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Asymmetric pelvis and term breech presentation: is planned vaginal delivery still a safe option?

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.

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Affiliations

Authors

Contributions

ML: protocol/project development, data collection or management, data analysis, manuscript writing/editing. TC: data collection or management, manuscript writing/editing. YO: data collection or management, manuscript writing/editing. SA: data collection or management. AB: manuscript writing/editing. DR: manuscript writing/editing. RR: manuscript writing/editing. PG: manuscript writing/editing. NM: protocol/project development, manuscript writing/editing.

Corresponding author

Correspondence to M. Lallemant.

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Conflict of interest

The author declares that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study has been approved by the Institutional Review Board of the French College of Obstetricians and Gynaecologists (CEROG No. 2019-OBS-0302).

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Informed consent was obtained from all individual participants included in the study.

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Lallemant, M., Ceri, T., Offringa, Y. et al. Asymmetric pelvis and term breech presentation: is planned vaginal delivery still a safe option?. Arch Gynecol Obstet 304, 919–927 (2021). https://doi.org/10.1007/s00404-021-06036-4

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Keywords

  • Asymmetric pelvis
  • Pelvic bony dystocia
  • Breech delivery
  • Computer tomography pelvimetry
  • Obstetrical prognosis
  • Vaginal delivery