Vaginal breech deliveries selected using computed tomographic pelvimetry may be associated with fewer adverse outcomes.
OBJECTIVE
Vaginal breech (VB) delivery at term remains controversial. Our objective was to compare neonatal and maternal outcomes in VB deliveries selected using computed tomographic (CT) pelvimetry to those selected clinically.


METHODS
A retrospective cohort study of singleton, term, VB deliveries with adequate clinical pelvimetry and estimated fetal weight of 3,850 g was performed. Women in the CT group had adequate pelvimetry by CT measurements. Neonatal and maternal outcomes were recorded.


RESULTS
Of the VB deliveries, 58 women had adequate CT pelvimetry and 37 women were selected using clinical criteria alone. There were no perinatal deaths. Neonatal morbidity was significantly lower in VB deliveries selected using CT criteria at 0% versus 10.8% in the clinically selected group (p=0.02).


CONCLUSIONS
VB deliveries selected using CT pelvimetry may be associated with fewer adverse neonatal outcomes than those selected using only clinical criteria. Therefore, it is inappropriate, without CT pelvimetry and strict selection criteria, to conclude that VB deliveries are unsafe. Our experience suggests that there may be a population in which VB delivery is a safe alternative if selected using a combination of specific clinical, sonographic, and CT criteria.
Jeyabalan
Arundhathi
A
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. ajeyabalan@mail.magee.edu
Larkin
Robert W
RW
Landers
Daniel V
DV
D000293:Adolescent; D000328:Adult; D015360:Analgesia, Epidural / Q000706:statistics & numerical data; D001946:Breech Presentation; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D007743:Labor, Obstetric; D010121:Oxytocin / Q000008:administration & dosage; D010298:Parity; D010387:Pelvimetry / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014469:Umbilical Arteries
D010121:Oxytocin