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PubMed1994

Rearing performance of Merino, Sa Mutton Merino and Dormer ewes in relation to live mass, reproduction and pelvic dimensions.

Live mass, reproduction and pelvic dimensions (determined mainly by radiographic pelvimetry at more than 4 years of age) were obtained for ewes of the Langgewens Merino flock (n = 102), ewes of the Tygerhoek Merino flock (n = 434) and ewes of the Elsenburg SA Mutton Merino (n = 130) and Dormer flocks (n = 130). Ewes were classified as "good" or "poor" according to their rearing ability (ewes rearing/ewes lambed--Er/El) and rearing performance (lambs reared/lambs born--Lr/Lb) averaged over at least 4 lambings in 4 to 5 lambing opportunities. Good ewes tended to be lighter than poor ewes at 18 months (Merino) or weaning (SA Mutton Merino and Dormer). This tendency was also reflected in live mass at the time of radiography, being significant (P < or = 0.01) in Tygerhoek Merinos. Good and poor ewes were similar with regard to fecundity (lambs born/ewes lambed) and lambing percentage (lambs born/ewes joined), but differed (P < or = 0.01) markedly with regard to rearing percentage (lambs reared/ewes joined), Er/El and Lr/Lb. Poor ewes constituted 6.9 to 21.7% of the available ewes in the respective flocks, and were involved in 38.9 to 56.9% of all cases of rearing failure. Good ewes had smaller (P < or = 0.07) transverse pelvic diameters than poor ewes in the Langgewens Merino and Elsenburg Dormer flocks, while rearing performance was independent of transverse diameter in the other two flocks. Good ewes generally had larger conjugate pelvic diameters than poor ewes, significantly (P < or = 0.05) so in the case of the 2 Merino flocks.

Animals↗

PubMedDate not supplied

[A knowledge-based system for the interpretation of pelvimetric findings].

Digital Image Intensifier Radiography (DIR) as well as Nuclear Magnetic Resonance Tomography (NMR) using an especially developed imaging routine for pelvimetry are suitable tools for the assessment of the anatomical conditions when mechanical problems are supposed to occur during birth (cephalopelvic disproportion, breech presentation). A concept for an optimised evaluation procedure of these imaging techniques has been developed, including: a more elaborate measuring protocol, easily and precisely executable due to appropriate software packages being implemented in the diagnostic units, calculation of obstetrically relevant parameters not deriving immediately from the imaging procedures. This is possible by means of multiple regression analysis of a data base from 467 evaluated female pelvis computed tomograms, calculation of intrapelvic soft tissue place requirements by means of correlative analysis of female computed tomograms and weight-/height-index, empirical determination of cut off values in borderline pelvi-fetometric constellations evaluating 190 births by means of logistic regression of the according pelvic-fetometric data. The calculations necessary to obtain all these parameters are implemented in a software package which also contains an algorithm for the general characterisation of an individual pelvis. Thus, a rather sophisticated knowledge base for pelvic assessment becomes easily accessible.

Adult↗

PubMed1993

Breech presentation.

This review covers recent literature relevant to breech presentation. Some have advocated routine elective cesarean delivery of the breech fetus of any gestational age to reduce the alleged increase in perinatal morbidity and mortality associated with breech presentation. This indication for cesarean delivery accounts for approximately 15% of all cesarean deliveries and costs society approximately US$ 1.4 billion per year. As a result of concerns with vaginal breech delivery, external cephalic version in the term fetus has become well accepted. A new scoring system has been developed to predict the success of external cephalic version. Repeated external cephalic version has been shown to be successful. Careful ultrasound continues to be important before the procedure. It has been suggested that magnetic resonance pelvimetry may be a practical alternative in evaluating candidates for breech vaginal delivery. There is still no compelling prospective data supporting cesarean delivery for preterm breech presentation. Legal considerations have prevented many from attempting vaginal breech delivery, even in carefully selected patients.

Breech Presentation↗

PubMed1996

Radiopelvimetry after cesarean section.

OBJECTIVE: To develop a method of identifying bony pelvic dystocia in a select group of primiparae who had had a cesarean delivery and might be at risk during a trial of labor in a subsequent pregnancy. STUDY DESIGN: Radiopelvimetry was performed on 70 postpartum primiparae after cesarean delivery for various reasons and prior to being discharged from the hospital. RESULTS: Using standard radiologic criteria, the pelvis was considered adequate in 32 patients (45.7%) and inadequate in 38 (54.2%). CONCLUSION: Postcesarean pelvimetry may be beneficial in some primiparae because it can guide the obstetrician in performing a cesarean delivery in subsequent pregnancies without an unnecessary trial of labor.

Adult↗

PubMed1977

Diagnostic irradiation of women during the reproductive period.

The date of onset of the last menstrual period should be given on radiographic requisitions for all women of reproductive age. Every effort should be made to avoid unnecessary irradiation of any woman who might be pregnant. Radiation damage in the first 2 weeks of pregnancy, however, should be "all or none", resulting in either a miscarriage or a normal child. Diagnostic radiology procedures are not indications for therapeutic abortion. Ultrasound has now replaced ionizing radiation in most examinations of the fetus and placenta. Pelvimetry should be done only when the decision to do a cesarean section hinges on precise knowledge of measurements of the bony pelvis. On the rare occasion when a radiograph of the fetus is necessary the woman should be prone for the examination. All such examinations are best ordered after consultation with a radiologist. Radiography of distant areas with the beam directed away from the woman's abdomen can be done without concern at any stage of pregnancy.

Abortion, Therapeutic↗

PubMedDate not supplied

[Meaning of assimilation pelvis according to Kirchhoff in modern obstetrics].

OBJECTIVE: To what extent is the cesarean section indication "arrest of labour" due to pathological forms of the pelvis and what is the meaning of the assimilation pelvis in modern obstetrics. PATIENTS: NMR-pelvimetries were performed in 166 post partum women from June 1993 to August 1995. The patients were divided into 4 groups. Group 1: patients who had had cesarean section owing to arrest of labour (n = 56), group 2: patients who had had cesarean section due to breech presentation (n = 20), group 3: patients who had had cesarean section owing to another indication (threatening fetal asphyxia, multiple pregnancy, premature delivery, placental abruption, gestosis, n = 40), group 4: patients who had a spontaneous delivery (control group, n = 50). After analysing the NMR pictures all the pelves were alloted to one of the case studies according to their pelvic form. The diagnosis "assimilation pelvis" was made according to the criteria of Kirchhoff (1949). The four groups were compared and analysed. RESULTS: In group 1 an assimilation pelvis was found in 61%. The obstetrically most unfavourable canal pelvis occurred most frequently, amounting to 29%. In only 9% we found a contracted pelvis. In group 2 the proportion of the assimilation pelvis was even higher, rising to 65%. Only 35% of all pelves had a normal shape. In group 3 we found an assimilation pelvis in 50% of all cases. 66% of all patients with spontaneous delivery had a normal pelvis. An assimilation pelvis was found in 34%. In these cases duration of labour was prolonged by 4 hours on average (mean value: 9.5 hours). CONCLUSIONS: Due to its frequency in our days the assimilation pelvis plays a major obstetrical role. This is true in particular when there is a pathological course of labour. From this results that pelvic parameters other than the conjugata vera will be of diagnostic importance, especially those parameters which are able to characterise the assimilation pelvis with its high promontory, the steepness of the pelvic inlet, the lengthening of the birth canal and the decrease of the hollow of the sacrum. We take the view that the angle of the pelvic inlet, the pelvic inclination and the direct length of the pelvis are of outstanding importance.

Breech Presentation↗

PubMed2026

CT-Derived pelvic morphometry for preoperative risk assessment of recurrent unilateral inguinal hernia.

BACKGROUND: Recurrent inguinal hernia remains a significant challenge in abdominal wall surgery despite advances in mesh-based repair techniques and minimally invasive approaches. Although pelvic skeletal morphology has been implicated in inguinal hernia development, its association with recurrent disease remains incompletely understood. This study aimed to evaluate computed tomography (CT)-derived pelvic morphometric parameters and investigate their potential value in preoperative recurrence risk assessment. METHODS: This retrospective study included 251 male patients with preoperative abdominal CT examinations and complete clinical records who underwent elective inguinal hernia repair at a tertiary referral center. After applying the predefined eligibility criteria, 188 patients with unilateral inguinal hernias constituted the primary study cohort, including 162 primary and 26 recurrent unilateral hernias. The Radoievitch angle and Ami's line were measured independently by two blinded radiology residents using a standardized CT-based pelvic morphometric measurement protocol, and the mean values were used for analysis. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed to evaluate the association between pelvic morphometric parameters and recurrent inguinal hernia. RESULTS: Patients with recurrent unilateral inguinal hernias demonstrated significantly greater affected-side Ami's line measurements (8.27 ± 0.63 vs. 7.90 ± 0.71 cm, p = 0.014) and larger Radoievitch angles (40.68 ± 4.02° vs. 38.80 ± 3.68°, p = 0.018) than patients with primary unilateral hernias. Both the Radoievitch angle (OR 1.14, 95% CI 1.01-1.28, p = 0.033) and Ami's line (OR 2.26, 95% CI 1.14-4.49, p = 0.020) remained independently associated with recurrent inguinal hernia after adjustment for age and body mass index. ROC analysis demonstrated modest discriminatory performance (AUC 0.634 for the Radoievitch angle and 0.633 for Ami's line), while the multivariable model incorporating age, body mass index, and Ami's line showed slightly improved discrimination (AUC 0.655). CONCLUSION: CT-derived pelvic morphometric parameters were independently associated with recurrent unilateral inguinal hernia. Although their individual discriminatory performance was modest, standardized CT-based pelvimetry may serve as an objective adjunctive tool for individualized preoperative recurrence risk assessment in patients who already undergo CT imaging for unrelated clinical indications. Prospective multicenter studies are warranted to validate these findings and determine their clinical applicability.

Humans↗

PubMed1983

Randomized management of the nonfrank breech presentation at term: a preliminary report.

Cesarean section has become the standard management used by many clinicians for breech presentation in labor. Proof of the superiority of routine cesarean section has been largely circumstantial. Concern over rising cesarean section rates has led to renewed interest in possible alternatives. Protocols have been developed to select which patients may be allowed a trial of labor with frank breech presentation at term. We undertook a prospective clinical trial comparing elective cesarean section with a selective management protocol for the nonfrank breech presentation at term. One hundred five patients with nonfrank breech presentations at term in labor were studied. Seventy (67%) were randomized to a trial of labor and 35 (33%) to elective cesarean section. Of the patients allowed a trial of labor, 31 (44%) were delivered vaginally, and 39 (56%) required cesarean section. The largest single cause of a "failed" trial of labor was inadequate pelvic dimensions on x-ray pelvimetry (23 patients, 59%). Neonatal morbidity assessed by Apgar scores, cord gases, birth injury, and hospital stay was not different for those delivered vaginally or by cesarean section. Maternal morbidity in terms of febrile morbidity, blood transfusion, wound infections, and hospital stay was significantly greater among women delivered by cesarean section. Two of three neonatal deaths occurred in infants with major congenital anomalies. The third infant, apparently normal, died after vaginal delivery. Extensive evaluation suggests the death was attributable to inadequate resuscitation. We conclude that the use of a selective management protocol under controlled conditions is a reasonable alternative to elective cesarean section. Approximately one half of patients allowed a trial of labor may be expected to deliver vaginally with neonatal morbidity comparable to that seen with cesarean section.

Adult↗

PubMed1991

The second stage of labor: factors influencing duration.

Prolonged second stage of labor is associated with increased perinatal mortality. Factors influencing second-stage duration are poorly understood. This study was undertaken to characterize those factors. A population of 473 nulliparous women and 491 multiparous women with spontaneous vaginal deliveries were analyzed extensively with history, physical examination (including clinical pelvimetry), labor and delivery data, and neonatal measurements. On the basis of stepwise multiple linear regression, epidural analgesia (p less than 0.0001), active-phase duration (p less than 0.0001), parity (p less than 0.0001), height (p less than 0.0004), birth weight (p less than 0.0003), and station at complete dilatation (p less than 0.027) predicted second-stage duration. The sum of their effect, however, accounted for less than 25% of the variability in second-stage length (total R2 = 0.233), leaving 75% of the variance unexplained.

Adult↗

PubMedDate not supplied

Are we losing the art of midwifery?

There has been an increasing emphasis on the use of technology for the assessment and evaluation of women during the antepartum and intrapartum periods. As a result, "hands-on" skills, such as abdominal palpation and clinical pelvimetry, receive less emphasis in educational programs and practice. Are nurse-midwifery educational programs turning the focus of their curriculum too frequently toward high-risk pregnancy and away from the normal pregnancy? There is a need to balance nurse-midwifery education, to consider the needs of all pregnant women while incorporating advances in technology appropriately. Some recent graduates are not adequately trained in the use of assessment skills that are not dependent upon technology; thus, their capability as practitioners is compromised. Integration of new content into nurse-midwifery curricula should always reflect the philosophy of each program. Renewed attention to teaching, using, and assessing these skills should be encouraged.

Clinical Competence↗

PubMed1986

Magnetic resonance imaging in obstetrics and gynecology.

Magnetic resonance imaging of the female pelvis permits visualization of soft tissue structure previously unseen with other radiological techniques. The internal architecture of the corpus uterus, cervix and vagina are directly visualized in any plane. Furthermore, the hormonal environment of the female can be indirectly determined via assessment of the MR appearance of the uterus. Similarly, the complex changes which occur during pregnancy, such as cervical effacement and the relationship of internal os, fetal part and placenta, are easily documented. MR pelvimetry enables fast, safe depiction of the birth canal. Finally, the demonstrated fetal anatomy may prove particularly useful in the evaluation of intrauterine growth retardation and anomalies indeterminate by ultrasound.

Female↗

PubMed2004

Dynamic assessment of pelvic floor and bony pelvis morphologic condition with the use of magnetic resonance imaging in a multiethnic, nulliparous, and healthy female population.

OBJECTIVE: The purpose of this study was to determine dynamic pelvic floor and bony pelvis morphologic condition in asymptomatic multiethnic women. STUDY DESIGN: Pelvic floor anthropometry, at rest and after the Valsalva maneuver, and pelvimetry were compared with the use of magnetic resonance imaging in nulliparous young volunteers from 5 ethnic groups (n=11 x 5 volunteers: Emirati, other Arab, Filipino, Indian/Pakistani, and European/white volunteers), with the white volunteers as the reference group. RESULTS: The white volunteers were significantly taller (P <.0001) than the other women. Their levator hiatus was significantly longer than the Emirati women (P=.03) and wider than the Filipino women (P=.04). The bladder neck descent on straining was also significantly greater than the other groups (P <.00001). The white women also had the longest transverse diameter of the pelvic inlet (P=.002). Their sagittal outlet diameter was significantly longer than the Emirati and Arab women (P=.02), and their interspinous diameter was significantly longer than the Arab women (P=.002). CONCLUSION: Nulliparous, healthy white women have larger levator hiatus and bony pelvis with greater bladder neck descent on straining than non-white women.

Adult↗

PubMed2006

[Twin delivery: a survey of French obstetrical policies].

OBJECTIVES: To describe obstetrical policy variations concerning the delivery management in the case of twins, at term. PATIENTS AND METHODS: A mail survey was undertaken among the medical supervisors of the maternity wards belonging to the AUDIPOG Network (N=170). RESULTS: The participating rate was 73.35%. 124 answers were analysed. Elective caesarean was realized by 0.8% of participants for diamniotic twins and by 57% of cases for monamniotic twins An elective caesarean is planned for respectively 74% of answers if first (J1) and second twin (J2) are in a breech presentation, 81% if J1 is in breech and J2 in cephalic presentation, and 68% if J1 is in breech and J2 in transverse presentation. Delivery with J1 in breech and J2 in cephalic presentation had a higher risk than a delivery of a single breech at term. When J1 and J2 had a breech presentation 73% of participants thought that this delivery is more difficult than a delivery of a single breech at term. However, they were only 17.5% to consider that a delivery of twin with J1 in cephalic and J2 in breech presentation had a higher risk than a single breech delivery. DISCUSSION AND CONCLUSION: Medical policy variations are not extensive except for X-ray pelvimetry and the presence for the delivery of one paediatrician and one anaesthesiologist. An elective caesarean policy for twins is infrequent in France.

Breech Presentation↗

PubMed2004

Obstructed labor: using better technologies to reduce mortality.

OBJECTIVE: To identify, from the best available evidence, underutilized and promising technologies that may reduce maternal mortality from obstructed labor. METHODS: The author sought systematic reviews of randomized trials, individual randomized trials, and, in the absence of randomized data, non-randomized studies and clinical consensus. Data were presented according to the level of the evidence. RESULTS: Obstructed labor causes approximately 8% of maternal deaths, and indirectly contributes to a greater percentage. Proven or widely accepted technologies that help reduce mortality from obstructed labor include contraception, external cephalic version, the partogram, augmentation of labor, selective amniotomy, selective episiotomy, vacuum extraction, caesarean section, symphysiotomy, and destructive procedures for non-viable fetuses. Technologies of uncertain usefulness include maternal height and shoe size, vaginal cleansing, upright posture for delivery and vaginal lubrication. Unuseful technologies include pelvimetry, estimating fetal weight, early labor induction, routine amniotomy and augmentation, routine episiotomy, and starvation during labor. CONCLUSION: Access to well-established technologies, particularly safe caesarean section, can reduce maternal mortality in resource-poor countries.

Cesarean Section↗

PubMed2003

Architectural differences in the bony pelvis of women with and without pelvic floor disorders.

OBJECTIVE: To investigate the hypothesis that the architecture of the bony pelvis differs between women with and without pelvic floor disorders. METHODS: We designed a case-control study of women who had undergone magnetic resonance imaging (MRI) of the pelvis at our institution. Records were reviewed to identify women with and without pelvic floor disorders (urinary or anal incontinence, other symptoms of urinary tract dysfunction, or pelvic organ prolapse). Pelvimetry techniques were standardized. Relevant measures included transverse diameter of the inlet, angle of the pubic arch, intertuberous diameter, interspinous diameter, sacrococcygeal length, depth of sacral curvature, anteroposterior conjugate, obstetrical conjugate, and anteroposterior outlet. Multiple logistic regression analysis was used to identify women with pelvic floor disorders as a function of their pelvic dimensions, controlling for potentially confounding variables. RESULTS: Subjects included 59 women with pelvic floor disorders and 39 women without pelvic floor disorders. Women with pelvic floor disorders had a wider transverse inlet, wider intertuberous diameter, wider interspinous diameter, greater sacrococcygeal length, deeper sacral curvature, and narrower anteroposterior outlet. When controlling for the confounding effects of age, race, and parity, we found that a wider transverse inlet (odds ratio 3.425) and a shorter obstetrical conjugate (odds ratio 0.233) were significantly associated with pelvic floor disorders. CONCLUSION: A wide transverse inlet and narrow obstetrical conjugate are associated with pelvic floor disorders. We speculate that these features of bony pelvic architecture may predispose the patient to neuromuscular and connective tissue injuries, leading to the development of pelvic floor disorders.

Adult↗

PubMed1998

Indications for caesarean section in breech presentation.

OBJECTIVE: The study was conducted because of the still considerable controversies about the variation in obstetric management in breech presentation, in combination with the still increasing caesarean section rate for this type of presentation, as well as doubt concerning the assumed improvement in neonatal and maternal morbidity and mortality obtained by increasing section rate in breeches. STUDY DESIGN: Two hundred and sixty eight consecutive breech presentations in two university hospitals were studied longitudinally and prospectively. In principle, vaginal delivery was attempted in all cases, under expert supervision and electronic monitoring, except in the presence of clear-cut contraindications. X-ray pelvimetry was not used. RESULTS: The incidence of caesarean section was 34%. The trial of vaginal delivery succeeded in 64% of the nulliparas and in 60% of the non-frank breeches, without statistically significant differences in outcome measures compared with the multiparous women and the frank group, respectively. Hyperextension of the foetal head rarely occurred. CONCLUSION: Several classic obstetric factors have a lower discriminating value for the route of delivery than is currently assumed. Progress of labour was an important factor in determining the route of delivery.

Birth Weight↗

PubMed2004

[Trial of labor in moderate pelvic dystocia at Dakar University Teaching Hospital].

OBJECTIVE: To study frequency of moderate pelvic dystocia, to evaluate the diagnosis value of clinical pelvic evaluation and prognosis of trial labor with only clinical monitoring. MATERIAL AND METHOD: This is a prospective, exposed and non-exposed study concerning 296 women selected among deliveries presenting moderate pelvic dystocia recorded at Dakar University Teaching Hospital from February 1st 2001 to July 31 2002. Trial labor was undertaken in 148 patients; the control group was chosen among women who underwent prophylactic caesarean section and had no other risk factors of maternal and perinatal complications. Pearson's chi-square test was used or statistic analysis with p value 5% and test of Kappa. RESULTS: Moderate pelvic dystocia was observed 5.3 per 100 deliveries. The most common epidemiological profile was primipara, young age (mean 24 years), height 161 cm (mean), 38-week pregnancy (mean). Clinical evaluation had good diagnosis value comparable with the radiological pelvimetry. Trial labor was undertaken in 148 women, 109 trials (73.6%) were successful; vaginal delivery rate was 27% in women with moderate pelvic dystocia. There were no maternal deaths, maternal morbidity was 4% in trial labor patients and 2.7% in prophylactic caesarean section patents (mainly infection). Post-natal mortality was 7.4% after trial of labour versus 4.1% of newborn child after prophylactic caesarean. CONCLUSION: These results confirm that trial of labor on moderate pelvic dystocia should be the rule whenever possible, even when only clinical monitoring is available.

Adult↗

PubMed2002

[Mechanisms of the stagnation of dilatation in the active phase of labor].

OBJECTIVE: Our study was designed to explain determinants of nonprogressive labor in nulliparous patients. STUDY DESIGN: One hundred consecutive nulliparous patients have got a cesarean section for active-phase arrest of labor after two hours of active management. Intrauterine pressure was monitored for all of them and a X-ray pelvimetry was done after surgery. RESULTS: Eighty-three percent of patients showed X-ray data considered as normal; hypotonic labor was found in 50% of cases and occiput posterior position in 60%. CONCLUSIONS: Our results suggest that occiput position and functional dystocia are more common in case of nonprogressive labor than abnormal measurements of the obstetrical pelvis.

Dystocia↗