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PubMed1980

The randomized management of term frank breech presentation: a study of 208 cases.

A prospective study of 208 women in labor at term with singleton fetuses in a frank breech presentation was carried out. One hundred fifteen patients were randomized to a vaginal delivery group and 93 to an elective cesarean section group. Of the 93 women scheduled for cesarean section, 88 were delivered according to protocol. Five women progressed rapidly in labor and were delivered vaginally without complications. Of the 115 women scheduled for vaginal delivery, x-ray pelvimetry was obtained on 112. Three women were delivered vaginally without incident before x-ray pelvimetry could be obtained. One of these women was delivered of an infant who died shortly after birth of lethal congenital anomalies. Of the 112 women with x-ray pelvimetry, 52 had one or more inadequate pelvic measurements and were scheduled for indicated cesarean section. Three women, however, were delivered vaginally without incident before operation could be performed. Of the remaining 60 patients in this group, 49 were delivered vaginally without a perinatal death. Eleven women required cesarean section for difficulties during labor. There were no maternal deaths, but 73 (49.3%) of the 148 women who were delivered by cesarean section in this study experienced postpartum morbidity. Only four (6.7%) of the 60 women delivered vaginally had postpartum complications. Based on the data, it seems resonable to allow vaginal delivery in carefully selected cases of term frank breech presentation.

Adult↗
PubMed1991

The fetal-pelvic index: a method of identifying fetal-pelvic disproportion in women attempting vaginal birth after previous cesarean delivery.

In 1986 the fetal-pelvic index was introduced as an accurate method of prospectively identifying the presence or absence of fetal-pelvic disproportion. The concept of the fetal-pelvic index is one in which the fetal head and abdominal circumferences (ultrasonographic mensuration) are compared with the respective maternal pelvic inlet and midpelvic circumferences (x-ray pelvimetry). The purpose of this study is to evaluate the efficacy of this index as a predictor of fetal-pelvic disproportion in gravid women attempting vaginal birth after previous cesarean delivery. Findings of the fetal-pelvic index are compared with those of two other means of identifying fetal-pelvic disproportion (Colcher-Sussman x-ray pelvimetry and ultrasonographically derived estimated fetal weight of greater than or equal to 4000 gm). Of the 65 prospective study participants, 18 (28%) failed to progress in labor, and a repeat cesarean delivery was required. Forty-seven of the 52 patients with a negative fetal-pelvic index value were delivered vaginally (negative predictability = 0.90). Of the five with false-negative fetal-pelvic index values, four fetuses persisted in an occipitoposterior position and failed to progress in labor. All 13 patients with a positive fetal-pelvic index value failed to progress in labor and required a cesarean delivery (positive predictability = 1.00). In contrast, when used alone, neither x-ray pelvimetry nor ultrasonography-determined estimated fetal weight of greater than or equal to 4000 gm provided accurate identification of fetal-pelvic disproportion.

Cesarean Section↗
PubMed2004

The magnetic resonance imaging-based fetal-pelvic index: a pilot study in the community hospital.

OBJECTIVE: This study was undertaken to assess feasibility of magnetic resonance imaging (MRI) pelvimetry in conjunction with fetal ultrasonography as a technique in evaluating patients with previous cesarean sections for cephalopelvic disproportion (CPD). STUDY DESIGN: Pregnant patients with one previous cesarean section for CPD who planned a trial of labor after cesarean (TOLAC) were recruited to undergo MRI pelvimetry and fetal ultrasonography at 37 to 38 weeks. Entry criteria included no previous successful vaginal deliveries and no contraindications for vaginal delivery in the ongoing pregnancy. A fetal-pelvic index was calculated for each patient but not disclosed to patients or their physicians. The pregnancies were managed routinely. Analysis after delivery was used to ascertain whether this index would have predicted clinical outcome. RESULTS: There were no difficulties in performing the MRI or ultrasound. Sixteen patients completed their pregnancies. Three patients did not labor. The fetal-pelvic index was plotted on a scattergram and compared with the outcome. Three discriminatory zones were identified. Five of 6 patients in the most favorable zone delivered successfully. Two patients in the most unfavorable zone had failed vaginal birth after cesarean section (VBAC) attempts. In the 5 patients in the middle intermediate zone, TOLAC success appeared to depend on fetal presentation and gestational age. CONCLUSION: The use of comparative MRI pelvimetry and fetal ultrasonography is feasible in a community hospital. In this pilot study, it appeared to have potential in enhancing the management of VBAC candidates. This technique may allow sorting of patients before labor into zones that would favor or preclude VBAC attempts.

Adult↗
PubMed1992

[Do the obstetrically relevant bony pelvic measurements change? A retrospective analysis of computed tomographic pelvic x-rays].

The important dimensions of pelvimetry were evaluated from 467 CT studies of the pelvis by trigonometric deduction. The age of the women was between 18 and 88 years. In addition to the diameters, which are routinely used for pelvimetry, transverse and sagittal diameters, pelvic angles and areas of pelvic planes were calculated. On condition that the pelvic dimensions do not depend on age the parameters can be regarded as representative of sexual maturity. 5 parameters showed highly significant and 7 parameters showed significant differences between the age-classes 1901-1920 and 1950-1971. An increase of pelvic dimensions (1950-1971) was found at the planes of the pelvic inlet and outlet in contrast to the dimensions of the pelvic center. The results confirm the importance of the bispinous diameter for pelvimetry as well as the demand for a revision of the standard values of the first half of the century.

Adolescent↗
PubMed2006

A narrow pelvic outlet increases the risk for emergency cesarean section.

BACKGROUND: The rate of cesarean section (CS) is increasing in Sweden as well as in most of the industrialized world. One of the most common indications for emergency CS is protracted labor. To what extent fetal pelvic disproportion is a cause of protracted labor is unclear. The value of pelvimetry has been questioned. The purpose of this study was to investigate whether women delivered with emergency CS because of protracted labor had a narrower pelvis than women delivered vaginally did. METHODS: Thirty women delivered with CS because of protracted labor comprised the study group. Thirty women vaginally delivered served as controls. The two groups were matched for gestational age, birth weight, and parity. The study group and the control group underwent an X-ray pelvimetry within 1 month of delivery. RESULTS: The study group and the control group did not differ in maternal age or body mass index. The mean birth weight was 3914 g in the study group and 3884 g in the control group. The mean pelvic outlet was 328 mm in the study group and 346 mm in the control group (P=0.0024). The mean pelvic inlet was 245 mm in the study group and 255 mm in the control group (P=0.0038). CONCLUSION: A narrow pelvic outlet is associated with an increased risk of emergency CS because of protracted labor. A postpartum pelvimetry is recommended and should be used when to decide on route of delivery in forthcoming pregnancies.

Adult↗
PubMed1982

Role of antenatal radiography in the management of breech deliveries.

a retrospective study was made of 228 mature singleton breech deliveries occurring over a 2 year period to determine the role of antenatal radiography, in particular, of pelvimetry. Many (65%) had abdominal radiography. Where antenatal pelvimetry was performed (38%) the infants were in significantly better condition during the neonatal period; this was most marked with parous women. There was no significant difference in the neonatal condition of 25 infants born vaginally of women with favourable pelvimetry compared with 31 infants born by elective caesarean sections.

Adult↗
PubMed1982

Hazards and uses of prenatal diagnostic X-radiation.

Diagnostic x-ray studies during any stage of gestation have been shown to increase the risk of childhood cancer in the irradiated fetus. This study reviews those risks and examines the uses of pregnant abdomen and x-ray pelvimetry studies. The abdominal films appear to have provided useful and necessary information in the management of labors and deliveries; however, the x-ray pelvimetry results appear to have provided much less usable information. The predictive values of both positive and negative x-ray pelvimetry studies were low, .57 and .66, respectively. The predictive values were low for both vertex and breech presentations. The definite hazards of prenatal diagnostic radiation studies should be carefully weighed against their possible benefits.

Apgar Score↗
PubMed1995

[Obstetrical study of the pelvis: a historical overview].

The female pelvis is fundamental to life itself, but it took ages to grasp this truism. During Antiquity, physicians had no need for the concepts of pelvic dystocia and cephalopelvic disproportion. When Aranzo (16th century), a practising physician, stated that a disproportion between the size of the fetus and that of the bony pelvis was the main culprit of difficult labor, his suggestion was overlooked, so much so that it was Hendrik van Deventer (1701) who came to be coined "father of the pelvic theory". The need for an accurate knowledge of the dimensions of the maternal pelvis and of the fetal skull became imperative in the middle of the 18th century, when forceps extraction had become popular. Levret, but above all William Smellie, made valuable contributions to the pelvic theory, which, however, were weakened by Baudelocque's fallacies concerning the intrinsic value of external pelvimetry. After the first quarter of the 19th century, the epicenter of scientific obstetrics moved to Germany and Austria, and German-speaking practitioners, e.g. Michaelis, Litzmann, and the Naegele, deepened our insight in the mechanism of labor. After the discovery of the X-rays (1895), the use of instrumental pelvimetry declined, but the clinical breakthrough of radiopelvimetry was delayed until the twenties of this century. Radiopelvimetry, a very valuable technique indeed, dispensed a large number of mothers from undergoing abdominal delivery. However, awareness of the hazards of fetal-maternal exposure to ionizing radiation pushed ante- and intrapartum radiopelvimetry from the scene. Thanks to the progress of chemistry, pharmacology and electronics, "dynamic pelvimetry" became the fad, heralded by what is called "active management of labour". The fetus now assumed the role of "dynamic pelvimeter". The historical circle was closed.

Dystocia↗
PubMed1999

Measurement of obstetric conjugate by ultrasonic tomography and its significance.

OBJECTIVE: The purpose of this study was to investigate the clinical usefulness of the measurement of ultrasonic obstetric conjugate. STUDY DESIGN: In 209 pregnant women, ultrasonic obstetric conjugate was measured twice at 28 and 36 weeks of pregnancy. In 26 of these patients the measurement of obstetric conjugate by x-ray pelvimetry was also performed at 36 weeks of pregnancy because of medical indications. Obstetric outcome was investigated in association with ultrasonic obstetric conjugate. The relationship between ultrasonic obstetric conjugate and x-ray pelvimetry was investigated. RESULTS: Ultrasonic obstetric conjugate ranged from 10.7 to 15.1 cm. In 12 patients (5.7%) ultrasonic obstetric conjugate was less than 12 cm. Six of them (50.0%) underwent cesarean section because of dystocia. This percentage was significantly higher than 7.1% of the cesarean section rate (14 of 197) in patients with ultrasonic obstetric conjugate more than 12 cm (P <.001). A close positive correlation was observed between ultrasonic obstetric conjugate and x-ray pelvimetry (r = 0.91; P <.0001). CONCLUSIONS: We conclude that ultrasonic obstetric conjugate measurement is a safe and useful procedure in the prediction of dystocia.

Adult↗
PubMed1983

A mathematical approach to problems of cephalopelvic disproportion at the pelvic inlet.

So many problems have been left unsolved by x-ray pelvimetry for the prognostic diagnosis of cephalopelvic disproportion that the clinical usefulness of x-ray pelvimetry has been questioned and a more scientific approach to evaluation of cephalopelvic disproportion has been sought. By unifying various factors that impose problems in cephalopelvic relationships into one index via new mathematical models, we attempted to estimate quantitatively the potential dystocia caused by inlet disproportion. The index is calculated from ten measurements of data obtainable on roentgenograms, and the practical calculations can be readily done with a programmable calculator. The validity of the assumptions used in the mathematical models and the reliability of the developed index were retrospectively analyzed in 300 primiparous women with cephalic presentations. This study suggests that the mathematical index could serve as a useful prognostic guide to the proper management of labor in association with disproportion.

Cephalometry↗
PubMed1988

Efficacy of the fetal-pelvic index as a predictor of fetal-pelvic disproportion in women with abnormal labor patterns that require labor augmentations.

The fetal-pelvic index, which compares fetal head and abdomen circumferences with respective maternal inlet and midpelvic circumferences, was introduced in 1986 as a means of identifying the presence or absence of fetal-pelvic disproportion. In this study the efficacy of the fetal-pelvic index was evaluated in 46 patients with abnormal labor patterns that required labor augmentations and was compared with that of two other means (Colcher-Sussman x-ray pelvimetry and ultrasonographically derived estimated fetal weight greater than or equal to 4000 gm). Of the 24 women who required operative intervention (19 cesarean sections and five operative vaginal procedures), 17 had positive fetal-pelvic index values (sensitivity = 0.71). Six of the seven fetuses of patients with false-negative fetal-pelvic index values persisted in an occipitoposterior presentation, and these patients failed to progress in labor. Of the 22 patients in whom vaginal deliveries were spontaneous, 21 had negative fetal-pelvic index values (specificity = 0.95). Of the 18 women with positive fetal-pelvic index values, 17 required operative intervention (positive predictability = 0.94). In contrast, when used alone, neither x-ray pelvimetry nor ultrasonographically derived estimated fetal weight greater than or equal to 4000 gm provided accurate identification of fetal-pelvic disproportion.

Body Weight↗
PubMed1988

Efficacy of the fetal-pelvic index in patients requiring labor induction.

The fetal-pelvic index is a recently described means of identifying the presence or absence of fetal-pelvic disproportion. In this follow-up study, the efficacy of the fetal-pelvic index was evaluated in 49 patients requiring labor induction and was compared with two other methods used to identify fetal-pelvic disproportion (Colcher-Sussman x-ray pelvimetry and ultrasound-derived estimated fetal weight). Twelve of 14 patients who required operative intervention also demonstrated a positive fetal-pelvic index (sensitivity = 86%). Spontaneous vaginal deliveries occurred in 35 patients, all of whom demonstrated negative fetal-pelvic index values (specificity = 100%). Overall the predictability of the fetal-pelvic index was 96%. In comparison, when used alone, neither x-ray pelvimetry nor ultrasound-derived estimated fetal weight accurately detected the presence or absence of fetal-pelvic disproportion in patients requiring labor induction.

Abdomen↗
PubMed1999

Computed tomography comparison of bony pelvis dimensions between women with and without genital prolapse.

OBJECTIVE: To compare bony pelvis dimensions between white women with and without genital prolapse using computed tomography (CT) pelvimetry. METHODS: Thirty-four multiparous white women with vaginal prolapse beyond the hymen and 34 matched white controls with no signs or symptoms of pelvic support defects underwent CT pelvimetry. The anteroposterior and transverse diameters of the pelvic inlet, the interspinous diameter of the midpelvis, and the intertuberous diameter of the pelvic outlet were measured. Post hoc power analysis showed that 22 women were needed in each group to detect a 10% difference in the pelvic dimensions between groups, with an alpha error of 1% and a beta error of 10%, resulting in a 90% power. RESULTS: Mean (+/- standard deviation [SD]) age of the subjects was 63.4+/-8.3 years, compared with 62.9+/-7.8 years for controls. Mean parity of the subjects was 3.3+/-1.7, compared with 3.6+/-1.7 for controls. Mean (+/- SD) anteroposterior (12.5+/-1.3 versus 12.8+/-1.0 cm), interspinous (11.5+/-0.8 versus 11.2+/-0.9 cm), and intertuberous (10.0+/-1.0 versus 9.8+/-0.8 cm) diameters were not significantly different between study groups. Mean transverse diameter of the pelvic inlet was significantly greater in women with prolapse than those without prolapse (12.9+/-0.7 versus 12.4+/-0.6 cm, P = .006). CONCLUSION: Women with advanced vaginal prolapse have larger transverse inlet diameters than do women with normal pelvic support.

Female↗
PubMed1975

Outcome of term breech delivery in primigravidae. a feto peivicbreech index.

Analysis of 340 term breech presentations in primigravidas showed a corrected perinatal mortality of 1.5%; the elective cesarean section rate was 15%. The incidence of complicated labour, defined in the study, was analyzed with regard to different parameters, e.g. X-ray pelvimetry data in all 340 cases. Complicated labour in vaginal deliveries markedly increased with increasing fetal weight (p less than 0.001) and decreasing pelvic capacity (p less than 0.001). In each case the fetal weight and smallest pelvimetry data were given score points and the sum of these was called the Feto Pelvic Breech Index, which was correlated to the incidence of complicated labour. By using this index the mortality and the routine use of elective cesarean section. The prognostic methods available to detect feto-pelvic disproportion are discussed.

Birth Weight↗
PubMed1989

Maternal height, birthweight, obstetric conjugate and their influence on the management of parturients with a previous cesarean scar.

A retrospective analysis was made of the second deliveries of 492 women who had previously undergone emergency cesarean section with a clinical indication of cephalopelvic disproportion and had undergone X-ray pelvimetry. In their index (second) pregnancy, 234 (47%) had an elective cesarean section; 122 (25%) gave birth vaginally and 136 (28%) had undergone an emergency cesarean section. Maternal height had a moderate value as a surrogate measure of pelvic capacity. A trial labor was more often allowed in women with larger obstetrical conjugate (inlet) measurements but likelihood of a successful outcome of labor was not influenced by the above pelvic measurements. A baby weighing more than 4000 g was associated with a greatly reduced chance of a vaginal delivery. The study confirms the limitations of X-ray pelvimetry measurements and proposes that antenatal estimation of fetal size may be of benefit in determining the likelihood of success in a trial labor.

Birth Weight↗
PubMed1998

[Prediction of cephalopelvic disproportion by ultrasonographic cephalopelic].

OBJECTIVE: To develop a prospective antepartum method of identifying cephalopelvic disproportion by comparing the diameters of fetal head with those of the maternal midpelvis. METHODS: Transvaginal ultrasound pelvimetry was performed on 190 healthy primigravidas with cephalic presentation at 28-35 weeks of gestation, and the diameters of their fetal heads were meassured within one week prior to delivery. These indices the cephalopelvic indices of diameter, cirumference and area, were calculated and compared. RESULTS: The cephalopelvic index of diameter (CID), defined as the difference between the mean diameter of the midpelvis and the fetal biparetal diaameter (BPD), showed the highest degree of accuracy (77.9%). Eighty three percent of women with CID less than 15.8 needed operative delivery; 76.2% of those with CId more than 15.8 mm underwent vaginal delivery. CONCLUSIONS: Transvaginal ultrasound pelvimetry and the CID by and large seems to be able to identify cephalopelvic disproportion before labor and may help obsetricians choose the most appropriate form of delivery in an uncomplicated vertex presentation.

Adult↗
PubMed1984

[Sonographic diagnosis of channel pelvis].

This paper reports the findings in 22 primigravidae in whom Caesarian section was performed because of impaction of the head in mid-pelvis. 100 women who had normal deliveries served as controls. The routinely-determined external measurements of the pelvis were within the normal range in all women, whereas the distances between symphysis and the 3rd or 5th sacral vertebra were reduced in comparison with the conjugata externa in patients requiring Caesarian section. For an exact diagnosis ultrasound and X-ray pelvimetry was performed post sectionem. A reduced distance between the symphysis and the 3rd or 5th sacral vertebra was ascertained by both methods. Hence, a channel pelvis might be the main reason in these women for standstill in labour. The ultrasound and X-ray pelvimetry results were comparable.

Adult↗
PubMed1980

[An error in the determination of the bi-ischial diameter by the Thoms grid (author's transl)].

After recalling the principles of homothetics which are the basis of radiological pelvimetry by the Thoms method, the authors carry out a study of the pelvimetry accessory presently the most distributed in France. It turns out that the grid introduces an error that, depending upon the conditions under which it is used, can reach levels of 4% underestimation. This error of 4% of something that itself is merely a calculation has little impact since it only affects 8% of the results.

False Negative Reactions↗