Abstract
BackgroundEven 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.MethodsIn 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.ResultsIn 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.ConclusionThe additional use of ISD may predict successful vaginal breech delivery and may be superior to the CV, which is more commonly used.Trial RegistrationDRKS00009957
Highlights
Breech presentation occurs in3-5% of all pregnancies and is one of the most common causes for elective caesarean section, today
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
In the receiver operating characteristic (ROC) analysis, the area under the curve (AUC) for interspinous diameter (ISD) was 67.7% (p
Summary
Breech presentation occurs in3-5% of all pregnancies and is one of the most common causes for elective caesarean section, today. Vaginal delivery is always an option, but the results and interpretation of the Term Breech Trial brought about incisive changes [4]. Even though this trial had significant problems in its methodology, the analysis demonstrated the superiority of caesarean section over vaginal breech delivery according to immediate neonatal outcomes. Maternal and neonatal long-term outcomes are comparable for vaginal and caesarean section deliveries when patients are carefully preselected and adequately treated [3,12,13]. 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
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