M Lallemant1,2, T Ceri3, Y Offringa4, S Aubry3, A Bourtembourg5, D Riethmuller6, R Ramanah5,7, P Guerby4, N Mottet5,7. 1. Department of Obstetrics and Gynecology, Besancon University Medical Centre, University of Franche-Comté, 3 Alexander Fleming Boulevard, 25000, Besançon, France. mlallemant@chu-besancon.fr. 2. Nanomedecine Laboratory, Imaging and Therapeutics INSERM EA 4662, University of Franche-Comté, Besançon, France. mlallemant@chu-besancon.fr. 3. Department of Musculoskeletal Imaging, Besancon University Medical Centre, University of Franche-Comté, Besançon, France. 4. Department of Obstetrics and Gynecology, Paule de Viguier University Medical Centre, Toulouse III University, Toulouse, France. 5. Department of Obstetrics and Gynecology, Besancon University Medical Centre, University of Franche-Comté, 3 Alexander Fleming Boulevard, 25000, Besançon, France. 6. Department of Obstetrics and Gynecology, Grenoble Alpes University Medical Centre, Grenoble, France. 7. Nanomedecine Laboratory, Imaging and Therapeutics INSERM EA 4662, University of Franche-Comté, Besançon, France.
Abstract
PURPOSE: To evaluate the obstetrical prognosis of term breech delivery in case of asymmetric pelvis. METHODS: An observational, comparative, retrospective, bi-centric study of 559 patients who had a computer tomography pelvimetry prior to delivery of a term breech presentation was conducted between August 2013 and August 2019. Patients with an attempted vaginal delivery were divided into two groups: a group of asymmetric pelvis (AP) when the difference between the lengths of both oblique diameters was ≥ 1 cm and a group of symmetric pelvis (SP) when the two oblique diameters differed by < 1 cm. The primary outcome was the rate of vaginal delivery. Secondary outcomes were a composite variable of neonatal and maternal morbidity and mortality. RESULTS: Of the 370 patients who attempted a vaginal breech delivery, 8% (n = 29) had an AP and 92% (n = 341) had a SP. In the AP group, the vaginal delivery rate was higher (93% versus 78%, p = 0.05). There was no statistically significant difference in neonatal (3% versus 1% in the AP and SP groups, respectively, p = 0.4) and maternal (17% versus 23% in the AP and SP groups, respectively, p = 0.5) morbidity and mortality. CONCLUSION: When a pelvimetry is performed before an attempt of vaginal breech delivery, a difference of less than two centimetres between both oblique diameters does not seem to reduce the rate of vaginal birth and is not an indication for an elective caesarean section.
PURPOSE: To evaluate the obstetrical prognosis of term breech delivery in case of asymmetric pelvis. METHODS: An observational, comparative, retrospective, bi-centric study of 559 patients who had a computer tomography pelvimetry prior to delivery of a term breech presentation was conducted between August 2013 and August 2019. Patients with an attempted vaginal delivery were divided into two groups: a group of asymmetric pelvis (AP) when the difference between the lengths of both oblique diameters was ≥ 1 cm and a group of symmetric pelvis (SP) when the two oblique diameters differed by < 1 cm. The primary outcome was the rate of vaginal delivery. Secondary outcomes were a composite variable of neonatal and maternal morbidity and mortality. RESULTS: Of the 370 patients who attempted a vaginal breech delivery, 8% (n = 29) had an AP and 92% (n = 341) had a SP. In the AP group, the vaginal delivery rate was higher (93% versus 78%, p = 0.05). There was no statistically significant difference in neonatal (3% versus 1% in the AP and SP groups, respectively, p = 0.4) and maternal (17% versus 23% in the AP and SP groups, respectively, p = 0.5) morbidity and mortality. CONCLUSION: When a pelvimetry is performed before an attempt of vaginal breech delivery, a difference of less than two centimetres between both oblique diameters does not seem to reduce the rate of vaginal birth and is not an indication for an elective caesarean section.