Objective To determine whether antepartum X‐ray pelvimetry (XRP) reliably identified women suitable for a trial labour or repeat elective caesarean section after one previous section. Design A prospective controlled trial in which women were randomly allocated to either an antepartum XRP group who had XRP at 36 weeks gestation to determine mode of delivery, or a control group who had a trial labour without antepartum XRP. Following delivery, all controls had postpartum XRP. Setting Department of Obstetrics and Gynaecology, King Edward VIII Hospital, Durban, South Africa. Subjects Three hundred‐six women with a history of one previous caesarean section. Main outcome measures Mode of delivery, birthweight and maternal and perinatal mortality and morbidity in the two groups. Results In the antepartum XRP group, 23 of 144 (16%) of women delivered vaginally compared with 60 of 144 (42%) controls (P<0.0001). Of the 84 women with adequate antepartum XRP only 23 (27.7%) delivered vaginally. In the control group, 33 of 60 (55%) women who had vaginal deliveries had inadequate postpartum XRP and would have had a caesarean section if this information was known in the antepartum period; 62 of 84 (74%) caesarean sections in the control group had adequate postpartum XRP. Birthweight of the infants was similar in the two groups. There were no maternal or perinatal deaths. Maternal morbidity was similar in the two groups. Neonatal morbidity was minimal. Conclusion Antepartum XRP is not necessary prior to a trial labour in women with one previous caesarean section. It increases the caesarean section rate and is a poor predictor of the outcome of labour.

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Labor outcome of primiparae less than 17 years was compared with non-juvenile primiparae in a population with a high incidence of contracted pelvis. Juvenile primiparae were referred to hospital on the basis of age, whereas non-juveniles were referred for an obstetric complication. There was no statistical difference in rates of cesarean section, Ventouse, operative delivery, low birth weight, or perinatal mortality between 538 juveniles and 5294 older "high risk" mothers. Symphysiotomy rates were actually higher in the juveniles (12.6% vs. 9.7%, P less than 0.05). These data support the practice of hospital referral for juvenile African women in labor.

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