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Calculating machines have made the use of Thoms grid unnecessary, and have many advantages: the exact measurements of the different diameters can be obtained, and it is now possible to establish a more precise prognosis by introducing supplementary data such as those obtained by ultrasonography.
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The definition of contracted pelvis set down by the Terminology Committee, Japan Society of Obstetrics and Gynecology concerns only the pelvic inlet. We maintain, however, that contracted pelvis in Japanese women should be considered from a three-dimensional viewpoint. It can be easily defined by the area of the pelvic inlet and the sacral shape. In the present study, the following results were obtained after extracting 108 sets of superior-interior and lateral pelviographs. 1) When the area of the pelvic inlet is > or = 110 cm 2, the possibility of contracted pelvis can be excluded. 2) When the area is < 100 cm2, the incidence of c/s is quite high; this condition should therefore be termed contracted pelvis. 3) Subjects with inlet areas of 100-110 cm2 are classified as "relative contracted pelvis" and account for about one third of the total number of patients. It is only in this group that lateral pelviographies should be taken. When it reveals the presence of sacral deformity, c/s is necessary in 1/2 of the cases, and vaginal deliveries can be expected in 95% without sacrum deformity. When a given pelvis is categorized as "normal" according to the definition, the c/s rate is as high as 50% in cases with a deformed sacrum, but when the sacrum is not deformed, the rate is as low as 25%, 4) The above technique consists of two steps: (a) First, a superior-inferior pelviography is taken to measure the inlet area to discriminate the high-risk group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Pelvic dimensions by x-ray of 282 pregnant adolescents and 181 adult women were compared to ascertain if the pelvis of the adolescent was smaller and contracted with greater frequency. The majority of 10 pelvic dimensions for black and white adolescents were significantly smaller or contracted with significantly greater frequency. The pattern of signifcant differences suggests that the adolescent pelvis has yet to mature fully by age 16. As a consequence of physiologic events during puberty, described by several authors, the adolescent pelvis grows at an accelerated rate and typically changes from an anthropoid to a gynecoid configuration. Caution must be taken in applying these results since pelvic size is not synonymous with obstetric outcome.
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We had studied in one year 110 cases of scano-pelvimetry, the clinical examination had not found a shrink pound in 41%, revealed by the sceno-pelvimetry. This method is more precisely than the classic pelvimetry, but more expansive. The simultaneous study of echography and pelvimetry had contributed to a better obstetrical decision.
The paper gives account of advantages and disadvantages of ultrasonic and conventional X-ray pelvimetries for diagnosing the contracted pelvis in obstetrics. It also describes a basically new X-ray pelvimetry by using a digital X-ray unit one of whose basic advantages is a low maternal and fetal load (one-twentieth as high as routine X-ray pelvimetry). X-ray pelvimetry with the use of the digital X-ray unit was performed in 366 pregnant and parturient women, of them 188 showed various forms of the anatomically contracted pelvis. Out of them 47% had deliveries by cesarean operation. The potentialities of this unit make it possible to predict both the biomechanism of labor and its outcome.
A review of 12 years' experience with term breech delivery at Overlake Memorial Hospital, Bellevue, Washington, was undertaken to ascertain patterns of care as practiced in a suburban community hospital setting. A total of 402 term breech deliveries were managed by 34 family practitioners and 21 obstetricians. X-ray pelvimetry was found to correlate with clinical pelvimetry in two thirds of the cases when used. There were 314 patients delivered vaginally and 88 by cesarean section (an over-all cesarean section rate of 21.9%). There was a striking increase to 43.9% during the last 2 years of the review. This review indicates increasing utilization of consultation with breech presentation, an increasing percentage managed by obstetricians, increasing use of x-ray pelvimetry, decreasing frequency of prolonged labor, a sharp increase in use of cesarean section, and a decline in perinatal morbidity.