Radiological pelvimetry and the general practitioner.
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Patients were X-rayed in supine and squatting positions in order to measure any increase in pelvic outlet diameters. An increase of less than 2% was found. Previous estimates of 20-30% increases in pelvic outlet area were not duplicated.
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PURPOSE: To establish obstetric magnetic resonance (MR) pelvimetric reference values in a large study population and stratify them according to delivery modality and to determine the intra- and interobserver error and intraindividual variability of MR pelvimetric assessment in volunteers. MATERIALS AND METHODS: MR pelvimetric data were retrospectively reviewed in 781 women (mean age, 28.9 years +/- 5.2 [SD]) clinically referred, and the data were correlated to obstetric history to derive normative values. Five observers assessed results of multiple MR pelvimetric examinations in 10 female volunteers (mean age, 34.7 years +/- 6.0; eight nullipara, two primipara) to provide data for measurement error analysis. RESULTS: All values were higher in the spontaneous vaginal delivery subgroup (n = 100) and lower in the cesarean section or vacuum extraction subgroup (n = 130; intersubgroup difference, P <.001, Mann-Whitney U test). Pelvimetric parameters in the group undergoing spontaneous vaginal delivery were as follows: obstetric conjugate, 121.7 mm +/- 8.6; interspinous distance, 112.3 mm +/- 7.9; intertuberous distance, 120.6 mm +/- 11.3; transverse diameter, 129.5 mm +/- 8.7; and sagittal outlet, 115.8 mm +/- 9.9. In the volunteer study, intraobserver, interobserver, and intraindividual reliabilities were high for the obstetric conjugate (0.94-0.96), interspinous distance (0.92-0.95), and transverse diameter (0.95-0.98) but low for intertuberous distance (0.64-0.87) and sagittal outlet (0.66-0.85). CONCLUSION: Pelvimetric dimensions are smaller in women undergoing cesarean section or vacuum extraction than they are in those delivering vaginally. The pelvimetric parameters associated with the largest measurement errors are intertuberous distance and sagittal outlet.
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Pelvic measurements in a group of 115 women delivering in breech presentation were compared with those in a group of 100 delivering in cephalic presentation. The average pelvic measurements were all a few mm larger in the breech cases and the average sum of the outlet diameters was significantly larger. Pelvic disproportion was not more common in breech presentation and no support was found for the theory that large pelvic measurements predispose to breech presentation. The small differences found are attributed to the moulding of the pelvis occurring during parturition.
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