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PubMed1996

Ambulatory urodynamics: extramural testing of the lower and upper urinary tract by Holter monitoring of cystometrogram, uroflowmetry, and renal pelvic pressures.

This article elucidates the clinical applicability and state of the art of ambulatory urodynamics. Ambulatory urodynamics have evolved into practical investigations like EAC, HFM, and EAC combined with renal pelvimetry. EAC has been shown to be the method of preference if detrusor overactivity is involved. Conventional filling cystometry has proved to be an unreliable way to exclude detrusor instability. De novo instability after suspension surgery often indicates that an existing detrusor overactivity was not identified preoperatively. EAC including flowmetry has shown considerable variance in obstructive and contractility parameters in males with LUTS indicative for BPH. This raises doubt whether the clinical flow analysis is the suitable "gold standard" as advocated by the ICS. For a real break through of EAC, less complex automatic analysis is necessary. HFM is a newer method within the range of ambulatory urodynamic tests. It has not yet been completely evaluated. But, because the technique is analogous to the office flowmetry, noninvasive and very well accepted by the patients, it is expected to be widely used. This expectation is strengthened by the fact that HFM seems to show individual therapeutic efficacy of drugs, such as alpha-blockers. As a research tool to evaluate efficacy, it is far more powerful than conventional methods because of the reduction of within-patient standard deviation to about 10%. Finally, EAC combined with pelvimetry offers a promising method for the clinical evaluation of a combined dysfunction of upper and lower urinary tract.

Humans↗
PubMed2000

Aetiology and management of the secondary brow.

The finding that a brow presenting within the pelvic cavity in the mento-anterior position during the second stage of labour could be easily and safely delivered by means of Kielland's forceps rotation and extraction led to a search for the cause of this rare phenomenon since normally brows are associated with non-engagement of the head. A personal series of six cases, collected over 39 years, were studied. Particular attention was paid to pelvic size and shape with detailed X-ray pelvimetry being obtained in the puerperium from the latter three patients. In all cases the pelvises were found to be commodious and, in the three where X-ray pelvimetries were taken, they were found to be anthropoid in shape, which is known to favour the occipito-posterior position. Past and subsequent pregnancies conducted by the author were in every instance associated with an occipito-posterior position, and a mechanism of labour for secondary brow presentations until impasse occurred was suggested. It was concluded that the condition only occurred when the pelvis was roomy and anthropoid in shape, and, for those experienced in their use, Kielland's forceps rotation and extraction was preferable to caesarean section. Furthermore, aficionados of the ventouse were warned to avoid attempting delivery with that instrument for such would be doomed to failure.

Journal Article↗
PubMedDate not supplied

Toxic agent and radiation control: meeting the 1990 objectives for the nation.

Toxic agent and radiation control is 1 of the 15 health priority areas addressed through the Public Health Service's Objectives for the Nation. Several gains in moving toward the 1990 goals for toxic agent and radiation control have been recorded. Research and technical assistance, combined with legislation to reduce the amount of lead in gasoline, have contributed to a decrease in the mean blood lead level of the general population. New testing procedures have been developed to evaluate both reproductive and developmental toxicities of chemicals. Educational implementation of pelvimetry referral criteria in a multiyear study involving approximately 200 U.S. hospitals has resulted in a 50 percent reduction in the number of pelvimetries performed. Health-related responses have been given to environmental problems such as exposures to polychlorinated biphenyls (PCBs) in Massachusetts and Florida and exposures to dioxin in Missouri and New Jersey. Chemical records for some 1,000 compounds likely to occur in chemical dumps or in bulk transit are being either created or updated to enhance online data retrieval services. For the foreseeable future, however, improvement of knowledge of the potential health risk posed by toxic chemicals and radiation must remain one of the most important priorities. To control toxic agents, development of surveillance systems and data bases are equally important.

Adult↗
PubMed1998

Does successful completion of the Perinatal Education Programme result in improved obstetric practice?

OBJECTIVE: To determine whether successful completion of the Perinatal Education Programme (PEP) improves obstetric practice. METHOD: The three midwife obstetric units (MOUs) in a health district of Mpumalanga were included in the study. Two MOUs enrolled in the PEP and the third did not. A 'before-and-after' study design was used to assess any changes in practice, and to monitor whether any changes occurred in the district during the time of the study; data were also collected at the third MOU. Data were collected by scoring of the obstetric files after the patient had delivered. OUTCOME MEASURES: We ascertained whether the obstetric history, syphilis testing, blood group testing, haemoglobin measurement and uterine growth assessment were performed during antenatal care along with whether appropriate action was taken. For intrapartum care, estimation of fetal weight, the performance of pelvimetry, blood pressure monitoring, urine testing, evaluation of head above pelvis, fetal heart rate monitoring, monitoring of contractions and plotting of cervical dilatation, and whether the appropriate actions were taken, were assessed. RESULTS: Eight of the 13 midwives at the two MOUs completed the PEP and all demonstrated an improvement in knowledge. Case notes of 303 patients from the various clinics were studied. There was no change in the referral patterns of any of the clinics during the study period. The obstetric history was well documented, but in no group was there a satisfactory response to a detected problem; appropriate action was taken in between 0% and 12% of cases. Syphilis testing was performed in 56-82% of cases, with no difference between the groups. The haemoglobin level was measured in only 4-15% of patients, with no difference before or after completion of the PEP. Where a problem in uterine growth was detected, an appropriate response occurred in 0-8% of patients and no difference before or after completion of the PEP was ascertained. In all groups, estimation of fetal weight and pelvimetry were seldom performed, the urine and fetal heart rate documentation were moderately well done and the blood pressure monitoring, assessment of head above pelvis, monitoring of contractions and plotting of cervical dilatation were usually performed. No differences before or after the PEP were detected. Where problems were detected, appropriate actions taken during labour improved, but not significantly. CONCLUSION: Completion of the obstetric manual of the PEP improved the knowledge of the midwives but no alteration in practice was detected.

Africa↗
PubMed1993

Influence of pelvic osteotomy on birth canal size.

Six pelvic osteotomies (Salter, Sutherland, Steel, Tönnis, Chiari, and periacetabular) were performed on the right hemipelvis of adult female pelvic plastic models. Each pelvis underwent conventional X-ray and computed tomographic digital pelvimetry before and after osteotomy. The change in the anteroposterior and transverse dimensions at the inlet, midpelvis, and outlet were calculated. None of the osteotomies significantly decreased the inlet. The Salter and Sutherland osteotomies decreased the midpelvis to borderline low. The Salter, Sutherland, and Steel osteotomies significantly decreased the pelvic outlet. These changes correlated closely with those in living patients. Much of this decrease is nullified when the osteotomy is performed prior to the pubertal growth spurt.

Adult↗
PubMed2002

The long-term effect of pelvic osteotomy on birth canal size.

The effect of pelvic osteotomy on birth canal size at skeletal maturity is unknown. This information would be useful to counsel women of reproductive age who have undergone pelvic osteotomy. It was the purpose of this study to answer that question. A retrospective review of girls who had undergone pelvic osteotomy in the period 1980-1999 was performed. Transverse plane birth canal dimensions (inlet, mid-pelvis, and outlet) were measured from radiographs before and after osteotomy and at final follow-up. Final follow-up diameters were compared to threshold values (obstetric pelvimetry and clinical guidelines). There were 37 patients (40 osteotomies: 31 Salter, 5 Steel, 2 Chiari, and 2 Ganz). The average age at osteotomy was 7.5 +/- 5.3 years (range 2.0-21.3 years), and at final follow-up was 16.0 +/- 4.7 years (range 2.9-25.7 years); the average follow-up was 8.5 +/- 5.2 years (range 0.5-17.6 years). The effect of osteotomy at skeletal maturity was investigated by analyzing the 30 children > or = 14 years of age at the final follow-up. The pelvic inlet was above the threshold for all 30 children. The mid-pelvis was below the low normal threshold (9.5 cm) in 3 of 21 Salter, 2 of 5 Steel, and 1 of 2 Chiari osteotomies. The pelvic outlet was below the threshold in 2 of 21 Salter and 2 of 5 Steel osteotomies. The mid-pelvis dimensions were narrower in those who underwent osteotomy when older: 7.1 +/- 4.9 years (n = 24) and 11.9 +/- 7.9 years (n = 6) (p = 0.06) for those above and below the 9.5 cm mid-pelvis threshold, respectively. In conclusion, 6 of the 30 cases had a mid-pelvis which was below threshold at skeletal maturity. If the transverse mid-pelvis diameter at skeletal maturity is < 9.5 cm, then the likelihood of Cesarean section is increased, and this information should be given to the patient.

Adolescent↗
PubMed1978

The randomized management of term frank breech presentation: vaginal delivery vs. cesarean section.

A prospective study of the management of term frank breech presentation is currently ongoing at LAC-USC Medical Center. To date, 57 patients have been randomized to an elective cesarean section group and 70 to a vaginal delivery group. Of the 70 patients selected for vaginal delivery, 35 had one or more inadequate pelvic measurements by x-ray pelvimetry and were scheduled for indicated cesarean section. Of the remaining 35 patients in this group, 30 delivered vaginally without perinatal death. Two of the infants, however sustained brachial plexus injuries. Of the 57 patients scheduled, 55 underwent elective cesarean section. There were no maternal deaths, but 20 (36.4%) patients experienced morbidity and 5(9.1 per cent) patients experienced intraoperative complications. Based on the data accumulated to date, it seems reasonable to allow vaginal delivery in carefully selected cases of term frank breech presentation.

Adult↗
PubMed1986

The fetal-pelvic index as an indicator of fetal-pelvic disproportion: a preliminary report.

The objective of this study was to develop a standardized method of identifying fetal-pelvic disproportion by comparing fetal head and abdomen circumferences with the respective maternal pelvic inlet and midpelvis circumferences. Fetal ultrasound and maternal x-ray pelvimetry measurements were performed on 75 term pregnant women with indications for a trial of labor. By means of individually measured fetal and maternal pelvic diameters, circumferences of the fetal head, fetal abdomen, maternal pelvic inlet, and maternal midpelvis were computed. Based on four circumference differences between the fetus and maternal pelvis (fetal head--maternal pelvic inlet, fetal head--maternal midpelvis, fetal abdomen--maternal pelvic inlet, and fetal abdomen--maternal midpelvis), a fetal pelvic index number was derived from the sum of the two most positive values. Of the 27 patients requiring cesarean sections for failure to progress in labor, all but four had positive fetal pelvic index values (sensitivity = 85%). Of the 48 patients who were delivered vaginally, all but four had negative fetal pelvic index values (specificity = 92%).

Birth Weight↗
PubMed1988

Efficacy of the fetal-pelvic index for delivery of neonates weighing 4000 grams or greater: a preliminary report.

The fetal-pelvic index was recently introduced as an accurate method of prospectively identifying the presence or absence of fetal-pelvic disproportion. In that report the ability to detect fetal-pelvic disproportion in patients with macrosomic fetuses was not specifically addressed. The objective of this study is to compare the efficacy of three methods used to identify the presence or absence of fetal-pelvic disproportion (the fetal-pelvic index, Colcher-Sussman x-ray pelvimetry, and estimated fetal weight greater than or equal to 4000 gm) in patients delivered of neonates weighing greater than or equal to 4000 gm after an adequate trial of labor (N = 34). Of the 18 patients requiring operative intervention, all but one had a positive fetal-pelvic index value (sensitivity = 94%). Of the 16 patients in whom vaginal deliveries were spontaneous, all but one had a negative value (specificity = 94%). On the basis of these data, the fetal-pelvic index is an accurate method of predicting the presence or absence of fetal-pelvic disproportion in patients delivered of neonates weighing greater than or equal to 4000 gm.

Birth Weight↗
PubMed1992

Efficacy of the fetal-pelvic index in nulliparous women at high risk for fetal-pelvic disproportion.

OBJECTIVE: The null hypothesis of this study is that the fetal-pelvic index will not determine the presence or absence of fetal-pelvic disproportion in 137 nulliparous women at high risk for fetal-pelvic disproportion. STUDY DESIGN: This study was undertaken by comparing the blinded fetal-pelvic index values and two other methods of identifying fetal-pelvic disproportion, ultrasonography-derived estimated fetal weight greater than or equal to 4000 gm and Mengert's index, to delivery outcomes in 137 nulliparous women at high risk for fetal-pelvic disproportion. RESULTS: After adequate labor trials, 55 of 73 patients who required operative intervention had a positive fetal-pelvic index (sensitivity = 75%). Seventeen of the 18 patients with a false-negative fetal-pelvic index value had persistent malpositions (15 occipitoposterior, 1 occipitotransverse, and 1 face presentation). Spontaneous vaginal deliveries occurred in 64 patients with 62 of them having a negative fetal-pelvic index (specificity 97%). The overall predictability of the fetal-pelvic index in this patient population was 85% and the positive predictability was 96%. However, neither ultrasonography-derived estimated fetal weight nor x-ray pelvimetry, when used alone, accurately detected the presence or absence of fetal-pelvic disproportion in nulliparous women at high risk for the condition. CONCLUSION: The fetal-pelvic index is efficacious in determining the presence or absence of fetal-pelvic disproportion in nulliparous women at high risk for the condition.

Birth Weight↗
PubMed1991

The effect of squatting on pelvic dimensions.

Lateral X-ray pelvimetry was performed on 63 women in the sitting and squatting positions on the 5th or 6th post-natal day to assess whether squatting has any effect on pelvic dimensions. Four assessors measured the inlet and outlet pelvic dimensions from 25 cases with good radiographic views in order to minimise observer bias. There was no statistically significant change in pelvic dimensions with squatting. Some possible explanations are discussed.

Female↗
PubMed2003

Factors associated with first service conception in artificially inseminated nulliparous Holstein heifers.

Animal and management factors associated with first service conception in nulliparous dairy heifers were determined in 601 Holstein heifers from a dairy farm in north central Florida. Animal data collected included body weight, height at the withers and tail head, body condition score at 6 months of age and just prior to first artificial insemination (AI), and pelvimetry measurements taken just prior to first AI. Management data included season of first AI, inseminator, service sire, method of estrus detection, whether the estrus of first insemination was induced using prostaglandin F(2alpha) (PGF(2alpha)), and whether the heifer received a modified live virus (MLV) vaccine within 21 days of first insemination. Data were analyzed using multivariable logistic regression. Heifers inseminated in the summer were more than four times less likely to become pregnant to first insemination than heifers bred during the rest of the year (odds ratio (OR)=0.24; 95% CI=0.14, 0.41). Using secondary signs for estrus detection instead of standing estrus resulted in significantly reduced odds of conception to first service (OR=0.37; 95% CI 0.13, 1.02). Also, heifers inseminated at estrus induced by PGF(2alpha) were approximately one-third less likely to conceive than those heifers inseminated to a naturally occurring estrus (OR=0.66; 95% CI 0.46, 0.95). An interaction between pelvic size and breeding season was found indicating that large pelvic size had a significant positive effect on fertility in the summer, but was not associated with conception to first service in the winter.

Analysis of Variance↗
PubMed2003

Use of fetal-pelvic index in the prediction of vaginal birth following previous cesarean section.

AIM: To clarify the usefulness of the fetal-pelvic index as a predictor of vaginal birth after previous lower segment cesarean section. METHODS: One hundred and seventy women with one lower segment cesarean section who attempted for trial of vaginal birth were enrolled. Pelvimetry was performed to measure maternal pelvic inlet and mid-cavity circumferences at 37 weeks gestation. Ultrasound was performed to measure fetal head and abdominal circumferences at 38-39 weeks. The fetal-pelvic index was derived. The predictability of fetal-pelvic index in the predicting the outcome of delivery was calculated. RESULTS: Fifty-seven (33.5%) women required repeated cesarean section and 113 (66.5%) delivered vaginally. Twenty-two women with positive fetal-pelvic index had repeated cesarean section. The predictability of positive fetal-pelvic index was 48.9%. Ninety of the 125 patients with a negative fetal-pelvic index delivered vaginally. The predictability of negative fetal-pelvic index was 72.0%. CONCLUSIONS: Fetal-pelvic index derived in the antenatal period has low predictive value in predicting of successful vaginal birth after cesarean section. This index is not useful in clinical practice.

Adult↗
PubMed1993

[Prevention of human birth trauma I. Computer-assisted simulation of delivery using magnetic resonance tomography and finite element analysis].

Imaging procedures suitable for diagnosis of cephalopelvic disproportion, such as radiological pelvimetry, computer- or magnetic resonance imaging (MRI) fail to reflect the dynamics of delivery, including deformations of the birth channel as well as of foetal structures. In order to validate findings of imaging procedures in this respect, a method has been developed to perform dynamic, biomechanical postprocessing of the static information obtained from MRI. Using a specially developed software MRI pixel, matrices of the maternal pelvis and the foetal head were colour-coded and--according to the principle of equal density--line data were created. After sectional attribution of the resulting polygones, a three-dimensional mesh of so called Finite Elements (FE) was created, which can then be used for deformation analysis. The foetal head was then moved through the birth channel by means of computed simulation. This allows not only ongoing deformations to be visualised, but also resulting forces can be calculated at any time of the delivery process for any point of the anatomical model. Furthermore, these calculations can be performed assuming various conditions such as different cephalopelvic dimensions and various labour forces or biomechanical properties of the tissues involved. This paper aims at presenting the method and its mode of working by means of one example of a computed birth simulation.

Adult↗
PubMed1990

[MR pelvimetric reference values].

Complete pelvimetry can be easily performed via MR. As shown by comparing the measurements of 4 observers its reproducibility is acceptable. The reference diameters obtained on 53 patients by MR are in 7 out of 9 dimensions larger than those of anatomical and obstetrical textbooks, which have not changed in the last 100 years. Hence, with the general increase in population size an increase in pelvic diameters has taken place.

Adolescent↗
PubMed1987

Soft tissue and pelvic dystocia.

This article has considered the subject of bony pelvic dystocia and soft tissue dystocia. Dystocia most often results from a combination of fetal and pelvic factors. However, on many occasions the size and shape of the pelvis is the initial problem, which encourages the fetus to take up a malposition such as occiput-posterior, and this in turn results in a dysfunctional contraction pattern that may or may not be corrected by oxytocin augmentation--a vicious circle that can only be broken by performance of a cesarean section. With minor degrees of pelvic dystocia, asynclitism and molding of the fetal head can often make a safe vaginal delivery possible. Clinically all pelvises can be categorized into adequate, questionable, and too small. The latter group is the least common and generally includes the congenitally or developmentally abnormal pelvises, and in most cases primary cesarean section should be the mode of delivery. In all other pelvises with a vertex presentation, a trial of labor is indicated because the fetal head is an excellent pelvimeter. With proper fetal monitoring with an intrauterine pressure catheter, with the use of a partograph to assist in the diagnosis of an active-phase arrest, followed by a cesarean section at the appropriate time, there is no increase in fetal or maternal morbidity. If the breech is the presenting part, then there are only two types of pelvis--very adequate and inadequate--and x-ray pelvimetry should be used to help in the classification.(ABSTRACT TRUNCATED AT 250 WORDS)

Contracture↗
PubMedDate not supplied

Fetal shoulder measurements with MRI.

OBJECTIVE: We studied the ability of MRI to predict fetal shoulder width (FSW). MATERIALS AND METHODS: In 30 patients referred for MR pelvimetry, measurement of FSW was performed and compared with caliper measurements at term. We report here the feasibility of a method using axial and coronal MR images oriented to the fetal body axes. RESULTS: Shoulder width by MRI (mean = 12.76 +/- 1.42 cm) correlated significantly with postnatal orthopedic caliper measurements (mean = 12.99 +/- 1.37 cm; r = 0.955, SEE = 4.29 mm, p = 0.00001) and with birth weight (r = 0.63, p = 0.0005). Mean paired differences showed a statistically significant 2.3 +/- 4.2 mm underestimation of FSW by MRI (p = 0.01). This reasonably quick nonionizing technique seems to have the potential for evaluating shoulder dystocia and deserves further evaluation.

Female↗