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PubMed1979

[The problems raised by the irradiation of pregnant women. Effects of ionizing radiations on the embryon and foetus (author's transl)].

In man, the period of maximum risk for the embryo and foetus is between the second and tenth week after conception. The most frequent and most severe malformation is microcephaly which in extreme cases is accompanied by mental retardation. The results of studies in experimental animals and man agree that it is impossible to demonstrate any increased risk of malformation with doses below 15 rads, and that the increase over the spontaneous incidence of malformation is slight at doses below 25 rads. A very small increase in the frequency of leukaemias and cancers has been observed after irradiation in utero for pelvimetry, which delivers a few rads; it can be estimated from these data that a dose of 2 rads induces at the most the risk of one case of cancer in 2,000 children. In practice, it is only exceptionally that an abortion is advised after a diagnostic radiological examination, since the doses in these circumstances are relatively low. A therapeutic termination of pregnancy should be advised when the dose is greater than 20 rads, but it is necessary to take into account other medico-social factors. Conversely, it is important to avoid any irradiation in women who could be pregnant and in particular avoid any irradiation of the true pelvis during the 10 days prior to menses and especially if there has been a delay in the start of menstruation. In pregnant women radiological examinations should only be made if they are of paramount importance for the mother, and all precautions taken to reduce the dose to the uterus in the absolute minimum.

Abnormalities, Radiation-Induced↗
PubMed2002

[Vaginal delivery in a patient with an artificial urinary sphincter and augmentation enterocystoplasty].

Few cases of management of pregnancy in patients with an artificial sphincter (AS) have been reported in the literature, but this situation is very likely to become increasingly frequent with the more frequent use of AS in children. The authors report the case of a pregnancy in a 36-year-old woman with lumbosacral spina bifida, treated by artificial urinary sphincter and augmentation enterocystoplasty. The pregnancy and vaginal delivery did not raise any particular problems. Vaginal delivery is possible provided several precautions are observed: pelvimetry, MRI at the 8th month of pregnancy and close collaboration between urologists and obstetricians near term. Emergency caesarean section should be avoided due to the risk of lesions caused by elements of the AS and the surgical difficulties related to the presence of the augmentation enterocystoplasty.

Adult↗
PubMed1975

[Diagram for the prognosis of cephalo-pelvic disproportions. Application in 300 cases of pelvic contraction].

The authors using the information obtained by X-ray pelvimetry and ultrasound cephalometry in 300 cases of contracted pelves, suggest a diagram of cephalo-pelvic disproportion that can be used in the great majority of cases of contracted pelves. It is not applicable to those where there is significant deformation of the middle strait or an abnormality of presentation. It is divided into three zones: 1. A superior zone, favourable, into which the majority (60%) of cases of contracted pelvis fit. The risk of a serious dystocia during delivery is so small (less than 2%) that it can be considered scarcely different from those found in women with a normal pelvis. 2. An intermediate zone into which 24% of cases of contracted pelvis fit where the prognosis is uncertain. The labour should be considered as an "at risk" labour and a trial of labour conducted. 3. A lower zone into which 16% of the cases fit and which consists of two categories: --those in which the biparietal diameter is equal to or less than 90 mm. Prophylactic caesarean section should be avoided in these cases where disproportion is rare and where there is a risk of delivering a premature infant: and --those more numerous (9 out of 10) where the biparietal diameter is more than 90 mm and where, unless there is a clinically definitely favourable prognosis, it is justifiable to carry out prophylactic caesarean section. If this line is followed: one can avoid a large number of trials of labour, all of which are inconvenient and some of which are dangerous for the child; few unnecessary caesarean sections are carried out.

Adult↗
PubMed2003

[Magnetic resonance imaging applications in obstetrics].

PURPOSE: To review the main indications and results of magnetic resonance imaging in the pregnant women. MATERIAL AND METHOD: We reviewed MRI practice during the pregnancy based on our own experience in a prenatal diagnostic center and data in the literature. Rapid improvement in MRI technology has allowed more extensive use, giving a good contrast-to-noise ratio and multiplanar imaging. RESULTS: Although ultrasound provides primary screening information, final diagnosis may require further investigations. MRI, to be performed in the second and third trimester, is the non-invasive second line tool of choice in this context. The most widespread indications are for brain disease: search for a cause of ventriculomegaly or biometric abnormality, confirmation of a malformative or acquired lesion. Progressively, indications were widened to head and neck, thorax, abdomen and pelvis areas. Moreover, systematic indications include previous fetal pathology or the pregnancy context. Other MRI indications have been suggested: placental malposition, pelvimetry and maternal genito-urinary tract. CONCLUSION: MRI is becoming the natural and necessary second line imaging technique, with increasing indications. It must be kept in mind however that all pathological conditions cannot be depicted by these morphological studies.

Congenital Abnormalities↗
PubMed1992

[Digital image intensifier radiography--what dose for what clinical problem?].

Due to a wide dynamic range it is possible to vary the dose of DIIR for each type of examination according to the required image quality. To define the possible decrease of dose compared to film-screen radiography (speed 200) the dependence of spatial resolution and contrast detectability upon dose was evaluated. We used a Polytron 1000 which was connected to a Siregraph D and an Optilux 57 (Siemens). Acquisition parameters were fixed for different types of examination and tested by imaging anthropomorphic phantoms as well as patients (n = 114). Our results demonstrate that the dose can be reduced by 60% for double-contrast examinations and by 85% for mono-contrast studies. Although DIIR is less suited for chest and skeletal imaging, a 14 cm image intensifier can be used for imaging small lesions. If poor image quality is acceptable (e. g. pelvimetry, sometimes in paediatrics), a maximum reduction of 95% is possible.

Humans↗
PubMed1992

Computed tomography in obstetrics and gynecology.

Computed tomography (CT) has become essential in the diagnostic evaluation of the female pelvic. CT allows accurate delineation of neoplastic and inflammatory processes and provides an effective means of guiding percutaneous needle biopsy of masses and aspiration/drainage of fluid collections. In the pregnant woman, pelvimetry and excretory urography can be performed using the CT scout view with a radiation dose significantly lower than with conventional x-ray techniques. This paper covers the clinically relevant technical considerations involved in performing CT on women and follows with an overview of normal female pelvic anatomy and frequently encountered pathologic conditions.

Biopsy↗
PubMed1990

[Biomechanical evaluation of the functional state of the locomotor system and the effectiveness of surgical treatment of children with Legg-Perthes disease].

For the first time in the patients with Perthes' disease (stages II-III) the authors have evaluated the functional state of the locomotor system in dynamics on the basis of a complex study which included a roentgenobiomechanical analysis of the loads on the hip joint (39 children) after F. Pauwels technique (1959), radio pelvimetry (75 children) after Kh. Z. Gafarov et al. (1984) and biomechanical and electromyographic (36 children) in the static position and during walking. The results obtained have allowed to make a substantial contribution into the characteristics of the functional state of the hip joint in Perthes' disease and to make an objective evaluation of the efficacy of the surgical treatment consisting in using new methods with the aim of decompression and distraction on the basis of not only anatomic but also functional and biomechanical criteria of evaluation.

Child↗
PubMed1990

Patient selection and outcomes for out-of-hospital births in one family practice.

This paper reports a study of the pregnancies followed to delivery in one family medicine group practice that offered a choice of childbirth settings. Those choosing out-of-hospital birth (OHB) were a self-selected group of highly motivated couples interested in natural childbirth or desiring to minimize the cost of pregnancy care. Of 790 singleton pregnancies followed to term, 71 (9.0%) planned home births, 510 (64.6%) planned clinic births, and 209 (26.5%) planned hospital births. Of those planning clinic or home birth, 73% gave birth outside the hospital as planned (44 at home and 379 in the clinic), 81 (14%) changed plans prenatally and gave birth in a local hospital, 46 (8%) were transferred to the local hospital intrapartum, and 29 (5%) were referred to tertiary care. Primiparas who initially chose OHB were more likely than multiparas to give birth in a hospital (46% vs 16%). Controlling retrospectively for obstetric risk and parity, there were few differences in outcome between local hospital and out-of-hospital births. The observed rates of serious complications for OHB were low, but overall, 27% of those initially considered candidates for birth outside the hospital required a change to a higher level of care. For primiparas initially planning clinic or home birth, discriminant analysis revealed five variables that together might have improved the prediction of the eventual decision for hospital delivery in 46%. Clinical pelvimetry was the most powerful variable, in keeping with the finding that most intrapartum transfers were for arrests of labor. The results also suggest that financial factors and other features of the physician-patient relationship influenced clinical decision making.

Adult↗
PubMed1989

[Central hemodynamics and kidney function in women with pre-eclampsia].

A radionuclide method with quickly disintegrating 99MTC labelled human albumin and DTPA in a volume of 0.3-0.5 ml and activity of 37 mVk with two consecutive examinations of central and renal hemodynamics was used in 91 pregnant women with preeclampsia and pyelonephritis. Marked hypovolemia was found in all groups of investigated women with preeclampsia with the exception of the group of women with pyelonephritis. There was also difference in arterial pressure in women with preeclampsia I degree and pyelonephritis, which was statistically significant with advancement of gravity and duration of the disease. The investigation of the functional state of kidneys and blood flow showed a tendency to slowing both in the arterial and venous circulation in women with pre-eclampsia of pregnancy. In the pregnant women of this group and the women with pyelonephritis there was asymmetry in the curves of the blood flow as well as in the temporary indices of renal filtration, which were increases two-folds in comparison with the normal values. They were mostly manifested on the side of the involvement in women with pyelonephritis. Irradiation loading was 0.212 mZv of both examinations and was ten times less than that of x-ray pelvimetry.

Adolescent↗
PubMed1987

Measurement of fetal shoulder width with computed tomography in diabetic women.

We conducted a feasibility study of the use of computed tomography (CT) to measure the width of the fetal shoulders and to predict large birth weight in infants of diabetic mothers. Computed tomography pelvimetry using low-dose digital radiographs was performed before delivery at term in 22 diabetic women. Shoulder width was estimated by direct electronic measurement on a single axial section through the shoulders of the fetus, and by orthopedic calipers within 48 hours of birth. Shoulder width by CT was 11.4-16.5 cm, and correlated significantly with postnatal measurements (r = 0.66, P = .01). Shoulder width by CT also correlated well with birth weight (r = 0.84, P less than .01), and measured more than 14 cm in all seven infants with birth weights more than 4200 g. Using 14 cm as a positive test and birth weight 4200 g as an abnormal result, the predictive value of a positive test was 78% and the predictive value of a negative test was 100%. This technique deserves further evaluation in assessing the risk of shoulder dystocia in potentially macrosomic infants.

Birth Weight↗
PubMed1986

Separation of the pubic symphysis. An underrecognized peripartum complication.

A retrospective review of symphysial separations during pregnancy revealed an incidence of 1:600 deliveries over the previous five years. This figure reflects an occurrence 40-fold or more frequent than the current literature suggests. All the cases in our 11 patients suffering peripartum pubic rupture occurred after spontaneous vaginal deliveries. Maternal age, parity, clinical pelvimetry and fetal weight did not play a clear role in the development of symphysiolysis. Rapid descent of the presenting part in the second stage, however, was a common feature. Nonoperative treatment of pubic diastasis and expectant management of subsequent deliveries seem advisable.

Adult↗
PubMed1985

[Roentgen studies (lateral distance image) for precise determination of tumors of the rectum].

The lateral distant view (LDV) of the rectum is proposed for more precise identification of localization of rectal tumors for preoperative planning and to increase the number of sphincter saving operations. In a prospective study 129 patients with rectal tumors were compared with radiologic and rectoscopic measurements and with the intraoperative tumor site. Other factors which may influence the resectability of tumors have been examined in a part of this patients by measuring the width of the presacral space, the anorectal angle and the pelvic diameters by radiological pelvimetry. Radiological measurement on the lateral distant view showed that tumors usually are located much higher (0.5 to 12.5 cm) than is suggested by rectoscopy. Unlike the rectoscopy, the lateral distant view also can be used for measuring the length of the anal canal. This measurement is most important for evaluating the distance between the tumor and the inner end of the anal canal and reflects the width of a possibly tumor-free margin. Sphincter saving operations could be predicted much better by the lateral distant view than by rectoscopy.

Adult↗
PubMed1984

[Delivery of black African women in France].

The African population is a specific entity. It is younger, the women have more babies and the pelvis is frequently narrow. Caesarean section for a narrow pelvis should be considered very carefully in this population, while the idea of feto-pelvic disproportion has to be a clinical one. Radiological pelvimetry and the use of Magnin's diagram play no part in deciding which way to deliver the women.

Adolescent↗
PubMed1978

Deflexion of the fetal head in breech presentation. Incidence, management, and outcome.

The deflexion attitude of the fetal head in 223 consecutive breech deliveries was radiologically evaluated and classified into four grades. Additional x-ray pelvimetry was performed on all primiparas (136 cases). Extended (35 cases with deflexion angle of 90 degrees or less) and hyperextended (2 cases with angle of more than 90 degrees) variants were found in 16.4%. In the cases of hyperextension, the patients had elective cesarean section, while in cases of other variants they were delivered vaginally in the absence of other indications to cesarean section. The overall cesarean section rate was 17.5%. No cases of perinatal mortality were recorded. Two hundred and sixteen babies had a 1-minute Apgar score of 7--10, 6 had a score of 4--6, and 1 had a score of 2. Only 1 of the 7 asphyxiated babies was of the group of 35 patients classified as having an extended variant. These favorable results confirm the importance of the radiologic assessment of the deflexion angle as a clinical tool.

Apgar Score↗
PubMed1994

[Clinical study on early artificial rupture of fetal membrane to shorten the stages of labor].

This study was conducted to utilize artificial rupture of membrane to accelerate birth process and compare this method with natural rupture of membranes in normal delivering parturient. 334 participants had artificial rupture of membranes done. The researcher found that artificial rupture of membrane in the early stage of delivery was a effective way to shorten the birth process, decrease the parturient's sufferings and dicrease complications. The result indicated that there was a significant difference between the two groups and artificial rupture of membrane could make the birth process shorter. It is recommended that artificial rupture of membrane can be used to accelerate the birth process if the parturient meet the following criteria: there are no obvious cephalopelvic disproportion and abnormal fetal position; have normal external pelvimetry; engagement of fetal head; cervix dilated to 2-3 cm; have regular uterine contraction; and no latent presentation of cord.

Adult↗
PubMed1996

The shapes of the female pelvis. Contributing factors.

OBJECTIVE: To determine the etiologic factors that play a role in shaping the female pelvis. STUDY DESIGN: The backgrounds of 611 pregnant women at term who underwent x-ray pelvimetry between 1962 and 1980 at term were extensively investigated. RESULTS: Several facts were statistically significant. First, 24.1% of the patients had an android pelvis, although only 5.7% presented any sign of hyperandrogenism. Signs of hyperandrogenism were similarly encountered in patients with a gynecoid and any other type of pelvis. Second, the android pelvis was encountered mostly in patients exposed to strenuous physical activity during adolescence. Third, the anthropoid pelvis was encountered more often when the acquisition of erect posture was delayed beyond the usual age of 14 months, while a platypelloid pelvis was more frequent when erect posture was acquired before 14 months. CONCLUSION: The final shape of the female pelvis seems to be determined by culture and environment as well as by genetics.

Aging↗
PubMed1996

[Delivery of women with cicatricial uterus].

Cesarean section rate has risen dramatically, particularly in the U.S., over the past 20 years, with results on maternal and perinatal mortality or morbidity and increase of delivery cost. To curb this inflation, trial of labor after cesarean section is proposed. Trial of labor often involves use of oxytocics. Regional analgesia is indicated for this high risk delivery. There are few absolute contra-indications to trial of labor and each case has to be analysed separately. Induction of labor leads to several advantages. The repeat cesarean section rate decreases significantly; this high risk delivery can take place during daytime with complete obsetetrical, anaesthetic and pediatric staff. The use of medication such as vaginal prostaglandins or mifepristone can also help lower this rate. X-ray pelvimetry must no longer be the major criterion for choosing the mode of delivery. Normality of labour must be judged according to previous vaginal delivery or not. Revision of uterine scar remains important for the diagnosis of dehiscence or rupture. This exploration should only be done if symptoms appear.

Cesarean Section↗
PubMed1995

The anterior dimensions of the pelvis in male and female Nigerians.

A retrospective study on the anteroposterior X-ray films of the pelvis of 40 male, and 31 female Nigerians was undertaken to verify if there was any significant difference in the values of the transverse diameter of the inlet (TID), bicristal diameter (BCD), bituberal diameter (BTD), and subpubic angle (SA) between the male and the female, between the younger age group (21-45 years) and the older age group (46-70 years) in each sex, using the student's t-test. Results showed that TID, BTD and SA each was significantly greater in the female than in the male (P < 0.001). BCD showed no significant difference between the sexes (P > 0.05). SA was significantly greater in the older age group than in the younger age group (P < 0.05) while the other variable showed no significant difference. TID showed significant positive correlation with BCD, and BTD in the female (P < 0.05), and with BCD, BTD, and SA in the male (P < 0.05). The value of SA in female is obtuse but overlaps between acute and obtuse in males. Ninety-three per cent of the female pelvis had subpubic angle above the 111.3 degrees demarking point (DP) but none of the male or female pelvis was marked out by the lower or upper demarking points of BCD, suggesting a relevance of DP of SA in sex discrimination. The mean ratio of TID to BTD was 1.5:1 in the male and 1.2:1 in the female suggesting a gynaecoid tendency in the latter. This study provided data that can be useful for clinical and radiological pelvimetry for use in obstetrical care of Nigerian women, and normal values for Nigerian male and female.

Adult↗