Vaginal breech delivery: a five-year prospective evaluation of a protocol using computed tomographic pelvimetry

Area of Science:

• Obstetrics and Gynecology
• Medical Imaging
• Perinatal Medicine

Background:

• A protocol using computed tomographic pelvimetry was established in 1983 for evaluating singleton term frank breech fetuses for vaginal delivery.
• The protocol defined specific criteria for a trial of labor, including fetal presentation, gestation, estimated weight, head extension, and adequate pelvimetry measurements.

Purpose of the Study:

• To prospectively analyze the obstetric and perinatal outcomes of breech fetuses evaluated with computed tomographic pelvimetry.
• To determine the success rates and complications associated with vaginal delivery attempts in selected breech pregnancies.

Main Methods:

• Prospective analysis of 122 patients undergoing computed tomographic pelvimetry for singleton term frank breech fetuses between January 1984 and July 1989.
• Evaluation of obstetric and perinatal outcomes, including Apgar scores, cord gases, hospital stay, and neonatal complications.
• Categorization into groups based on adequate pelvimetry for trial of labor, inadequate pelvimetry with cesarean delivery, and outcomes.

Main Results:

• Of 85 patients with adequate pelvimetry, 81% (69/85) achieved successful vaginal delivery.
• 19% (16/85) of the adequate pelvimetry group required cesarean delivery due to fetal distress or labor disorders.
• No significant differences in infant complications were observed between vaginally and abdominally delivered groups.

Conclusions:

• Computed tomographic pelvimetry is a valuable tool for selecting candidates for trial of labor in term frank breech presentations.
• The established protocol demonstrated a high success rate for vaginal breech delivery with comparable perinatal outcomes to cesarean delivery.
• Maternal complications were minimal and not significantly different across study groups.