title: New MRI Criteria for Successful Vaginal Breech Delivery in Primiparae.
abstract: BACKGROUND
  Even if lower vaginal delivery success rates and impaired neonatal short-term outcomes have been reported for primiparous women with breech presentation, vaginal breech delivery remains an option for carefully selected patients. Because Magnetic resonance imaging (MRI) pelvimetry can provide additional information on maternal pelvic morphology, we sought to identify new MRI parameters that predict successful vaginal breech delivery.
  
  
  METHODS
  In this retrospective unicentre study, 240 primiparous women with breech presentation at term underwent MRI pelvimetry. For all patients vaginal delivery was planned, according to German guidelines and if the conjugata vera (CV) was ≥12 cm. The patients with uneventful vaginal deliveries and the patients who underwent a secondary caesarean section were compared according to pelvimetric parameters and outcomes. Regression analyses were performed.
  
  
  RESULTS
  In the vaginal delivery group (n = 162, (67.5%)), the distance between the spinae ischiadicae (interspinous diameter, ISD) was significantly enlarged. The ISD significantly influenced the mode of delivery in the regression analyses. The CV did not significantly differ between the groups. The patients with successful vaginal deliveries were significantly younger than the patients who underwent caesarean section. In the receiver operating characteristic (ROC) analysis, the area under the curve (AUC) for ISD was 67.7% (p<0.001, 95% CI [0.303-0.642]) and was higher considering the mother's age (AUC = 73.1%, p<0.001, 95% CI [0.662-0.800]). The neonatal short-term outcomes were comparable in both groups.
  
  
  CONCLUSIONS
  The additional use of ISD may predict successful vaginal breech delivery and may be superior to the CV, which is more commonly used.
  
  
  BACKGROUND
  DRKS00009957.
authors.affiliation: University of Leipzig, Department of Obstetrics, Liebigstrasse 20a, 04103 Leipzig, Germany.
authors.forename: Janine
authors.initials: J
authors.lastname: Hoffmann
authors.affiliation: University of Leipzig, Department of Obstetrics, Liebigstrasse 20a, 04103 Leipzig, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Thomassen
authors.affiliation: University of Leipzig, Department of Radiology, Liebigstrasse 20, 04103 Leipzig, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Stumpp
authors.affiliation: University of Leipzig-Heart Center, Department of Radiology, Struempellstrasse 39, 04289 Leipzig, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Grothoff
authors.affiliation: University of Leipzig, Institute for Medical Informatics, Statistics and Epidemiology, Haertelstrasse 16-18, 04107 Leipzig, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Engel
authors.affiliation: University of Leipzig, Department of Radiology, Liebigstrasse 20, 04103 Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kahn
authors.affiliation: University of Leipzig, Department of Obstetrics, Liebigstrasse 20a, 04103 Leipzig, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Stepan
mesh_terms: D000328:Adult; D001946:Breech Presentation / Q000000981:diagnostic imaging* / Q000601:surgery*; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005858:Germany; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods*; D015999:Multivariate Analysis; D010298:Parity; D010387:Pelvimetry / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D055815:Young Adult