The objective of this chapter is to examine on the basis of the knowledge currently available the criteria available before labour for selecting women who would be eligible for trial of vaginal delivery.
Bibliographical research in French and English using the Medline and Cochrane databases between 1980 and 2019 and the recommendations of international societies.
It is recommended to offer women who wish to attempt a vaginal delivery at term a pelvimetry to decide with them on their mode of delivery (Grade C). The pelvimetric standards used at the time of the PREMODA study were anteroposterior diameter of inlet≥105mm, a transverse diameter of inlet≥120mm, a transverse interspinous diameter≥100mm. However, since there is no evidence about which pelvic measures to use, nor any evidence to set decision-making thresholds other than those set in published studies, the selected decision-making thresholds can be adjusted according to gestational age at delivery or fetal biometrics (Professional consensus). There is no argument for recommending the practice of pelvimetry in the case of delivery before 37 weeks gestational age (Professional consensus) and in the case of breech presentation discovered at the time of beginning of labour, the absence of pelvimetry alone does not contraindicate the attempt of vaginal delivery (Professional consensus). There is insufficient data to recommend the systematic use of fetal weight estimation and/or biparietal diameter measurement as acceptance criteria for a vaginal delivery attempt. In the event of a known fetal weight estimation before birth greater than 3800g, a cesarean section is to be preferred (Professional consensus). The breech presentation is not in itself a contraindication to an attempt of vaginal delivery for a small fetus for gestational age (Professional consensus). The presentation of the non-frank breech is not in itself a contraindication to an attempt of vaginal delivery (Professional consensus). In the case of premature breech delivery, current data do not allow to recommend one delivery route over another (Professional consensus). It is recommended to check the absence of hyperextension of the fetal head by ultrasound before an attempt of vaginal delivery (Professional consensus) and to prefer a cesarean section if such a position is found (Professional consensus). It is not recommended to propose a caesarean section with the sole reason of nulliparity (Grade C). The history of cesarean section is not in itself a contraindication to an attempt of vaginal delivery in the case of fetal breech presentation (Professional consensus). Premature rupture of the membranes is not in itself a contraindication to an attempt of vaginal delivery (Professional consensus).
A number of the factors analyzed in this chapter are to be incorporated into the decision-making process in order to choose with the woman whose fetus is in breech presentation the delivery route.

To issue guidelines on management of labour induction and breech vaginal delivery.
Bibliographic search restricted to French and English languages using Medline database®, Cochrane Library and international guidelines of medical societies.
Breech delivery must take place in a maternity ward, in the presence of an obstetrician and gynaecologist and with the immediate availability of an anesthesiologist and a pediatrician during active second stage (Professional consensus). Term breech is not a contraindication to labour induction when the criteria for acceptance of vaginal delivery are met (Grade C). In this case, oxytocin or prostaglandins can be used (Grade C). Epidural analgesia with low concentrations of local anesthetics should be encouraged in case of vaginal delivery attempt (Professional consensus). It is recommended to use continuous monitoring of the CTG (Professional consensus). The use of second-line fetal monitoring is not recommended (Professional consensus). The administration of oxytocin is possible for labour augmentation (Professional consensus). It is better to start the expulsive efforts when the presentation is engaged as low as possible in the pelvic excavation (Professional consensus). Breech presentation is not an indication of episiotomy (Professional consensus). Due to insufficient data, it was not possible to make recommendations on specificities of preterm breech delivery.
In case of planned vaginal delivery, labour induction is possible for term breech fetuses, even with unfarable cervix. Guidelines for labour and vaginal delivery management have a low level of evidence.

Since its first description in 1980, the Zavanelli maneuver - reintroduction of the fetus in the uterus after failure of maneuver to reduce shoulder dystocia - remains an extraordinary and nearly unknown remedy. We report a Zavanelli maneuver performed in a case of irreducible raising arm of a fetus in breech presentation. Literature and our observation indicate that fetal and neonatal prognosis in Zavanelli maneuver is pretty good if breech presentation. This exceptional situation should remain in mind of obstetricians.

OBJECTIVE: To describe and compare the indications and modalities of X-ray pelvimetry in obstetrical practice in the Northeast French maternities.
METHODS: An anonymous questionnaire was sent to the heads of obstetric departments in the Northeast French maternities. The questionnaire was built around four issues: description of the hospital characteristics, assessment of the obstetrical prognosis (modalities of delivery), indications and modalities of X-ray pelvimetry.
RESULTS: The response rate was 47%. The evaluation of the obstetrical prognosis was performed in 77% of maternities. Indications were: breech presentation (86%), suspicion of fetal-pelvic disproportion (78%), mother size lesser than 150cm (64%) and previous caesarean section (42%). Pelvic computed tomography was performed in the majority of the maternities (94%), between 35 and 37 weeks of amenorrhea (47%). Level III maternities and maternities with more than 2000 deliveries per year seemed to observe fewer indications than other maternities, but these indications were still globally excessive, comparing with the Collège national des gynécologues et obstétriciens français\' recommendations.
CONCLUSIONS: These results should lead professionals to develop an assessment of their practices about the indications of X-ray pelvimetry.