Recent reports have affirmed the safety of vaginal delivery for selected breech presentations in labor. The purpose of the present study was to examine the outcome of vaginal delivery of the term breech infant, accomplished by means of a standard protocol, and to determine the effect of that protocol on the cesarean section rate for breech presentations.A retrospective analysis of term breech deliveries during a 4-year period was carried out by means of chart review. Singleton term breech presentations were managed by a protocol which required cesarean section for all nonfrank breech presentations and for previous cesarean deliveries, hyperextension of the fetal cervical spine, and certain other complications. All other patients were candidates for vaginal delivery and were assigned to one of three groups. based on x-ray pelvimetry measurements and estimated fetal weight.Group 1 consisted of patients with adequate pelvimetry and estimated fetal weight less than 3600 gm. These patients were managed by a trial of labor with oxytocin augmentation. Group 2 included those with borderline pelvimetry or with adequate pelvimetry in combination with an oversized fetus (3600ndash;4000 gm). They were given oxytocin if necessary for induction, but no oxytocin was administered in the active phase of labor. The patients assigned to group 3 had contracted pelves or macrosomic fetuses (weight more than 4000 gm). These patients were delivered by cesarean section.Of the 254 patients considered. 91 (35.8 per cent) had nonfrank breech presentations, and all but three of these
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