Macroscopic evidence of a platelet-rich thrombus in a diabetic patient with non-ST-elevation myocardial infarction.

Breech is one of the most common abnormal fetal positions in obstetrics. The incidence of breech during full-term pregnancy is 3%-4% []. Natural delivery in breech has a high risk of fetal asphyxia and intrauterine accidents. Existing clinical study had confirmed that vaginal breech delivery is associated with increased perinatal mortality and short-term neonatal morbidity []. Specifically, the perinatal mortality rate of breech delivery is 3 times higher than that of cephalic delivery, and the incidence of various functional disorders caused by birth trauma is 12 times higher []. Consistent with these findings, current obstetric guidelines recommend cesarean section as the preferred mode of delivery for full-term breech fetuses. Clinically, we have also observed a gradual increase in the proportion of planned cesarean sections for full-term breech presentation in recent years []. However, cesarean section is associated with a series of adverse maternal outcomes, including prolonged hospital stay, postoperative fever, surgical site infection, and increased postpartum hemorrhage []. More importantly, 80%-96% of women with a primary cesarean section opt for repeat cesarean section in subsequent pregnancies to avoid uterine rupture risk related to vaginal birth after cesarean (VBAC) []. Repeat cesarean sections further elevate the risk of severe maternal complications such as placenta accreta, uterine scar defects, and adhesive intestinal obstruction, which affect immediate maternal recovery and pose long-term threats to reproductive health and quality of life [–]. Dahlquist K et al. pointed out that planned cesarean section has a higher risk of short-term maternal complications than planned vaginal delivery [], so vaginal delivery is a better choice for both mothers and newborns. External cephalic version (ECV) is a conventional manual intervention in obstetrics, which involves manipulating the fetus through the maternal abdominal wall to convert non-cephalic positions (breech, transverse lie) into cephalic presentation, thereby facilitating vaginal delivery. As a safe and minimally invasive procedure, ECV can effectively reduce the incidence of full-term breech presentation and the corresponding cesarean section rate [, ], thus mitigating dual risks of breech vaginal delivery and cesarean section for mothers and neonates. Previous study had identified several potential predictors of ECV success, including amniotic fluid index (AFI), absence of placenta previa, favorable pelvic conditions, and body mass index (BMI) < 25 []. Additionally, clinical study had confirmed that preterm ECV is more effective in reducing non-cephalic delivery than no ECV attempt [], providing evidence for the optimal timing of ECV in clinical practice.