9/2 52 22 347000 • 10/7 54 26 477000 • 11/4 60 27 275000 • 12/1 50 22 506000 • 1/6 57 22 474000 • 2/2 60 36 TBD • 2/23 68 26 TBD • 3/1 70 TBD TBD

Thank You for Your Support!!! • Next 12 weeks – • Jungle Gem Super Team becomes PACU Quality Circle to ensure all PACU outcomes mature. • VCC Continuous Quality Improvement Team expands/embraces new role as innovation/excellence catalyst for Business Unit. • Stay Tuned to learn more in June!!!

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Warner Bros. Pictures at CinemaCon 2024: Everything Announced and Revealed

Joker: folie à deux, furiosa: a mad max saga, beetlejuice beetlejuice, and much more..

CinemaCon 2024 has officially kicked off and many of the big movie studios are in Las Vegas ready to show off what the future holds for each of them. We here at IGN are in attendance and will be breaking down all the big news from the biggest presentations.

We must sadly share, however, that not everything is released to the public right away after a presentation, do we will do our best to describe as much as we can so you can learn more about your favorite upcoming films!

Warner Bros. Pictures' presentation was the first we attended and was highlighted by Joker: Folie à Deux, Furiosa: A Mad Max Saga, and Beetlejuice Beetlejuice. We also got a new look at Kevin Costner's Horizon and M. Night Shyamalan's Trap.

Check out all the big news from Warner Bros. Pictures' CinemaCon panel below and be sure to stay tuned for more coverage as the week continues. And be sure to let us know what your favorite reveal was at CinemaCon!

Joker: Folie à Deux First Trailer Unites Joaquin Phoenix's Arthur Fleck With Lady Gaga's Harley Quinn

As we mentioned, not everything shown at CinemaCon is released to the public. Luckily for DC fans, the first trailer for Joker: Folie à Deux was and it is already taking the internet by storm.

In the footage, we see parts of Joaquin Phoenix's Arthur Fleck and Lady Gaga's Harley Quinn relationship. What is perhaps most striking is how it appears to switch from what could be described as their romantic delusions to a grimmer reality. It also looks to confirm a big change in Harley Quinn's story in that she will now be a patient at Arkham Asylum rather than a psychiatrist.

Director Todd Phillips took the stage to discuss the film and confirmed that while the sequel is not a full musical, music will be an "essential element." It also apparently won't "veer" too much from the original film and that Arthur Fleck has always had "music in him."

Joker: Folie à Deux will hit theaters on October 4, 2024.

Furiosa: A Mad Max Saga Footage Shows Anya Taylor-Joy on a Mission

The above trailer is not from CinemaCon.

Those in attendance at Warner Bros. Pictures' CinemaCon panel were treated to an extended sneak peek at Furiosa: A Mad Max Saga. The few moments on display showcased the early life story of Anya Taylor-Joy's Furiosa and her arduous journey to avenge her mom and lost childhood. We also saw some of this story in the most recent trailer for Furiosa.

Director George Miller also stopped by CinemaCon and said Furiosa will take place over a span of 16-18 years of backstory and Taylor-Joy shared that this is "the story of one woman's committment to impossible hope."

Furiosa: A Mad Max Saga rides into theaters on May 24, 2024.

Beetlejuice Beetlejuice Is Almost Back After 36 Years of Waiting

Beetlejuice Beetlejuice took center stage at Warner Bros.' presentation and we were shown new footage of the sequel in action alongside previous clips from the trailer. We get good looks at Keaton's Beetlejuice, the Deetzes - Winona Ryder's Lydia, Catherine O'Hara's Delia, and Jenna Ortega's Astrid - and even Willem Dafoe's character. Lydia also seemingly confirms the film will deal with the dead and the living trying to co-exist.

Keaton has seen the film two times now and says it is "really f***** good" and that Ortega is "just perfect" in the movie and got what they were going for right away.

Beetlejuice Beetlejuice opens in theaters on September 6, 2024.

Mickey 17 Trailer Shows the Many Lives of Robert Pattinson's Mickey

The first trailer for Mickey 17 was shown at Warner Bros.' panel and showed how Robert Pattinson's Mickey is an "expendable" asset who can be reprinted whenever he dies. The film is based on Edward Ashton's Mickey 7, but director Bong Joon-ho of Parasite fame changed the title to Mickey 17 because he kills Pattinson's character 10 more times than the book did.

The footage featured Pattinson acting against himself multiple times in this futuristic sci-fi world and Bong-ho knew he could play all these different versions of Mickey because he has a "crazy thing in his eyes." We also got to see Mark Ruffalo's dictator character, his wife who is played by Toni Collette, Mickey's girlfriend who is played by Naomi Ackie, and Steven Yeun, who will be playing Mickey's "strange buddy."

Mickey 17, which really is the story of a "simple man who ends up saving the world," will be released in theaters on January 31, 2025.

Horizon: An American Saga Gets a Breathtaking First Look

Footage from Horizon: An American Saga, the two-part Western epic that stars and is directed, produced, and co-written by Kevin Costner, was revealed at CinemaCon and what was shown was a breathtaking sizzle reel of sorts from the films that tell a story set in the Civil War expansion and settlement of the American West.

Costner said to the audience that he first tried to make these films back in 1988 and then in 2012 and he's so happy he now finally gets to get them across the finish line. However, his full plan for Horizon involves four movies that tell more of the story.

He also discussed how this film will explore the "promise" of America that was earned by people who claimed it for their own by being tough and resilient. However, that came at the expense of those already here. He also wants music to be an important focus for this epic and he even went to Scotland to get 92 musicians to work on the score.

Horizon: An American Saga Part 1 is set to arrive in theaters on June 28, 2024, and the second part will be released on August 16, 2024.

M. Night Shyamalan's Trap Looks to Send Audiences to a Concert Gone Wrong

M. Night Shyamalan's next film is called Trap and he told us that his daughter Saleka, who is a musician, helped him form the idea for the project. As for what the movie is about, Trap looks to tell a story of an immersive experience like a concert that turns into a thriller.

When the concert begins and the singer Lady Raven (played by Saleka!) comes on stage, something terrible happens and you come to find out this has all been a trap to capture a wanted serial killer who is played by Josh Hartnett.

Trap will be released in theaters on August 9, 2024.

Have a tip for us? Want to discuss a possible story? Please send an email to [email protected] .

Adam Bankhurst is a writer for IGN. You can follow him on X/Twitter @AdamBankhurst and on TikTok.

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2024 NBA playoffs: 16 games this week will help determine almost every postseason seed

There's a week of regular-season action left, and only one seed is locked in.

With five days of regular-season basketball left on the schedule, only one out of the 20 postseason seeds has been locked in definitively. The Boston Celtics will be the No. 1 seed in the Eastern Conference (and, should they reach the NBA Finals, will have home-court advantage against whomever their Western Conference opponent turns out to be). Otherwise? Every seed is technically in play.

That alone makes this week of games exciting, but the schedule-makers have done their part as well. The last week of games is filled with matchups that have high stakes for both teams. Seeds will be won and lost in the coming days, so as your prepare to watch the last week of regular-season basketball for the 2023-24 season, here is our viewing guide for the stretch run. In total, there are 16 games remaining with significant implications for both sides. As a reminder: there are no games scheduled for Monday, April 8 and Saturday, April 14. Monday is in deference to the NCAA Men's Championship Game, and Saturday is to ensure that nobody plays their final game as part of a back-to-back.

Tuesday, April 9:

Tuesday's slate is crowded as a result of Monday's off-night, but only three games really stand out:

Kings at Thunder . Oklahoma City's injury management of the past week or so suggests that the Thunder are content to slide into the No. 3 seed if it means good health, but this game still means quite a bit to Sacramento. The Kings need to win three of their last four to guarantee a top-eight seed, and if the Thunder do put their whole roster on the floor for this one, that's going to be no easy task.
Clippers at Suns . Both teams control their own destiny for critical seeds. Phoenix's head-to-head tiebreaker over New Orleans means that if the Suns win out, they are guaranteed to finish sixth or better and avoid the play-in. The Clippers hold a two-game lead over the field for No. 4, which guarantees home-court advantage in the first round. Here's the rub: the Suns and Clippers play each other twice in a row on Tuesday and Wednesday. Two Suns wins put the Clippers in danger of slipping to No. 5. Two Clipper wins would knock the Suns down to 34 losses on the season, and considering their winless record against the Lakers , that could potentially drop them to No. 9.
Warriors at Lakers . The loser of this game is probably finishing 10th in the West. A Laker win drops the Warriors to two losses behind the field. A Warriors win gives Golden State the tiebreaker over Los Angeles. But here's where things get interesting: the Warriors are dealing with injuries and managing their players conservatively. They have another game on Wednesday as the second half of a back-to-back, and in the grand scheme of things, they might prefer it if the red-hot Lakers got out of the No. 9 slot in favor of the depleted Kings. The Warriors probably view their chance of escaping No. 10 as too great to punt... but that might be in their best interest.

Wednesday, April 10:

Wednesday and Thursday are our two lightest slates of the week, but both have a few critical games to cover:

Suns at Clippers . We've covered them already. This is the second half of their home-and-home back-to-back.
Magic at Bucks . Both of these teams control their own destiny for the No. 2 seed in the Eastern Conference... because the Magic and Bucks play each other twice in the regular season's final week. Meanwhile the Knicks , with a fairly easy schedule the rest of the way, are just sitting here ready to jump whoever doesn't finish No. 2 (and perhaps get up there themselves). Seeding matters aside, the Bucks have lost four games in a row to a very underwhelming set of opponents. If they can't take care of business against Orlando, should they even be taken seriously in the postseason?
Timberwolves at Nuggets . Oh baby, this is the big one. Technically, we can't say for certain that the winner of this game is the Western Conference's No. 1 seed... but that's the likeliest outcome here. Minnesota's tiebreaker would virtually assure the Timberwolves home-court advantage with a victory, as they would functionally have a two-game lead with three to play. The champs have dealt with injuries recently, and it's unclear just how much they need to care about seed after going 6-3 on the road last postseason. All things considered, this is the most important game of the week (and maybe the season).

Thursday, April 11:

Thursday has only five games on the schedule, and only one of them as playoff implications for both sides.

Pelicans at Kings . The Kings trail the Pelicans by only game in the standings right now, so they could conceivably climb back out of the play-in round if they win this game (and their others). The Pelicans would need some help to escape the play-in, but Phoenix's brutal schedule the rest of the way creates a real opening if New Orleans can take care of business.

Friday, April 12:

Here's where things heat up. We have two days of games left to cover, but nine of our 16 games are still ahead of us:

Magic at 76ers . Neither team is competing for the same seed, but both still have something to play for. If the bracket breaks right, the 76ers and Magic might wind up playing one another in the first round.
Pacers at Cavaliers . Don't look now, but the Cavaliers, once in the running for the No. 2 seed, now lead the Pacers by only a single game for the No. 5 spot. If the Pacers win, they not only close that one-game gap, but they also gain the head-to-head tiebreaker.
Bucks at Thunder . The Thunder may or may not be locked into the No. 3 seed out West when this game begins, but the Bucks will have something to play for either way. Even if seeds are locked, this is a perfect tune-up game for both sides. Oklahoma City's biggest weakness is dealing with the sort of size Milwaukee can throw at it. The Bucks struggle to defend the point of attack, a major problem against guards like Shai Gilgeous-Alexander .
Pelicans at Warriors . The Warriors probably can't catch the Pelicans with three games separating them as of this writing, but if the Warriors beat the Lakers, they'll need to keep winning in order to protect their No. 9 seed (and possibly move up to No. 8), while the Pelicans are obviously fighting to climb back up to No. 6.
Suns at Kings . The good news for the Pelicans as they try to get back up to No. 6 is that one of the Suns or Kings has to lose this game. That bad news is that one of them has to win. The Pelicans are probably rooting for the Kings, but with their own head-to-head matchup on Thursday, circumstances can change quickly.

Sunday, April 14:

And so, we've reached the final day of the season. Almost every game matters in some way, but these are the four biggest:

Bucks at Magic . There is a chance that this game not only decides the No. 2 seed, but No. 3 and No. 4 as well. Adding to the tension: you could credibly argue that No. 3 or No. 4 is the most desirable of the three options. Why? Well, that depends on how the bracket shakes out, but given their experience and top-end talent, it's fair to say that the Heat and 76ers are scarier possible first-round opponents than the Cavs or Pacers. If Miami and Philadelphia are in the play-in round, No. 3 suddenly becomes the best spot on the board. It guarantees an easier first-round opponent and avoids Boston's side of the bracket. Don't be surprised if there's some chicanery between the Bucks, Magic and Knicks on the last day of the season in an effort to rig the bracket in their favor.
Suns at Timberwolves . Minnesota may have the No. 1 seed locked up by now with a win over Denver, but if it's still in play, this becomes a must-win game. Every game is a must-win game for the Suns right now. No team in the West has more variability in terms of seeding.
Lakers at Pelicans . The Lakers still have an outside chance at passing the Pelicans. A win in this game would give the Lakers the head-to-head tiebreaker, and with only two games separating the two teams now, this is their only opportunity to pick up a head-to-head win over the teams they are chasing in the standings.
Mavericks at Thunder . Again, we don't know how much this game will mean to the Thunder. The same is true for the Mavericks, who have a two-game buffer in either direction from No. 5 right now. Theoretically, either one of these teams could hand this game to the other if their own seed is locked in.

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Google Cloud Next 2024: Everything announced so far

Google’s Cloud Next 2024 event takes place in Las Vegas through Thursday, and that means lots of new cloud-focused news on everything from Gemini, Google’s AI-powered chatbot , to AI to devops and security. Last year’s event was the first in-person Cloud Next since 2019, and Google took to the stage to show off its ongoing dedication to AI with its Duet AI for Gmail and many other debuts , including expansion of generative AI to its security product line and other enterprise-focused updates and debuts .

Don’t have time to watch the full archive of Google’s keynote event ? That’s OK; we’ve summed up the most important parts of the event below, with additional details from the TechCrunch team on the ground at the event. And Tuesday’s updates weren’t the only things Google made available to non-attendees — Wednesday’s developer-focused stream started at 10:30 a.m. PT .

Google Vids

Leveraging AI to help customers develop creative content is something Big Tech is looking for, and Tuesday, Google introduced its version. Google Vids, a new AI-fueled video creation tool , is the latest feature added to the Google Workspace.

Here’s how it works: Google claims users can make videos alongside other Workspace tools like Docs and Sheets. The editing, writing and production is all there. You also can collaborate with colleagues in real time within Google Vids. Read more

Gemini Code Assist

After reading about Google’s new Gemini Code Assist , an enterprise-focused AI code completion and assistance tool, you may be asking yourself if that sounds familiar. And you would be correct. TechCrunch Senior Editor Frederic Lardinois writes that “Google previously offered a similar service under the now-defunct Duet AI branding.” Then Gemini came along. Code Assist is a direct competitor to GitHub’s Copilot Enterprise. Here’s why

And to put Gemini Code Assist into context, Alex Wilhelm breaks down its competition with Copilot, and its potential risks and benefits to developers, in the latest TechCrunch Minute episode.

Google Workspace

Image Credits: Google

Among the new features are voice prompts to kick off the AI-based “Help me write” feature in Gmail while on the go . Another one for Gmail includes a way to instantly turn rough email drafts into a more polished email. Over on Sheets, you can send out a customizable alert when a certain field changes. Meanwhile, a new set of templates make starting a new spreadsheet easier. For the Doc lovers, there is support for tabs now. This is good because, according to the company, you can “organize information in a single document instead of linking to multiple documents or searching through Drive.” Of course, subscribers get the goodies first. Read more

Google also seems to have plans to monetize two of its new AI features for the Google Workspace productivity suite. This will look like $10/month/user add-on packages. One will be for the new AI meetings and messaging add-on that takes notes for you, provides meeting summaries and translates content into 69 languages. The other is for the introduced AI security package, which helps admins keep Google Workspace content more secure. Read more

In February, Google announced an image generator built into Gemini, Google’s AI-powered chatbot. The company pulled it shortly after it was found to be randomly injecting gender and racial diversity into prompts about people. This resulted in some offensive inaccuracies. While we waited for an eventual re-release, Google came out with the enhanced image-generating tool, Imagen 2 . This is inside its Vertex AI developer platform and has more of a focus on enterprise. Imagen 2 is now generally available and comes with some fun new capabilities, including inpainting and outpainting. There’s also what Google’s calling “text-to-live images” where you can now create short, four-second videos from text prompts, along the lines of AI-powered clip generation tools like Runway , Pika and Irreverent Labs . Read more

Vertex AI Agent Builder

We can all use a little bit of help, right? Meet Google’s Vertex AI Agent Builder, a new tool to help companies build AI agents.

“Vertex AI Agent Builder allows people to very easily and quickly build conversational agents,” Google Cloud CEO Thomas Kurian said. “You can build and deploy production-ready, generative AI-powered conversational agents and instruct and guide them the same way that you do humans to improve the quality and correctness of answers from models.”

To do this, the company uses a process called “grounding,” where the answers are tied to something considered to be a reliable source. In this case, it’s relying on Google Search (which in reality could or could not be accurate). Read more

Gemini comes to databases

Google calls Gemini in Databases a collection of features that “simplify all aspects of the database journey.” In less jargony language, it’s a bundle of AI-powered, developer-focused tools for Google Cloud customers who are creating, monitoring and migrating app databases. Read more

Google renews its focus on data sovereignty

closed padlocks on a green background with the exception of one lock, in red, that's open, symbolizing badly handled data breaches

Image Credits: MirageC / Getty Images

Google has offered cloud sovereignties before, but now it is focused more on partnerships rather than building them out on their own. Read more

Security tools get some AI love

Data flowing through a cloud on a blue background.

Image Credits: Getty Images

Google jumps on board the productizing generative AI-powered security tool train with a number of new products and features aimed at large companies. Those include Threat Intelligence, which can analyze large portions of potentially malicious code. It also lets users perform natural language searches for ongoing threats or indicators of compromise. Another is Chronicle, Google’s cybersecurity telemetry offering for cloud customers to assist with cybersecurity investigations. The third is the enterprise cybersecurity and risk management suite Security Command Center. Read more

Nvidia’s Blackwell platform

One of the anticipated announcements is Nvidia’s next-generation Blackwell platform coming to Google Cloud in early 2025. Yes, that seems so far away. However, here is what to look forward to: support for the high-performance Nvidia HGX B200 for AI and HPC workloads and GB200 NBL72 for large language model (LLM) training. Oh, and we can reveal that the GB200 servers will be liquid-cooled. Read more

Chrome Enterprise Premium

Meanwhile, Google is expanding its Chrome Enterprise product suite with the launch of Chrome Enterprise Premium . What’s new here is that it mainly pertains mostly to security capabilities of the existing service, based on the insight that browsers are now the endpoints where most of the high-value work inside a company is done. Read more

Gemini 1.5 Pro

Everyone can use a “half” every now and again, and Google obliges with Gemini 1.5 Pro. This, Kyle Wiggers writes, is “Google’s most capable generative AI model,” and is now available in public preview on Vertex AI, Google’s enterprise-focused AI development platform. Here’s what you get for that half: T he amount of context that it can process, which is from 128,000 tokens up to 1 million tokens, where “tokens” refers to subdivided bits of raw data (like the syllables “fan,” “tas” and “tic” in the word “fantastic”). Read more

Open source tools

Open source code on a computer screen highlighted by a magnifying glass.

At Google Cloud Next 2024, the company debuted a number of open source tools primarily aimed at supporting generative AI projects and infrastructure. One is Max Diffusion, which is a collection of reference implementations of various diffusion models that run on XLA, or Accelerated Linear Algebra, devices. Then there is JetStream, a new engine to run generative AI models. The third is MaxTest, a collection of text-generating AI models targeting TPUs and Nvidia GPUs in the cloud. Read more

We don’t know a lot about this one, however, here is what we do know : Google Cloud joins AWS and Azure in announcing its first custom-built Arm processor, dubbed Axion. Frederic Lardinois writes that “based on Arm’s Neoverse 2 designs, Google says its Axion instances offer 30% better performance than other Arm-based instances from competitors like AWS and Microsoft and up to 50% better performance and 60% better energy efficiency than comparable X86-based instances.” Read more

The entire Google Cloud Next keynote

If all of that isn’t enough of an AI and cloud update deluge, you can watch the entire event keynote via the embed below.

Google Cloud Next’s developer keynote

On Wednesday, Google held a separate keynote for developers . They offered a deeper dive into the ins and outs of a number of tools outlined during the Tuesday keynote, including Gemini Cloud Assist, using AI for product recommendations and chat agents, ending with a showcase from Hugging Face. You can check out the full keynote below.

International

Israel-Hamas war

2024 campaign

April 11, 2024 - Israel-Hamas war

By Heather Chen , Antoinette Radford, Tori B. Powell , Aditi Sangal and Elise Hammond , CNN

Our live coverage of Israel's war on Hamas in Gaza has moved here .

UN committee fails to reach consensus on full Palestinian membership, Security Council president says

From CNN’s Richard Roth and Michael Rios

A specialized UN committee failed to reach a consensus Thursday on Palestinian membership in the United Nations, according to the president of the UN Security Council.

Two-thirds of the committee members were in favor of moving on with membership, with many countries arguing that “Palestine fulfills all the criteria that are required” to be granted full state member status, Malta's Ambassador and Security Council President Vanessa Frazier said.

She added that no one explicitly objected to the membership qualifications.

Frazier also said she would circulate a draft report on the deliberations as soon as Friday. If the committee doesn’t agree on the report, it could hold another meeting to iron out any differences.

Asked whether the process of deliberating Palestinian membership in the committee is now over, Frazier said, “Unless the next step of agreeing (to) the report of the committee warrants another meeting to iron out the differences, it’s not foreseen that there would be any further committee action.”

But she noted that any UN Security Council member can still table a resolution to vote on Palestinian membership at any time, regardless of the committee's report.

The US and Middle East brace for a possible Iran attack that could escalate the conflict. Here's the latest

From CNN staff

People attend the funeral procession for seven Islamic Revolutionary Guard Corps members killed in a strike in Syria, which Iran blamed on Israel, in Tehran on April 5.

Concerns about a possible Iranian attack against Israel has prompted many diplomatic conversations around the globe.

Here are some developments on diplomacy around the threat of an attack:

Iran's statement: The imperative for Tehran to "punish" Israel for the deadly strike on the Iranian consulate in Damascus last week might have been avoided if the attack had been condemned at the United Nations, Iran’s Mission to the UN said Thursday.
US and UK diplomacy: US Secretary of State Antony Blinken spoke with the foreign ministers of Turkey, China and Saudi Arabia on Wednesday night and Thursday morning to tell them that countries should be urging Iran not to escalate the conflict in the Middle East after threats made by Tehran against Israel, according to a State Department spokesperson. The top US general for the Middle East is also in Israel . Additionally, Britain's foreign secretary warned his Iranian counterpart on Thursday that Tehran “must not draw” the Middle East into a wider conflict .
Israel receives US support: Israeli Defense Minister Yoav Gallant spoke with Blinken and US Defense Secretary Lloyd Austin. The US officials expressed the country's support for Israel against Iranian threats. Gallant warned that such an attack could lead to a regional escalation.
Travel restrictions: The US State Department restricted the travel of US government personnel in Israel in the wake of public threats against Israel by Iran. “The security environment remains complex and can change quickly depending on the political situation and recent events,” the alert noted. US officials are on high alert for a potential retaliatory strike by Iran or its proxies against Israel.

Meanwhile, here's some other updates:

Hamas on hostages: A member of Hamas' political bureau said a prisoner-hostage exchange is being discussed as part of larger ceasefire negotiations. "Part of negotiations is to reach a ceasefire agreement to have enough time and safety to collect final and more precise data" on the hostages held in Gaza, Basem Naim said in a statement on Thursday. "Because they (hostages) are in different palaces, (being held) by different groups, some of them are under the rubble killed with our own people, and we negotiate to get heavy equipment for this purpose."
Updates on aid to Gaza: It is clear that Israel is working to ramp up humanitarian aid to Gaza, but it has not yet implemented all of the measures it has announced, a top United Nations humanitarian official said. Aid coming in trucks from Israel has to be "segregated from water, from food, from medical items" before it goes into Gaza, said Jamie McGoldrick, the UN’s humanitarian coordinator in Jerusalem. “Getting 400 trucks from Kerem Shalom doesn't mean 400 trucks go into Gaza,” he said, adding that the logistical complications are numerous, and take time to resolve. He also said Israel’s restrictions on movement inside the strip complicate matters.

Anera charity resumes work in Gaza after pausing when Israeli strike killed 7 World Central Kitchen staff

From CNN's Tala Alrajjal and Mohammed Tawfeeq

American Near East Refugee Aid (Anera) has resumed Gaza operations "after a temporary pause" following an airstrike that killed seven World Central Kitchen (WCK) aid workers on April 1.

"As you know, the decision to temporarily pause our operations was not an easy one. We followed the direction of our staff in Gaza, who've faced death, loss, and destruction since the start of the war," Sean Carroll, the president and CEO of Anera, said in a statement on Thursday. "After the killing of Anera staff member Mousa Shawwa , followed by the attack that killed seven aid workers from World Central Kitchen, we made the difficult but necessary decision to pause aid operations on April 2," Carroll added in the statement.

Carroll said Israeli authorities informed him during a meeting Thursday that "certain measures would be taken to protect humanitarian aid workers in Gaza – including Anera's staff."

"With the full support of our Gaza team, we have determined that the circumstances have changed sufficiently to resume our vital humanitarian work in Gaza," Carroll said.

Anera on Thursday resumed "full operations in Gaza to deliver meals, food parcels, hygiene kits, tents, medical treatments, and more to families in dire need," according to the statement.

Iran says its imperative to punish Israel could have been avoided had UN Security Council condemned attack

From CNN’s Natalie Barr and Adam Pourahmadi

Emergency services work at a building hit by an air strike in Damascus, Syria, on April 1.

The imperative for Tehran to "punish" Israel for the deadly strike on the Iranian consulate in Damascus last week might have been avoided if the attack had been condemned at the United Nations, Iran’s Mission to the UN said Thursday.

“Had the UN Security Council condemned the Zionist regime’s reprehensible act of aggression on our diplomatic premises in Damascus and subsequently brought to justice its perpetrators, the imperative for Iran to punish this rogue regime might have been obviated," the mission said on X.

The UN Secretary-General António Guterres condemned the attack on April 1, according to a statement from the UN spokesperson Stephan Dujarric. A Security Council discussion was held on April 2 to discuss the attack, but differences among members prevented any formal action or condemnation from taking place.

The United States is on high alert and actively preparing for a “significant” attack by Iran targeting Israeli or American assets in the region in response to the strike in Damascus that killed top Iranian commanders.

UK foreign secretary warns Iran not to draw Middle East into wider conflict

From CNN's Natalie Barr

British Foreign Secretary David Cameron speaks during a joint press conference with US Secretary of State Antony Blinken in Washington, DC, on April 9.

Britain's foreign secretary warned his Iranian counterpart on Thursday that Tehran “must not draw” the Middle East into a wider conflict following a series of escalating threats made by Iran toward Israel.

British Foreign Secretary David Cameron told Iran's Foreign Minister Hossein Amir-Abdollahian that the United Kingdom was "deeply concerned about the potential for miscalculation leading to further violence. Iran should instead work to de-escalate and prevent further attacks," according to a post on X .

Iran's state-aligned Tasnim news agency on Thursday reported that Amir-Abdollahian had told Cameron that the silence from the UK and the United States following Israel’s attack on the Iranian consulate in Damascus last week only served to encourage Israel to continue waging war in Gaza and expand its conflict in the region.

US and Israeli defense leaders discuss fears of Iranian attack

From CNN’s Michael Conte in Washington, DC, Tamar Michaelis in Jerusalem and Larry Register in Atlanta

US Defense Secretary Lloyd Austin spoke with Israeli Defense Minister Yoav Gallant today to “reaffirm the US ironclad commitment to Israel’s security against threats from Iran and its proxies,” according to a Pentagon spokesperson.

The call comes a day after Iran's Supreme Leader Ayatollah Ali Khamenei said Israel " must be punished and it will be" following a strike on an Iranian embassy compound in Syria that killed seven Iranian officials.

Israel “will not tolerate an Iranian attack on its territory,” the statement read, adding that the two defense leaders also discussed detailed preparations “for an Iranian attack against the State of Israel.”

Gallant said an Iranian attack on Israel could lead to a regional escalation.

It is the second discussion held between Gallant and Austin over the past week, according to the statement. Gallant expressed his appreciation for Austin’s personal commitment to the security of the State of Israel and for the deepening cooperation between the defense establishments of both countries, as well as between the Israel Defense Forces and US CENTCOM.

State Department restricts personnel travel in Israel amid concerns over Iranian threats

From CNN's Jennifer Hansler

The US State Department has restricted the travel of US government personnel in Israel in the wake of public threats against Israel by Iran.

“Out of an abundance of caution, U.S. government employees and their family members are restricted from personal travel outside the greater Tel Aviv (including Herzliya, Netanya, and Even Yehuda), Jerusalem, and Be’er Sheva areas until further notice,” a security alert posted by the US Embassy Thursday said. “U.S. government personnel are authorized to transit between these three areas for personal travel.” “The security environment remains complex and can change quickly depending on the political situation and recent events,” the alert noted.

State Department spokesperson Matthew Miller said he would not “speak to the specific assessments that led to us to restrict our employees and family members’ personal travel, but clearly we are monitoring the threat environment in the Middle East and specifically in Israel.”

“We have seen Iran making public threats against Israel in the past few days,” Miller said. “Israel is in a very tough neighborhood and we have been monitoring the security situation. You saw us slightly adjust for travel warnings at the beginning of this conflict and we conduct ongoing assessments all the time about the situation on the ground.”

US officials are on high alert for a potential retaliatory strike by Iran or its proxies against Israel.

Hamas says ceasefire with Israel is essential to collect data on hostages held in Gaza by different groups

From CNN's Abeer Salman and Mohammed Tawfeeq

A member of Hamas' political bureau said a prisoner-hostage exchange is being discussed as part of larger ceasefire negotiations.

"Part of negotiations is to reach a ceasefire agreement to have enough time and safety to collect final and more precise data" on the hostages held in Gaza Basem Naim said in a statement on Thursday. "Because they (hostages) are in different palaces, (being held) by different groups, some of them are under the rubble killed with our own people, and we negotiate to get heavy equipment for this purpose," he added.

Naim's statement was in response to questions from media outlets about whether Hamas has been rejecting the latest proposal, which was made in Cairo over the weekend, because it can not release 40 hostages in the first phase of a three-stage ceasefire deal.

According to an Israeli official and a source familiar with the discussions, Hamas indicated it is currently unable to identify and track down those 40 Israeli hostages, raising fears that more hostages may be dead than are publicly known.

CNN's record of the conditions of the hostages also suggests there are fewer than 40 living hostages who meet the proposed criteria.

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Photos show damage, flooding as Southern states are hit with heavy rain and tornadoes

Southern states have been hit by torrential rain, flooding and other storm damage this week as a deadly weather system continues to move through the country.

Multiple tornadoes were reported across Texas, Louisiana and Alabama Tuesday and Wednesday, and wind advisories warned of gusts in the central Appalachians and parts of the Southeast.

The Gulf Coast was hit hard Wednesday, with school closures, power outages, travel complications and building damage from the storms. One person, a 64-year-old woman, died in Mississippi after her oxygen machine stopped working after losing power in Scott County, according to Weather.com, citing Scott County Sheriff Chief Deputy Brad Ellis.

Storms were expected to spread across the eastern part of the Southeast as the system moves towards the Atlantic.

Follow here for weather updates: Deadly storm system brings more flooding, tornado concerns to eastern US

Photos show damage from severe weather, tornadoes in southern states

Videos show damage from southern storms.

Contributing: Anthony Robledo, USA TODAY.

COMMENTS

Fetal Positions For Birth: Presentation, Types & Function
Possible fetal positions can include: Occiput or cephalic anterior: This is the best fetal position for childbirth. It means the fetus is head down, facing the birth parent's spine (facing backward). Its chin is tucked towards its chest. The fetus will also be slightly off-center, with the back of its head facing the right or left.
Your Guide to Fetal Positions before Childbirth
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Obstetric Examination
Fetal movement (>24 weeks) Surgical scars - previous Caesarean section, laproscopic port scars; ... Presentation. Palpate the lower uterus (below the umbilicus) to find the presenting part. Firm and round signifies cephalic, soft and/or non-round suggests breech. If breech presentation is suspected, the fetal head can be often be palpated in ...
24 weeks pregnant: fetal development
She might start moving about just as you're trying to sleep, or when you're in the middle of a presentation at work! Advertisement | page continues below ... et al. 2014. 4D ultrasound study of fetal facial expressions at 20-24 weeks of gestation. Int J Gynaecol Obstet 126(3):275-9 Tommy's. nd. Premature birth statistics. www.tommys.org Opens a ...
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Weeks to go! That face! At 24 weeks pregnant, your baby's facial features are becoming more defined. At this rate, your little one will be ready for all those photos you'll snap after you give birth! On the symptoms front, around now is the time your belly button may have "popped." It will go back to normal after delivery.
24 Weeks Pregnant: Symptoms and Baby Development
By 24 weeks pregnant, you may have gained about 10 or 15 pounds, and your belly bump is still growing in size day by day. Around this time, your fundal height in centimeters will usually match the number of weeks you're pregnant. So, at 24 weeks, the distance from your pubic bone to the top of your uterus will be around 24 centimeters (plus ...
Possible explanation of cephalic and noncephalic presentation during
Up until 24 gestational weeks, the frequencies of breech and cephalic presentations are equal within the longitudinal situs [29]. From the 25th to 36th week of gestation there is an increase in ...
Course of Fetal Position Changes
Before 24 weeks and sometimes to 28 weeks, ... Fetal repositioning to a left-sided presentation can happen when the twist unwinds. Keeping the torsion from returning also may take a few daily activities and good maternal body mechanics. Few people, even providers, know this path of baby positions. ...
Periviable Birth
In contrast from 2008 to 2011 at 24 0/7 weeks to 24 6/7 weeks of gestation, 55% of neonates survived and 32% survived without evidence of neurodevelopmental impairment at 18-22 months of corrected age. ... this discussion should include an unbiased presentation of data related to the chance of both survival and long-term neurodevelopmental ...
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At 28 weeks or less, about a quarter of babies are breech, and at 32 weeks, 7 percent are breech. ... Turning foetal breech presentation at 32-35 weeks of gestational age by acupuncture and moxibustion. ... 24. weeks pregnant. 25. weeks pregnant. 26. weeks pregnant. 27. weeks pregnant. 28. weeks pregnant. 29.
Breech Position: What It Means if Your Baby Is Breech
Very rarely, a problem with the baby's muscular or central nervous system can cause a breech presentation. Having an abnormally short umbilical cord may also limit your baby's movement. ... Pregnancy Week 24. Pregnancy Week 25. Pregnancy Week 26. Pregnancy Week 27. Pregnancy Week 28. Pregnancy Week 29. Pregnancy Week 30. Pregnancy Week 31 ...
Management of Stillbirth
Induction of labor has also been demonstrated to be less effective and to have higher complication rates than dilation and evacuation between 13 weeks and 24 weeks of gestation with an adjusted risk ratio of 8.5 (95% CI, 3.7-19.8) 105. Health care providers should weigh the risks and benefits of each strategy in a given clinical scenario and ...
When Is Breech an Issue?
During the month before 30 weeks, about 15% of babies are breech. Since breech baby's spine is vertical, the womb is "stretched" upwards. We expect babies to turn head down by 28-32 weeks. Breech may not be an issue until 32-34 weeks. If you know your womb has an unusual limitation in shape or size, such as a bicornate uterus then begin ...
Cephalic presentation at 24 weeks
1/1 people found this helpful. cephalic presentation is the presentation in which the head present first ..If you're trying for normal vaginal delivery then this is the favourable position... however if you are delivering earlier ... Read More. Cephalic presentation seen at my last scan. I am 24 weeks pregnant.
Prenatal Nonstress Test
Prenatal non-stress test, popularly known as NST, is a method used to test fetal wellbeing before the onset of labor. A prenatal non-stress test functions in overall antepartum surveillance with ultrasound as a part or component of the biophysical profile. The presence of fetal movements and fetal heart rate acceleration is the most critical feature of the non-stress test. It is a non-invasive ...
Breech presentation
In the absence of good evidence, if diagnosis of breech presentation prior to 37 weeks' gestation is made, prematurity and clinical circumstances should determine management and mode of delivery. The UK Royal College of Obstetricians and Gynaecologists (RCOG) recommends that corticosteroids should be offered to women between 24 and 34+6 weeks ...
Approach to Infants Born at 22 to 24 Weeks' Gestation: Relationship to
METHODS: Inborn infants of 401 to 1000 g birth weight and 22 0/7 to 27 6/7 weeks' gestation at birth from 2002 to 2008 were enrolled into a prospectively collected database at 20 centers participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Markers of an aggressive approach to care for 22- to 24-week infants included ...
Rescue Cervical Cerclage : Prevention of a Previable Birth
Case presentation. A 26-year-old female with a previous history of one miscarriage at 22 weeks presented to the emergency at 24 weeks of gestation with heaviness in the lower abdomen. ... Ultrasound showed a single live fetus corresponding to 24 weeks with fundal placenta and an effective fetal weight of 900 grams. The patient was explained all ...
Cephalic Presentation At 24 Weeks
Cephalic Presentation At 24 Weeks. Answered 1 year ago. Share. Bookmark. Report. I am 28 year old lady, g.a by lmp is 24 week 04 days report is single live fetus in longitudinal lie with cephalic prese ... Dr. Girish Dani MD - Obstetrtics & Gynaecology, FCPS, DGO, Diploma of the Faculty of Family Planning (DFFP) Gynaecologist.
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Former President Bill Clinton, former first lady and Secretary of State Hillary Clinton, actor Robert De Niro, and Amazon founder Jeff Bezos are among the distinguished guests arriving at the ...
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Iran's statement: The imperative for Tehran to "punish" Israel for the deadly strike on the Iranian consulate in Damascus last week might have been avoided if the attack had been condemned at the ...
PDF Final PFAS National Primary Drinking Water Regulation
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Southern states have been hit by torrential rain, flooding and other storm damage this week as a deadly weather system continues to move through the country. Multiple tornadoes were reported ...