Term breech delivery: does X-ray pelvimetry help?

Over a 3-year period a retrospective audit was performed of all uncomplicated singleton breech presentations at term to assess the role of X-ray pelvimetry. The review included 267 term breech presentations. Seventy-seven women (Group A) delivered in a consultant unit where X-ray pelvimetry was not used for decision making regarding the mode of delivery; 125 women (Group B) delivered in 2 consultant units where X-ray pelvimetry was always used, and 65 women (Group C) delivered in a fourth consultant unit where X-ray pelvimetry was used selectively. Obstetric outcome was measured in terms of mode of delivery. Short-term neonatal outcome was assessed by Apgar score at 5 minutes, evidence of birth trauma and admission to the neonatal special care unit for more than 24 hours. Significantly fewer women (12.9%) had an elective Caesarean section in group A compared with the other 2 groups (27.2% in group B and 33.8% in group C; p < 0.05). The vaginal delivery rates following a trial of labour were not significantly different (79.1% for group A, 65.9% for group B and 65.1% for group C) and neonatal outcome was similar in all groups. It is concluded that fewer Caesarean sections were done, without adversely affecting the neonatal outcome, when X-ray pelvimetry was not used to select the mode of delivery of uncomplicated singleton breech presentation at term. Satisfactory progress in labour is the best indicator of pelvic adequacy.