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PubMed1985

Maternal height and shoe size as predictors of pelvic disproportion: an assessment.

A total of 351 women who gave birth in the Paddington and North Kensington Health District were studied in order to establish a factual basis for recording height and shoe size as indicators of pelvic adequacy. Because only 19 women had radiological pelvimetry assessment, type of delivery and length of labour were used as proxy measures of disproportion. Of the 57 women with a shoe size less than 4 1/2, 21% were delivered by caesarean section compared with 10% of the group with shoe size between 4 1/2 and 6 and only 1% of the group with shoe size greater than or equal to 6 1/2. Similar relations with height were not generally found. The data were further examined using logistic regression models of the expected percentages of mothers having an adverse delivery. The models confirmed and extended the more simple analysis.

Body Height↗
PubMed1985

Vaginal delivery following caesarean section.

A retrospective analysis was made of 456 patients who had previously undergone Caesarean section and who were considered suitable for a trial of labour. Sixty percent of patients had a vaginal delivery. Patients with obstructed labour or failure to progress as the indication for primary Caesarean section were significantly more likely to require a repeat operation but 44% of these patients still achieved a vaginal delivery. Patients who had had a vaginal delivery prior to, or subsequent to, the Caesarean section had a low incidence of repeat Caesarean section. X-ray pelvimetry was of limited value in predicting outcome. Intravenous oxytocin was used in 17% of patients. No uterine rupture occurred and no fetal mortality resulted directly due to the trial of labour. Trial of labour following Caesarean section is a safe procedure when conducted in an appropriate hospital setting.

Adolescent↗
PubMed1990

The influence of maternal height, obstetrical conjugate and fetal birth-weight in the management of patients with breech presentation.

The value of erect lateral X-ray pelvimetry for selecting patients for a safe trial of vaginal delivery was assessed in a retrospective study of 424 women with a breech presentation. A trial labour was more often allowed in women with larger inlet conjugate measurements and the chance of successful vaginal delivery was better with larger pelvic measurements. However, there was no absolute level of pelvic contraction below which vaginal delivery was impossible. The size of the fetus did not determine the rate of planned elective Caesarean section. A fetus weighing greater than 3,500 g, had less than 50% chance of vaginal delivery. It is suggested that antenatal assessment of fetal size should be considered in patients with breech presentation before deciding on the mode of delivery.

Birth Weight↗
PubMed1975

The effects of diagnostic X-ray exposure on the human fetus: an examination of the evidence.

Epidemiological studies have demonstrated an increased incidence of morbidity and mortality among children exposed prenatally or preconceptually to diagnostic x-rays, as compared to nonirradiated controls. In those studies radiation exposure occurred on a selective basis, as the examination was always medically indicated. Comparisons of those studies and comparable ones in which radiation exposure occurred on a nonselective basis (from routine pelvimetry examinations or atomic bomb radiation) indicate that the latter studies do not confirm the former and a significant discrepancy is present in each instance. Thus, some doubt is cast on the validity of the former studies.

Child↗
PubMed1999

Obstetric MR imaging.

The surge in the development of fast magnetic resonance (MR) techniques has revolutionized our ability to image the pregnant patient and the fetus. Fast MR imaging techniques provide excellent resolution for imaging the maternal and fetal anatomies without the need for sedation. This article addresses the use of fast MR imaging techniques in the evaluation of the pregnant patient for adnexal masses, pelvimetry, hydroureteronephrosis of pregnancy, and placenta accreta. In addition, fetal anomalies for which MR imaging has proved useful, such as ventriculomegaly, arachnoid cysts, and abdominal masses, are described.

Female↗
PubMed1984

The changing place of radiology in obstetrics.

In 1970 42% of antenatal patients had an X-ray examination (88.6% involving abdominal exposure) but with the introduction of an ultrasound service in 1976 this figure had dropped to 3% by 1980. Looking at the indications for these it can be seen that X rays were still commonly performed for the detection of fetal abnormality and a further reduction in X-ray exposure of pregnant women could be achieved by using ultrasound in this situation. There was a dramatic decline in the use of erect lateral pelvimetry when the fetal presentation was known to be cephalic, especially when the head was engaged, reflecting an increasing awareness by obstetricians that this investigation is unrewarding in clinical practice.

Congenital Abnormalities↗
PubMed1977

The influence of the bony pelvis in persistent occiput posterior position.

Roentgenologic pelvimetry has been performed in 68 consecutive cases of occiput posterior position. The results point to an influence from a transverse narrowing of the pelvis or a tendency towards large dimensions. In many cases, however, no clear correlation to pelvic dimensions is found. A significant difference exists in the rate of obstetrical complications between nulliparous and parous women. The reasons for this and for the persistent OP position are discussed.

Female↗
PubMed1984

The course of subsequent pregnancies after previous cesarean section.

The course of pregnancies subsequent to cesarean section (CS) was studied. During the years 1970-72, 543 women were delivered by CS at Borås Central Hospital. A questionnaire was sent to all 543 during the autumn of 1976 and the spring of 1977. The questions concerned further conceptions and the outcome of all subsequent pregnancies after CS. Of the 440 (81%) women who answered the questionnaire, 244 (55.5%) became pregnant, the total number of subsequent pregnancies being 306. The incidence of spontaneous abortion, extra-uterine pregnancy and legal abortion was not significantly higher than the corresponding rate for the total material for our department during the same period. Among the 215 women who completed a new pregnancy, an elective CS was performed in 81 cases (38%). Trial of labor occurred in 143 patients, 91 of whom (68%) gave birth per vaginam , while 43 (32%) were delivered by acute CS. In nearly half of the acute CS cases the indication was a narrow pelvis not detected until labor had started. This indicates that roentgenologic pelvimetry should be considered in certain cases, when planning delivery after a previous CS.

Abortion, Spontaneous↗
PubMed1986

Results of a five-year prospective study using a feto-pelvic scoring system for term singleton breech delivery after uncomplicated pregnancy.

Two hundred and twenty-six term singleton breech deliveries were managed prospectively during a 5-year period according to Westin's feto-pelvic scoring system based on X-ray pelvimetry, estimated fetal weight, type of breech, and outcome of previous vaginal deliveries. The vaginal delivery rate was 45.1% and cesarean section rate 54.9%. 81.5% of cesarean sections could be planned in advance, based on the scoring system. Corrected neonatal mortality was nil and persistent morbidity was 0.4% for the whole material. Asphyxia, defined as 5 min Apgar score less than 7, occurred in only 1% of cases, evenly distributed among vaginal and planned cesarean deliveries. It was possible by means of the scoring system to identify a group of women who could give birth vaginally, without any mortality or persistent morbidity.

Adolescent↗
PubMed1987

Influence of the pelvic outlet capacity on fetal head presentation at delivery.

The influence of pelvic outlet capacity on fetal head presentation in 1,402 term primiparas with normal pregnancies was studied. In all cases radiological pelvimetry was carried out and labor started spontaneously. Occiput posterior (OP) delivery occurred in 5.1%. As pelvic outlet capacity decreased an increased frequency of OP presentations and need for epidural anesthesia (EDA) was found. With OP presentation the duration of labour was longer, the frequency of EDA, instrumental delivery, cesarean section and low Apgar score at 1 minute were all higher, all compared with occiput anterior (OA) presentation. No difference in fetal morbidity was found. When the influence of the pelvic outlet capacity was eliminated through comparison of matched groups, the course of delivery became more similar whether the presentation was OA or OP and the frequency of EDA became the same. Reduced pelvic outlet capacity seemed to be one cause of both OP presentation and the use of EDA.

Anesthesia, Epidural↗
PubMed1988

[Possibilities of obstetric pelvic diagnosis].

The management of pelvic examination in the department of obstetrics and gynecology, county-hospital Suhl is pointed out. Discussion of all clinical and radiological facilities in the pelvic examination both in breech and in head presentation. The X-ray pelvimetry is recommended in case of suspicion of a contracted outlet of the pelvis and generally for planning the management in case of breech presentation after the exclusion of an indication for a primary caesarean section.

Breech Presentation↗
PubMed1986

[New aspects in improved management of labor].

The increase of obstetric operating frequency observed in the last years is to attribute to a better recognition and valuation of maternal and fetal risk and on the other hand to a false interpretation of cardiotocography. With respect to induction and management of labour from a lot of partly controversial opinions is the following to conclude for the practice: Utilisation of all diagnostic possibilities including fetometry, pelvimetry, and cervical ripeness. Therapeutic arrangement should include cervical ripening, mobilisation of patient and labour timing depending on internal tocometry. The operative delivery is to consider as an ultima ratio. Labour management can be optimated by means of a clinic-specific partogram considering the active phase. Every indicated induction of labour demands internal tocometry. The pharmacological control of uterine activity must be used differentially. It must be waited for, if the quantification of labour activity improves the obstetrical-perinatological parameters.

Cesarean Section↗
PubMed1979

Pelvic dimensions and the outcome of trial labour in Shona and Zulu primigravidas.

Pelvic contraction is very prevalent in Africa while radiological facilities to assess pelvic size and shape are seldom available. A trial of labour using simple guidelines on a cervicograph can enable the midwife to detect dysfunctional labour and can help medical staff to manage these problems. Radiological checks in 116 Black primigravid patients with dysfunctional labour demonstrated that an active trial of labour is accurate in determining which of these patients have marked disproportion requiring caesarean section, minimal disproportion requiring assisted delivery, or primary uterine inertia responding to oxytocic stimulation. The role of radiological pelvimetry in African obstetrics is discussed, and the radiological features of the Shona and Zulu pelves in this series are described.

Black or African American↗
PubMed1984

Vaginal delivery for the selected frank breech infant at term.

A retrospective analysis of 254 term breech deliveries was done, with term breech presentations managed by a protocol in which cesarean section was done for nonfrank breech presentation, or estimated fetal weight in excess of 4000 g. Patients with frank breech presentation were assigned to one of three groups based on x-ray pelvimetry and estimated fetal weight. Of 70 group 1 patients (adequate pelvis with estimated fetal weight less than 3600 g), 79% had a vaginal delivery. Of 21 group 2 patients (borderline pelvis or estimated fetal weight of 3600 to 4000 g), 67% delivered vaginally. In group 3 (contracted pelvis or estimated fetal weight greater than 4000 g), all patients were delivered by cesarean section. The overall cesarean section rate for frank breech infants was 36%. Apgar scores were not significantly different for infants delivered vaginally or abdominally. The crude perinatal mortality rate was 11.8; the corrected perinatal mortality rate was 0. These findings further substantiate the safety of these criteria in management of term breech presentations.

Birth Weight↗
PubMedDate not supplied

Floating fetal head in primiparas at term.

A total of 924 pelvimetries made for floating fetal head at term in primiparas was analyzed according to the pelvic parameters and outcomes. More android and platypelloid type pelves, and more OP position and Naegele's obliquities were found. Significant shortening of obstetrical conjugate. A-P diameter of actual inlet and reduced Mengert area of the inlet were the common characteristics in this series. One third of the patients required abdominal delivery, and half of the vaginal deliveries needed instrumental help.

Female↗
PubMed1980

[The diagnostic value of petrous bones in the fetal scalp (author's transl)].

We studied the orientation of the petrous bones in the fetal scalp in 200 X-ray pelvimetries. It is easy to measure the petrous bones' orientation when the fetal scalp is studied with Thoms view. It is possible to measure the height of the head in the pelvis in the lateral view. We have been able to measure asynclitism in flexion using a calculating machine. It seems to us that these findings are useful for the practical conduct of labour and can be of helpful prognostic value.

Female↗
PubMed1981

[Obstetric manipulations including amnioscopy, amniotomy, and vaginal examination and duration of labour -- impact on maternal susceptibility to infection (author's transl)].

A detailed analysis was made of 139 deliveries, which had been systematically supervised, following amnioscopy and pelvimetry, in comparison to 104 deliveries, following spontaneous onset of labour and timely rupture of the amnion. Both variants were compared for the relative risk of infection to the mothers involved. --While infection morbidity was, surprisingly, unaffected by the interval between rupture and parturition, it was found to depend strongly on the duration of labour with the amniotic sac intact. --Morbidity, also, went up clearly along with the number of previous amnioscopies and of surgical deliveries, in particular caesarean section. --Discoloration of amniotic fluid, obviously, did not stimulate germ growth nor was any detrimental effect recordable from vaginal examination. --Early artificial rupture is considered good prophylaxies not only against infection but also against asphyxia.

Female↗