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PubMed2005

Vaginal breech deliveries selected using computed tomographic pelvimetry may be associated with fewer adverse outcomes.

OBJECTIVE: Vaginal breech (VB) delivery at term remains controversial. Our objective was to compare neonatal and maternal outcomes in VB deliveries selected using computed tomographic (CT) pelvimetry to those selected clinically. METHODS: A retrospective cohort study of singleton, term, VB deliveries with adequate clinical pelvimetry and estimated fetal weight of 3,850 g was performed. Women in the CT group had adequate pelvimetry by CT measurements. Neonatal and maternal outcomes were recorded. RESULTS: Of the VB deliveries, 58 women had adequate CT pelvimetry and 37 women were selected using clinical criteria alone. There were no perinatal deaths. Neonatal morbidity was significantly lower in VB deliveries selected using CT criteria at 0% versus 10.8% in the clinically selected group (p=0.02). CONCLUSION: VB deliveries selected using CT pelvimetry may be associated with fewer adverse neonatal outcomes than those selected using only clinical criteria. Therefore, it is inappropriate, without CT pelvimetry and strict selection criteria, to conclude that VB deliveries are unsafe. Our experience suggests that there may be a population in which VB delivery is a safe alternative if selected using a combination of specific clinical, sonographic, and CT criteria.

Adolescent↗
PubMed2005

Magnetic resonance imaging pelvimetry and the prediction of labor dystocia.

OBJECTIVE: To study whether magnetic resonance imaging (MRI) pelvimetry has the ability to identify those women who require cesarean delivery for labor dystocia. METHODS: From July 2003 to April 2004, nulliparous women scheduled for a labor induction for prolonged pregnancy (42 weeks) were asked to participate in a pelvimetry study. Those who consented underwent fast-acquisition MRI that included two 90-second acquisitions to evaluate fetal biometry and volumetry and maternal pelvimetry, including novel measurements of pelvic bony and soft tissue volumes as determined by MRI. Information about each patient's pregnancy, labor course, and neonatal outcome was prospectively collected. Pelvimetry results for those women undergoing operative delivery for labor dystocia were compared with those who did not. Single fetal and maternal pelvic measurements, as well as ratios of both, were analyzed. In addition, previously described radiographic pelvimetry techniques and formulas to predict dystocia were used. RESULTS: One hundred one women underwent MRI, and 22 of these underwent cesarean delivery for dystocia. No single fetal measurement was statistically associated with dystocia. Several maternal pelvic measures, fetal-to-maternal ratios, and previously reported pelvimetric techniques were significantly associated with dystocia. The ratio of magnetic resonance (MR) fetal head volume to pelvic soft tissue volume had statistical significance (P = .04). Receiver operator characteristic curves were developed for the different measurements, ratios, and formulas studied to assess whether any of the techniques could accurately predict labor dystocia requiring operative delivery. The area under the curve values ranged from 0.6 to 0.8, with the ratio of MR head volume to pelvic soft tissue being 0.7. These values suggest that MRI can identify those women at greatest risk for dystocia, but it cannot with accuracy predict which ones will require a cesarean. CONCLUSION: We found significant associations with MRI pelvimetry and labor dystocia, but MRI was not a significant improvement over previously described pelvimetric techniques. LEVEL OF EVIDENCE: II-3.

Adult↗
PubMed1994

[Pelvimetry in Norwegian maternity departments].

A questionnaire was sent to 39 maternity departments in Norway. We asked about indications for and use of pelvimetry in the department. 36 departments returned the filled in questionnaire. This paper presents the results of the survey together with a brief discussion of possible harmful effects of pelvimetry. The results show that in Norway every pregnant woman has access to pelvimetry, but there is wide variation as regards the indications and which limits to use. Many obstetricians doubt the value of pelvimetry, especially in vertex presentation. Some are still concerned about the possible harmful effect of ionising radiography. All maternity departments should critically discuss their use of pelvimetry. In the future other methods should replace pelvimetry so that mother and foetus will no longer be exposed to ionising radiography.

Female↗
PubMed1998

A study of the use of radiological pelvimetry in a Chinese population.

BACKGROUND: To audit the use of radiological pelvimetry in a teaching obstetric unit in a Chinese population. METHODS: A prospective observational study included all radiological pelvimetries performed in one obstetric unit over 8 months. All pelvimetries were assessed by one of the authors, and the outcome of pregnancy was reviewed. RESULTS: Among 5576 women delivered in that period, 298 (5.3%) had a pelvimetry. The anteroposterior diameter of the outlet (APO) was on average 9.3 mm smaller than the obstetric conjugate (OC), and was below the definition of pelvic contraction in more than 70% of cases. Previous Cesarean sections accounted for 90.9% of the antenatal radiological pelvimetries. The result of this investigation affected the clinical management in more than 80% of these patients. The chance of successful vaginal delivery was directly related to the pelvic dimensions. CONCLUSIONS: Radiological pelvimetry may provide additional information which could facilitate the counseling of patients with a history of previous Cesarean section.

Asian People↗
PubMed2001

Pelvimetry: changing trends and attitudes.

Review of the literature regarding pelvimetry shows conflicting views as to its value. This study shows the decline in the use of pelvimetry in a teaching hospital obstetric unit over two time periods (1993 and 199798) and the change of views of the clinicians working in this unit. The number of pelvimetries performed fell from 56 per 1000 births to 4 per 1000 over this period. Most pelvimetries in 1993 (55.3%) were performed postpartum following caesarean section. However, in 199798, the majority (over 75%) were performed antepartum in breech presentation. The trend towards a more reluctant use of pelvimetry was mirrored by changes in clinicians' views. Recent publications and RCOG guidelines have effected a dramatic change in the use of pelvimetry over the last decade, largely restricting its use to a small selected group of patients.

Journal Article↗
PubMed1964

X-RAY PELVIMETRY.

The results of x-ray pelvimetry performed on 66 pregnant women, with a view to predicting the outcome of pregnancy, were reviewed. It was concluded that such pelvimetry was most valuable in cases in which it indicated a normal pelvis or gross bony disproportion. It was least effective in those with a "borderline" pelvis, in which the correct management of the patient requires an adequate trial of labour. The authors believe that pelvimetry in the later stages of pregnancy has no ill effects on the unborn baby or the mother.Indications for use of x-ray pelvimetry in obstetrics, the technique employed, the various types of female pelvis and the relation of these to the course of labour are considered. Pelvimetry findings are compared with the eventual outcome of labour in women with suspected cephalopelvic disproportion. It is emphasized that the pelvic assessment should be made jointly by the radiologist and obstetrician.

Cephalopelvic Disproportion↗
PubMed2000

Pelvimetry for fetal cephalic presentations at term.

BACKGROUND: Pelvimetry assesses the size of a woman's pelvis by clinical examination, or by conventional X-rays, computerised tomography scanning, or magnetic resonance imaging. OBJECTIVES: The objective of this review was to assess the effects of pelvimetry (performed antenatally, intrapartum or postpartum) on the method of delivery, and on perinatal mortality and morbidity, and on maternal morbidity. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register was searched. SELECTION CRITERIA: Acceptably randomised comparisons of the use of pelvimetry in cephalic presentations. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted by one author. MAIN RESULTS: Four trials of over 1000 women were included. The trials were generally not of good quality. Women undergoing pelvimetry were more likely to be delivered by caesarean section (odds ratio 2.17, 95% confidence interval 1.63 to 2.88). No significant impact was detected on perinatal outcome. REVIEWER'S CONCLUSIONS: There is not enough evidence to support the use of X-ray pelvimetry in women whose fetuses have a cephalic presentation.

Cesarean Section↗
PubMed1997

Low-field MRI pelvimetry.

The purpose of this study was to evaluate the usefulness of low-field MRI pelvimetry and to correlate the results with X-ray pelvimetry. A total of 19 women underwent low-field MRI pelvimetry. Mediosagittal and transverse planes were used to measure the diameters of the minor pelvic cavity. Correlations between MRI and X-ray pelvimetry were 0.96 for the sagittal inlet, 0.94 for the sagittal outlet, 0.93 for the transverse diameter (diameter transversa, DT) and 0.94 for the bispinous distance (interspinous distance, IS). The repeatability of the measurements was good. For fetuses with cephalic presentation it was also possible to determine the biparietal diameter (BPD). Low-field MRI pelvimetry was well accepted by the patients. The scanning time was less than 6 min, which is comparable with the time of X-ray examination with two planes. Magnetic resonance imaging provides a reliable method to image pelvic structures and soft tissue without ionizing radiation.

Adult↗
PubMed2006

Magnetic resonance-based serial pelvimetry: do maternal pelvic dimensions change during pregnancy?

OBJECTIVE: The purpose of the study was to evaluate the stability of the maternal pelvis over the course of the third trimester and the puerperium. STUDY DESIGN: Pregnant patients were recruited to undergo comparative magnetic resonance-based pelvimetry and fetal ultrasonography at 37 to 38 weeks of gestation. Most of the patients were recruited from a study of women who planned a trial of labor after a previous cesarean delivery for cephalopelvic disproportion. These results have been reported previously. Patients then underwent magnetic resonance-based pelvimetry within 3 days and at 3 months after delivery. Postdelivery analysis was used to answer the question: Do pelvic dimensions change after delivery? RESULTS: Eighteen patients completed the study. Eleven of the patients underwent cesarean deliveries, of which 4 deliveries were before labor. Seven patients had successful vaginal births after their previous cesarean delivery. Statistical analysis of the 18 patients determined that pelvic measurements did not demonstrate change over the course the study. CONCLUSION: Serial magnetic resonance-based pelvimetry showed relative stability of pelvic measurements through the course of pregnancy and delivery. If comparative pelvimetry is to be useful as an antepartum predictor of labor success, then it may be possible to obtain reliable pelvimetry in those patients anytime after delivery.

Cesarean Section↗
PubMed1993

Term breech delivery: does X-ray pelvimetry help?

Over a 3-year period a retrospective audit was performed of all uncomplicated singleton breech presentations at term to assess the role of X-ray pelvimetry. The review included 267 term breech presentations. Seventy-seven women (Group A) delivered in a consultant unit where X-ray pelvimetry was not used for decision making regarding the mode of delivery; 125 women (Group B) delivered in 2 consultant units where X-ray pelvimetry was always used, and 65 women (Group C) delivered in a fourth consultant unit where X-ray pelvimetry was used selectively. Obstetric outcome was measured in terms of mode of delivery. Short-term neonatal outcome was assessed by Apgar score at 5 minutes, evidence of birth trauma and admission to the neonatal special care unit for more than 24 hours. Significantly fewer women (12.9%) had an elective Caesarean section in group A compared with the other 2 groups (27.2% in group B and 33.8% in group C; p < 0.05). The vaginal delivery rates following a trial of labour were not significantly different (79.1% for group A, 65.9% for group B and 65.1% for group C) and neonatal outcome was similar in all groups. It is concluded that fewer Caesarean sections were done, without adversely affecting the neonatal outcome, when X-ray pelvimetry was not used to select the mode of delivery of uncomplicated singleton breech presentation at term. Satisfactory progress in labour is the best indicator of pelvic adequacy.

Adult↗
PubMed1975

Role of pelvimetry in active management of labour.

All cases referred for pelvimetry in 1970-1 and all breech presentations referred for pelvimetry in 1972-4 were reviewed. Indications for pelvimetry fell into four main categories: high head in the antenatal clinic (47-8%); high head in labour (13-9%); breech presentation (20-9%); and previous caesarean section (14-8%). In the first two categories pelvimetry rarely if ever influenced management, and it should not be performed routinely. In breech presentation and cases of caesarean section pelvimetry seemed to be of value, but in the latter group it should be performed puerperally to avoid the known radiation hazard to the fetus. A fairly close correlation between obstetric conjugate and pelvic capacity was shown, which suggested that a 3400-g baby might pass through a pelvis of obstetric conjugate of 10 cm as a cephalic trial of labour, but would need an obstetric conjugate of 11-7 cm for safe vaginal breech delivery.

Birth Weight↗
PubMed1986

The pelvic outlet. A comparison between clinical evaluation and radiologic pelvimetry.

A random sample of 798 primiparas was screened with clinical evaluation and radiologic low-dose pelvimetry of the pelvic outlet. The purpose was to study the accuracy of clinical evaluation in comparison with X-ray pelvimetry and to determine whether clinical evaluation could reveal any other factor influencing labor. A significant agreement between clinical and X-ray pelvimetry was found, but the sensitivity of clinical evaluation was low and as many as half the patients with a contracted pelvis, according to pelvimetry, were not detected. Delivery outcomes in two matched groups with similar pelvic outlet measurements but different clinical evaluation did not differ, indicating that clinical evaluation did not detect any other factor not revealed by X-ray pelvimetry.

Delivery, Obstetric↗
PubMed2005

[Pelvimetry with compute tomography].

BACKGROUND: In 1993, Ullevaal University Hospital started CT pelvimetry. The accuracy of CT pelvimetric measurements and a low fetal dose are very important. In our study we tested the accuracy of CT pelvimetry and measured the fetal dose and the effective dose to the mother. METHOD: A lead scalar was exposed in different heights compared to the isocentre. Measurements were done at front and side scout views and compared to the real scale. Dose estimates were done in CT dosimetry (NRPB). Effective doses to patient as well as fetal doses were measured in this study. Fetal dose was estimated as uterus dose. RESULTS: Our results show that the measurements are overestimates when the table is moved away from the isocentre against the tube. If the table is moved away from the tube and against the detector, the measurements are underestimates. The measurements in the isocentre are accurate. This means that CT pelvimetric measurements are accurate if the patient is placed in the isocentre. In our study the estimated fetal dose was 0.74 mGy and mother's effective dose was 0.3 mSv. INTERPRETATION: Our results show that the fetal dose is as low or lower than with conventional pelvimetry. The CT pelvimetric measurements are accurate if they are performed on patients in the isocentre. We recommend that CT pelvimetry replace conventional pelvimetry.

Female↗
PubMed1990

[The importance of x-ray pelvimetry for the prognosis of pelvic dystocia].

The frequency of roentgenological pelvimetry at the Research Institute of Obstetric and Gynecology during 1988 is 4.79%. Thirty-five pelvimetries out of 276 (12.68%) were urgent, but the remaining 241 (87.32%) were planned. Pelvimetries showed normal measurements in 113 of pregnant women (40.94%), but there was shortening in one or more diameters of the single planes of the pelvis in 163 women (59.06%). The measures of the diameters of the pelvic cavity were shortened most frequently, more rarely at the pelvic inlet and most rarely at the pelvic outlet. Changes in the bony pelvis were indicated after secondary traumatic deformity of the pelvis. The role of roentgenological pelvimetry in taking decision for delivery of breech presentation of the fetus was analyzed. It is pointed out that the roentgenological pelvimetry is the single, easy, convenient, safe and available method for determination of pelvic diameters, respectively for prognosis of pelvic dystocia.

Dystocia↗
PubMedDate not supplied

Low dose pelvimetry with biplane digital radiography.

The digital moving slit technique as used by most CT scanners for overview images, was used for antero-posterior and lateral views of the pelvis for pelvimetry. The method was evaluated in phantom experiments and clinical examinations were performed in 23 patients. The method was compared with conventional pelvimetry in 14 patients. Estimated ovarian dose was reduced by a factor of 14.2. The discrepancy in measurements of the pelvic diameters by computed tomography compared with conventional pelvimetry was considered to be without practical importance from an obstetric point of view. Digital pelvimetry is easier for the patient, faster and the need for repeated exposures is eliminated. Based on these facts it is suggested that digital pelvimetry should replace the conventional method whenever possible.

Female↗
PubMed1982

Value of X-ray pelvimetry in primiparas. II: influence on management of labor.

Despite its potential risks x-ray pelvimetry remains a common diagnostic procedure performed during labor. In order to determine whether x-ray pelvimetry measurements influence the outcome of labor (vaginal vs cesarean), 280 consecutive primiparous parturients were studied.Most parturients were black at term with a vertex presentation. Most pelvimetries were ordered for suspected cephalopelvic disproportion. Of the total number of parturients studied, 31.8 percent had cesarean deliveries, 85.4 percent of them because of CPD. The clinical characteristics compared were similar among the groups studied. X-ray pelvimetry values obtained by two techniques were similar to those previously reported. Although correlations between measurements and delivery route were noted, these values, by themselves, did not have a necessary correlation to the route of delivery in the majority of parturients studied.This finding, like others reported, emphasizes the need to abandon x-ray pelvimetry as a requirement for documenting contracted pelves before abdominal deliveries. CPD should be documented by evaluating the pelvis, quality of labor, and maternal-fetal well-being by other appropriate, less risky means readily available.

Female↗
PubMed2004

[Low dose helical CT pelvimetry: evaluation of radiation dose and image processing].

PURPOSE: to estimate from phantom measurements the radiation dose and the accuracy of helical ct pelvimetry. MATERIALS AND METHODS: Eight helical CT acquisitions using different tube current (100, 50, 25 or 10mAs) and pitch factor (1.125 or 1.375) settings but identical collimation (2mm) and kilovoltage (120 kVp) were evaluated using a four-channel MDCT scanner and compared with conventional CT pelvimetry including a single scout and two transverse images. A plexiglas phantom combined with an ionization chamber was used to calculate the CTDIw and DLP for each acquisition. Then, an ex vivo phantom of bony pelvis was used to evaluate the accuracy of helical acquisitions for the measurement of pelvic diameters (i.e. the antero-posterior inlet, the transverse inlet and the interspinous distance). Reconstructions of helical acquisitions were performed using 2D MPR, 3D MIP and 3D SSD algorithms. RESULTS: CTDIw and DLP of conventional pelvimetry were 26 mGy and 42 mGy.cm respectively. The radiation dose of helical acquisitions decreased linearly with tube current (CTDIw: from 13 to 1.3 mGy, DLP: from 218.3 to 18.7 mGy.cm). Compared to conventional CT, the dose was nearly similar at 25 mAs and reduced at 10 mAs. Helical acquisitions provided accurate measurements of pelvic diameters with a pitch of 1.125 and a 2D MPR algorithm to evaluate the AP inlet and a 3D MIP algorithm to evaluate the transverse inlet and the interspinous distance. Variations of tube current did not influence the accuracy of pelvic diameter measurement. CONCLUSION: Our results suggest that accurate low-dose helical CT pelvimetry using 10-25 mAs and a pitch factor of 1.125 combined with 2D MPR and 3D MIP reconstructions is possible.

Algorithms↗
PubMed1992

[Obstetric pelvimetry using nuclear magnetic resonance tomography (MRI): clinical experiences with 150 patients].

Between Oct. 1987 and Oct. 1991 150 patients of the Frauenklinik Freiburg were examined by MR pelvimetry (MRI), 135 of which were "ante partum", i.e. just before delivery. The indications were: earlier operative or strongly protracted delivery, clinical suspicion of disproportion between head and pelvis, or obstetrical "problem pelvis" indicated by manual pelvic examination or ultrasonic foetometry. Previous experimental measurements with a phantom and the comparison with conventional radiograms by Guthmann and Martius of 10 patients in puerperium have shown, that the mean divergence was +/- 2 mm, the maximum divergence 5 mm. The MRI method for pelvimetry "ante partum" or in childbed, proved to be a method of high accuracy and a very good option to judge the pelvic shape, whilst being well accepted by the patients. Furthermore, it allows to determine the foetal BIP (biparietal head-diameter), to judge the pelvic soft-tissue, as well as the visualisation of the birth canal, all without any exposure to radiation. MR pelvimetry is thus part of today's clinical routine. The disadvantages are still the high costs as well as the fact, that only few centres have access to MRI equipment. Nevertheless, the pelvimetry "post partum" can be safely practised radiologically due to the very low radiation exposure.

Female↗