Early Neonatal Outcomes Research Articles

Prenatal buprenorphine exposure: Effects on biochemical markers of hypoxia and early neonatal outcome

To evaluate the possible association between prenatal buprenorphine exposure and compromised early neonatal outcome in view of markers of perinatal hypoxia. DESIGN, SETTING AND SAMPLE: The study group consisted of 27 full-term neonates exposed to buprenorphine prenatally and prospectively followed up at a special tertiary outpatient clinic for pregnant drug abusers. Serving as controls were 27 full-term neonates exposed prenatally to illicit substances other than opioids and 38 full-term neonates from uncomplicated pregnancies of healthy parturients. Apgar scores, cord pH and base excess were recorded. Cord serum samples were collected at birth for analysis of biochemical markers of fetal hypoxic stress: erythropoietin (EPO; chronic hypoxia), cardiac troponin T (cardiac involvement) and S100 (neural damage). All infants were born in good condition according to Apgar scores and pH of cord blood. No statistically significant differences were found between the three groups in cord serum concentrations of EPO (33.0 median, range: 9.0-476.0 U/L in the buprenorphine-exposed group vs 27.0, range: 8.0-114.0 U/L in substance-abusing controls vs 28.1, range: 11.6-260.0 U/L in healthy controls) or S100 (0.47, range: 0.25-0.91 microg/L vs 0.40, range: 0.12-1.22 microg/L vs 0.47, range: 0.20-2.15 microg/L). No significant differences existed in cardiac TnT levels (0.017, range: 0.010-0.072 U/L vs 0.010, range: 0.010-0.075 U/L vs 0.024, range: 0.010-0.075 U/L). While no significant differences in asphyxia markers were observed between the three groups, a tendency towards higher levels of EPO emerged in the buprenorphine-exposed group.

Comparison of Neonates Born Outside and Inside Hospitals in a Children Emergency Unit, Southwest of Nigeria

To describe the effects of out-of-hospital birth on early neonatal morbidity and outcome among referred newborns. Using a structured case record form, we prospectively collected data on place of birth, morbidity, and outcome of all neonates admitted to the Emergency Ward, University College Hospital, Ibadan, in the first week of life. Of the 541 admitted in the early neonatal period, 61.8% and 38.2% were delivered outside and inside the hospital setting, respectively. Babies were delivered at religious or "mission" house (46.7%), house of residence (38.0%), traditional birth attendants' homes (8.4%), and on the way to the hospital (6.9%). Births outside the hospital significantly increased as the birth order increased (chi = 34.04; P = 0.000). Over half of the out-of-hospital deliveries took place under personnel whose primary responsibilities did not include labor care. Women who had less than secondary level of education and those from the lower social class were more likely to deliver outside the hospital (P < 0.05). Out-of-hospital births were significantly associated with many complications, namely, hypothermia (53.6%), perinatal asphyxia (48.5%), hemorrhage (26.5%), cephalhematoma (12.9%), prematurity (9.9%), and neonatal tetanus (4.2%). Neonatal mortality rate of 12.6% in the out-of-hospital group was significantly higher than 6.3% obtained in the hospital birth group (P = 0.019). Out-of-hospital births had greater risk of morbidity than hospital births. There is need to retrain and monitor the activities of birth attendants and midwives involved in births outside the hospitals closer than it is presently done.

Lower early neonatal mortality among singletons in transnational marriage families: Taiwan Birth Registry

The nativity composition of the Taiwan population has changed substantially since 1980, which resulted in one in six children being born to foreign-born mothers in 2004. The purpose of this study was to compare the early neonatal mortality rates among babies of foreign-born and Taiwan-born mothers. Data was obtained from the Taiwan Birth Registry Database in 2004 by the Bureau of Health Promotion, Department of Health, Taiwan. Multivariate analysis was used to examine the influence of the different maternal nationalities on early neonatal mortality after adjusting for important maternal and infant variables. Infants born to foreign-born mothers had a lower early neonatal mortality rate (5.6 per thousand) compared to those born to Taiwan-born mothers (9.4 per thousand). Even after adjusting for important maternal and infant variables, newborns of foreign-born mothers still had a lower risk of early neonatal death compared to newborns of Taiwan-born mothers (odds ratio = 0.68, 95% CI = 0.57-0.80). Foreign-born status may serve as an important index of differentiation in early neonatal mortality among the current Taiwan population. Selection, economic and non-economic aspects may explain the paradox of favorable early neonatal mortality outcomes.

Maternal pulse oximetry perfusion index as a predictor of early adverse respiratory neonatal outcome after elective cesarean delivery

Evidence suggests increased morbidity, in particular early neonatal respiratory complications, in newborns from elective cesarean section compared with those from vaginal delivery. No reliable maternal predictors of adverse neonatal outcome at elective cesarean section are known. Here, we prospectively tested the hypothesis that a low maternal perfusion index at the baseline phase (i.e., preanesthesia) of the elective cesarean section is a predictor of early adverse neonatal respiratory outcome. Prospective cohort study. Operating and delivery rooms of a public health hospital with a tertiary-level neonatal intensive care unit. Forty-four healthy pregnant women with no known risk factors undergoing elective cesarean section at term gestation. Elective cesarean section was divided into nine phases. Analysis of pulse oximetry-derived signals (perfusion index, pulse rate, and oximetry) and systolic, diastolic, and differential blood pressure were recorded. Maternal arterial and venous newborn cord blood gas analyses and placental histology were evaluated. Early respiratory complications (transient tachypnea of the newborn, n = 5; respiratory distress syndrome, n = 1) were observed in 13.6% (6 of 44) of the newborns. A maternal perfusion index < or = 1.9 (lower quartile) during the preanesthesia phase of the elective cesarean section was an independent predictor of early adverse neonatal respiratory outcome (odds ratio 68.0, 95% confidence interval 6.02-767.72; p < .0001). A decreased perfusion index value in the preanesthesia phase of elective cesarean section is a maternal predictor of increased neonatal morbidity and is significantly related to subclinical placental inflammatory disease. These observations suggest the feasibility of a noninvasive pulse oximeter prenatal screening of the high-risk fetus/newborn in elective cesarean section.

473: Early onset preeclampsia and neonatal outcomes

473: Early onset preeclampsia and neonatal outcomes

Oral glucose tolerance test and pregnancy outcomes

CONTEXT: Women with Gestational Diabetes Mellitus (GDM) were at increased risk of developing maternal, neonatal complications and postpartum diabetes mellitus. AIMS: The study compares relative value of antenatal criteria used for diagnosis of GDM in predicting pregnancy outcome and insulin need. SETTINGS AND DESIGN: The study was a longitudinal, prospective clinical trial performed in Al Ain Hospital, UAE. METHODOLOGY: Eligible population was made up of patients who participated in an early screening program for GDM and had a positive oral glucose tolerance test (OGTT). A total of 165 GDM patients gave birth consecutively at Al Ain Hospital, UAE (from July, 2002 to January, 2003) and were followed-up for 6 months during postpartum period. Sources of information used were maternal, neonatal hospital records and laboratory results for patients both antenatally and postnatally. Specifi c patient information regarding maternal and neonatal complications was collected. STATISTICAL ANALYSIS: The Pearson chi-squared test and/or the Fisher’s exact test were used for analysis as appropriate. RESULTS: The number of diagnostic antenatal OGTT values obtained during diagnosis of GDM was signifi cantly correlated with the development of maternal and neonatal complications. The number of abnormal diagnostic antenatal OGTT values using Coustan and Carpenter Criteria (CCC) signifi cantly infl uenced the development of postpartum diabetes mellitus (P = 0.044) within six months of delivery. Number of abnormal OGTT values significantly contributed to insulin need during index pregnancy (P < 0.05). CONCLUSIONS: Number of abnormal OGTT values obtained during early GDM diagnosis infl uences maternal and neonatal outcomes. Antenatal

The obstetrical and neonatal outcome of babies born after single-embryo transfer in IVF/ICSI compares favourably to spontaneously conceived babies

Recently, concern has risen about poor obstetrical and neonatal outcome of singletons after IVF/ICSI. Because the population of patients receiving single-embryo transfer (SET) resulting in singleton pregnancies is different from the one that would have become pregnant (with a singleton) before SET was introduced, we wanted to investigate whether the outcome of singleton pregnancies after SET differed from spontaneously conceived singletons. The obstetrical and early neonatal outcome of all pregnancies originating from SET after IVF/ICSI procedures between 1 January 1998 and 31 December 2003, was prospectively collected and analyzed. Data from 251 singleton pregnancies and births after SET were analyzed and compared to data from 59,535 spontaneously conceived singletons retrieved from the Centre for Perinatal Epidemiology. The mean birthweight of the singletons after SET was 3322 g (+/-538 SD) versus 3330 g (+/-531 SD) for the spontaneously conceived singletons (P = 0.82). The mean gestational age was 38.7 weeks (+/-1.9 SD) for SET and 38.9 weeks (+/-1.8 SD) for spontaneously conceived singletons (P = 0.06). The proportion of very preterm birth (<32 weeks) was 0.8% in each group, and the proportion of preterm birth (<37 weeks) was 10.0% for SET singletons and 6.24% for spontaneous singletons (P = 0.03). However, mean birthweight of very preterm, preterm and term SET singleton babies was similar to the mean birthweight in every category of gestational age in the spontaneous conceived control group. Stillbirth was 0.4% for both populations (P = 0.99). Good prognosis patients, in whom SET is applied, do not only have a higher chance of conception but do not have an unfavourable outcome of their singleton baby when compared to spontaneous singletons.

Mega-dose carbamazepine complicating third trimester of pregnancy

A case of coma due to carbamazepine ingestion with the intention of committing suicide at 33 weeks' gestation is presented. Management included activated charcoal administration and exchange plasmapheresis. A fetal non-stress test was non-reassuring but the Apgar score, cord blood gases and early neonatal outcome were normal. Differential diagnosis of coma in pregnancy should include investigation for drug intoxication.

Combining Phenobarbital and Indomethacin to Improve Early Neonatal Outcomes in the Extremely Low Birth Weight Infant

In this retrospective study, we tested the following hypotheses: rates of severe intraventricular hemorrhage (SIVH) and early neonatal survival are similar among extremely low birth weight (ELBW) infants treated with combination prophylaxis of phenobarbital and indomethacin compared with phenobarbital alone or no prophylaxis; and rates of patent ductus arteriosus (PDA) and necrotizing enterocolitis (NEC) are similar among indomethacin-exposed and nonexposed ELBW infants. Data were abstracted on 265 ELBW infants admitted into a level 3 neonatal intensive care unit from 1994 through 2002. Combination prophylaxis neither reduced the odds ratio (OR) of SIVH (OR = 1.53; 95% confidence interval [CI], 0.43 to 1.16) versus phenobarbital (OR = 2.91; 95% CI, 0.91 to 9.27 versus none (OR = 1; 95% CI, reference) nor increased the odds of early neonatal survival (OR = 0.72; 95% CI, 0.17 to 3.09 for combination prophylaxis versus OR = 0.66; 95% CI, 0.16 to 2.67 for phenobarbital versus OR = 1; 95% CI, reference for none). Indomethacin exposure reduced the odds of PDA (OR = 0.35; 95% CI, 0.17 to 0.75) without increasing the risk of NEC (OR = 1.37; 95% CI, 0.60 to 3.12). In conclusion, combination prophylaxis does not improve SIVH and early neonatal survival outcomes. Early exposure to indomethacin offers some benefits without any added risks.

Variations in Early and Intermediate Neonatal Outcomes for Inborn Infants Admitted to a Canadian NICU and Born of Hypertensive Pregnancies

Objective: To determine whether neonatal intensive care unit (NICU) outcomes vary by centre for inborn neonates of hypertensive pregnancies and, if so, whether that variation might be related to between-centre variations in obstetric practice.Methods: The study comprised a prospective cohort of 13 505 singleton neonates admitted to 17 Canadian NICUs. Adjusting for potential confounders, we used multivariate regression to analyze the relation between centre of delivery and 6 dependent variables: (1) Apgar score < 7 at 5 minutes; (2) Score of Neonatal Acute Physiology-II (SNAP-II) score ≥ 10; (3) neonatal death; (4) neonatal death or morbidity (owing to bronchopulmonary dysplasia [BPD], intraventricular hemorrhage [IVH], necrotizing enterocolitis [NEC], persistent ductus arteriosus [PDA], or periventricular leukomalacia [PVL]); (5) BPD alone; and (6) major neonatal morbidity (that is, at least one of IVH, PVL, NEC, or PDA). NICU practices known to influence these outcomes were included in the modelling for neonatal death and neonatal morbidity. In a sensitivity analysis for practice variation, antenatal steroid exposure was both included and excluded in each regression.Results: For 5 of the 6 dependent variables, we identified between-centre variation that was not explained solely by variation in antenatal corticosteroid use. Adjusted odds ratios varied from 0.11 to 5.6 (the reference centre was the median rate of the adverse outcome).Conclusions: In the pregnancy hypertension setting, between-centre variations in practice are associated with variations in neonatal physiology and survival. For infants admitted to NICU, the obstetric management of hypertensive pregnancies appears to have an effect on both short- and medium-term neonatal outcomes, even after correction for NICU management.

Prediction of perinatal asphyxia with nucleated red blood cells in cord blood of newborns

Objective: To determine normal level of nucleated red blood cells (NRBC) per 100 white blood cells (WBC) in cord blood of term non-asphyxiated newborns and to investigate variations in NRBC counts in perinatal asphyxia. Methods: A total of 75 cases were studied. Levels of NRBC per 100 WBC in umbilical venous blood were compared between 26 asphyxiated newborns (group I) and 49 non-asphyxiated newborns (group II). Correlation with neonatal outcome was also evaluated. Results: The mean (±S.D.) NRBC per 100 WBC level in umbilical blood of newborns in group I was 16.5±6.4, range 3–25; whereas that in group II was 8.6±7.01, range 1–26. This difference was statistically significant (P<0.001). A statistically significant negative correlation existed between NRBC level and markers of acute intrapartum asphyxia, Apgar score and umbilical arterial pH (r=−0.50, P<0.001 and r=−0.48, P<0.001, respectively). Positive correlation was demonstrated with evidence of chronic antepartum asphyxia, presence of pregnancy induced hypertension and intrauterine growth restriction (r=2.66, P=0.02). A high NRBC count in umbilical blood correlated with poor early neonatal outcome. Conclusions: The level of NRBC per 100 WBC correlates both with acute as well as chronic antepartum asphyxia. Further, it can be used as a reliable index of early neonatal outcome.

Perinatal implications of maternal hypertension

Hypertensive disorders of pregnancy are prototypical of maternal conditions associated with reduced uteroplacental blood flow. Hypertensive disorders in pregnancy include chronic hypertension, preeclampsia-eclampsia, superimposed preeclampsia, and gestational hypertension. Pathophysiology of these disorders include deficient uterine vascular modeling in the process of placentation and aberrations of vasomotor regulation. Aberrations of uterine renin-angiotensin system may play a proximate role in the pathogenesis of preeclampsia syndrome. Clinical manifestations are explained in this review based on resultant vasoconstriction and ischemia in systemic and regional circulations. Perinatal implications of hypertensive disorders both in terms of early neonatal outcome and long-term neurodevelopmental effects are described. Methods of antenatal assessment of the fetus and, briefly, principles of clinical management are described.

Early neonatal brain injury in histologic chorioamnionitis

The relation between clinical or histologic chorioamnionitis and early neonatal adverse neurologic outcome was investigated (n = 483). Histologic, but not clinical, evidence of chorioamnionitis was found to be a significant predictor of periventricular echodensity (odds ratio, 2.4; 95% CI, 1.8-3.2), echolucency (3.3; 1.9-5.6), ventriculomegaly (2.7; 1.8-4.2), intraventricular hemorrhage ≥3 (3.5; 2.4-5.2), and seizures (2.3; 1.4-3.7). (J Pediatr 2001;138:101-4)

Perinatal Outcome in 41 Sets of Triplets

Objective: To determine the perinatal outcome associated with triplet pregnancies and to compare abdominal delivery with vaginal delivery. Methods: Retrospective analysis of maternal and neonatal medical records of 41 triplets. 21 were delivered vaginally and 20 were delivered by cesarean section. Main Outcome: To measure perinatal mortality and early neonatal complications. Results: Between January 1, 1994, and June 30, 1999, there were 41 triplets delivered at our institution. Of these 21 triplets were delivered vaginally and 20 triplets were delivered abdominally. The perinatal mortality rate was 32/123 (26.0%), primarily due to the respiratory distress syndrome. The perinatal deaths are mainly at a birth weight of 500–1,500 g (29/32; 90.6%). Breech presentation was associated with a significantly higher perinatal mortality rate than vertex presentation (62.5 vs. 37.5%). Cesarean delivery was associated with a higher perinatal mortality rate than vaginal delivery (30.0 vs. 22.2%). Conclusions: Abdominal delivery in triplets is not superior to vaginal delivery in terms of fetal and early neonatal outcome. The perinatal deaths are increased with low birth weight (500–1,500 g) and with breech presentation. The main cause of neonatal mortality is the respiratory distress syndrome.

F125Fetal pulmonary venous Doppler flow velocity waveforms in congenital heart defects

Aim of the studyis to analyze blood flow velocity waveforms (FVW) in the pulmonary veins using pulsed Doppler ultrasound in fetuses with a prenatally detected congenital heart defect (CHD).MethodsIn 96 fetuses with various CHD Doppler FVW from the pulmonary veins were assessed. Gestational age varied between 18 and 38 weeks. Following Doppler parameters were analyzed and compared to reference ranges: systolic (S), diastolic (D) peak velocity, end‐diastolic velocity during atrial contraction (A), peak velocity index for veins (PVIV) and Pulsatility Index for veins (PIV).ResultsWe could distinguish 5 different patterns of FVW reflecting different stages of pulsatility and preload within the left atrium. Abnormal patterns were mainly observed in fetuses with left atrial obstruction and a restrictive foramen ovale having a reversed A‐wave as well as in mitral regurgitation.ConclusionsAbnormal FVW in fetal cardiac defects depend from the left atrial pressure rather than on the cardiac defect itself. Patterns of FVW can help in quick differentiation of increased interatrial pressure, which can impair early neonatal outcome.

Perinatal outcome in 41 sets of triplets in Jordan.

Triplet births, which have increased greatly throughout the world in recent years, have a much greater risk of poor birth outcome than singleton births. The purpose of this study was to determine the perinatal outcome associated with triplet pregnancies and to compare abdominal delivery with vaginal delivery. We conducted a retrospective study of 41 sets of triplets born between January 1, 1994, and June 30, 1999, at the Princess Badee'a Teaching Hospital in Amman, Jordan. The primary outcome measures were perinatal mortality and early neonatal complications. Of these sets, 21 triplets were delivered vaginally and 20 triplets were delivered by cesarean section. The perinatal mortality rate was 260 per 1000 live births in this series, primarily due to respiratory distress syndrome. The perinatal deaths occurred to infants whose birthweights were primarily 500 to 1500 g (90.6%). Breech presentation was associated with a significantly higher perinatal mortality rate than vertex presentation (62.5% vs 37.5%). Cesarean delivery was associated with a higher perinatal mortality rate than vaginal delivery (30.0% vs 22.2%). These results suggested that cesarean delivery in triplets is not superior to vaginal delivery in terms of fetal and early neonatal outcome. The perinatal mortality rate was significantly higher than that in other recent series due to limited resources in Jordan.

▪ Electronic Fetal Heart Rate Monitoring: Early Neonatal Outcomes Associated with Normal Rate, Fetal Stress, and Fetal Distress

▪ Electronic Fetal Heart Rate Monitoring: Early Neonatal Outcomes Associated with Normal Rate, Fetal Stress, and Fetal Distress

Electronic fetal heart rate monitoring: Early neonatal outcomes associated with normal rate, fetal stress, and fetal distress

Objective: The purpose of this study was to test the ability of a clearly defined classification system for electronic fetal heart rate monitoring to predict early neonatal outcome. Study Design: All labors of women with singleton pregnancies ≥32 weeks’ gestation electronically monitored at 2 institutions were examined. Tracings in the final hour before delivery were defined as normal, fetal stress, or fetal distress. After delivery, Apgar scores, cord blood gas values, and admission to the neonatal intensive care unit were examined as measures of early neonatal outcome. Results: Among the 898 patients who qualified for study, 627 (70%) had tracings classified as normal, 263 (29%) had tracings classified as fetal stress, and 8 (1%) had tracings classified as fetal distress. There was a significant worsening of neonatal outcome across these 3 groups with regard to depressed Apgar scores 1 minute (5.1%, 18.3%, and 75.0%; P < .05), depressed Apgar scores at 5 minutes (1.0%, 3.8%, and 37.5%; P < .05), and admission to the neonatal intensive care unit (5.6%, 10.6%, and 37.5%; P < .05). There was also a progressive worsening of cord blood pH (7.27 ± 0.06, 7.21 ± 0.08, and 7.06 ± 0.14; P < .05), a progressive increase in PCO2 (53.39 ± 8.34 mm Hg, 58.51 ± 10.55 mm Hg, and 78.31 ± 20.35 mm Hg; P < .05), and a progressive decline in base excess (–3.18 ± 2.02 mEq/L, –5.11 ± 3.11 mEq/L, and –9.07 ± 4.59 mEq/L; P < .05). Conclusion: This simple classification system for interpreting fetal heart rate tracings accurately predicts normal outcomes for fetuses as well discriminating fetuses in true distress. Further, it identifies an intermediate group of fetuses with a condition labeled fetal stress who might benefit from additional evaluation and possibly from expeditious delivery. (Am J Obstet Gynecol 2000;182:214-20.)

Randomised Controlled Trial of Magnetic-Resonance Pelvimetry in Breech Presentation at Term

Summary Background Pelvimetry is widely used in women with breech presentation at term to select those for whom planned vaginal delivery is appropriate. However, its clinical value has never been established. We evaluated pelvimetry in a randomised controlled trial. The main outcome measures were the elective and emergency caesarean-section rates and the early condition of the neonate. Methods Magnetic-resonance (MR) pelvimetry was done on 235 women. The women were then randomly assigned to two groups–for the study group (n=118), the pelvimetry results were reported to the responsible obstetricians, who used them as the basis for decisions on whether to schedule elective caesarean or trial of labour; for the control group (n=117), the pelvimetry results were not disclosed until 8 weeks post partum, and decisions about obstetric management were made on the basis of clinical factors only. Findings 35 women (15 [13%] study group, 20 [17%] control group) had abnormalities on pelvimetry. The overall caesarean-section rates did not differ significantly between the study and control groups (50 [42%] vs 59 [50%], p=0·24) but the emergency caesarean-selection rate was significantly lower in the study group than in the control group (22 [19%] vs 41 [35%], p=0·0052). The mean 1 min Apgar scores in the study and control groups were 8·1 and 8·0 (p=0·93) and the mean 3 min scores 9·5 and 9·4, respectively (p=0·28). There were no significant differences in the early neonatal outcome for infants born vaginally, by emergency caesarean section, or by elective caesarean section in the two groups, except for a significantly lower Apgar score in the six infants born vaginally to control-group women who had pelvic abnormalities. Interpretation The use of MR pelvimetry in breech presentation at term did not significantly reduce the overall caesarean-section rate. However, it allowed better selection of the delivery route, with a significantly lower emergency caesarean-section rate. Neonatal outcome was not compromised by use of the pelvimetry data.

Randomised controlled trial of magnetic-resonance pelvimetry in breech presentation at term

Pelvimetry is widely used in women with breech presentation at term to select those for whom planned vaginal delivery is appropriate. However, its clinical value has never been established. We evaluated pelvimetry in a randomised controlled trial. The main outcome measures were the elective and emergency caesarean-section rates and the early condition of the neonate. Magnetic-resonance (MR) pelvimetry was done on 235 women. The women were then randomly assigned to two groups--for the study group (n = 118), the pelvimetry results were reported to the responsible obstetricians, who used them as the basis for decisions on whether to schedule elective caesarean or trial of labour; for the control group (n = 117), the pelvimetry results were not disclosed until 8 weeks post partum, and decisions about obstetric management were made on the basis of clinical factors only. 35 women (15 [13%] study group, 20 [17%] control group) had abnormalities on pelvimetry. The overall caesarean-section rates did not differ significantly between the study and control groups (50 [42%] vs 59 [50%], p = 0.24) but the emergency caesarean-section rate was significantly lower in the study group than in the control group (22 [19%] vs 41 [35%], p = 0.0052). The mean 1 min Apgar scores in the study and control groups were 8.1 and 8.0 (p = 0.93) and the mean 3 min scores 9.5 and 9.4, respectively (p = 0.28). There were no significant differences in the early neonatal outcome for infants born vaginally, by emergency caesarean section, or by elective caesarean section in the two groups, except for a significantly lower Apgar score in the six infants born vaginally to control-group women who had pelvic abnormalities. The use of MR pelvimetry in breech presentation at term did not significantly reduce the overall caesarean-section rate. However, it allowed better selection of the delivery route, with a significantly lower emergency caesarean-section rate. Neonatal outcome was not compromised by use of the pelvimetry data.