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PubMed2006

Vaginal birth after cesarean section: X-ray pelvimetry at term is informative.

OBJECTIVE: To examine whether X-ray pelvimetry data to evaluate the likelihood of vaginal birth after previous cesarean section. DESIGN: Retrospective study. SETTING: University hospital. POPULATION: Patients with a previous cesarean delivery who underwent X-ray pelvimetry and gave birth at gestational age 37 weeks during a seven-year period. METHODS: 1190 patients with a scarred uterus were compared with 15,189 patients without a scarred uterus. In the scarred uterus group, 760 patients with a transverse pelvic diameter > or =12 cm were compared with 430 patients with a transverse pelvic diameter <12 cm. MAIN OUTCOME MEASURES: The obstetrical outcomes were spontaneous or induced labor, and mode of delivery. The maternal morbidity outcomes were hemorrhage requiring transfusion of packed red cells, uterine rupture, bladder injury, and hysterectomy due to hemorrhage. The neonatal morbidity outcomes were the 5-min Apgar score, transfer to intensive care, and intubation. RESULTS: Patients with a scarred uterus had a significantly higher rate of cesarean section (35.5%) than those with no prior cesarean section (9%). Among patients with a scarred uterus who were selected for vaginal delivery, 81% delivered vaginally when the transverse diameter (TD) of the pelvic inlet was greater than 12 cm, 68% when the TD was between 11.5 and 12 cm, and 58% when the TD was less than 11.5 cm. Maternal morbidity was significantly higher in the patients with a scarred uterus. The neonatal results were comparable in the different groups. CONCLUSION: X-ray pelvimetry tailors the information given to each patient about the likelihood of having a vaginal delivery. It can also be used to optimize the selection of patients allowed to enter labor.

Case-Control Studies↗
PubMed1985

Pelvimetry by digital radiography and its dosimetry.

Sonography is firmly established in obstetrics as the method of choice for the localization of fetus and placenta. However, for the determination of pelvic dimensions sonography does not suffice. Thus, for a few strictly selected indications conventional x-ray pelvimetry is used. This has the disadvantage of the relatively high radiation dose for the fetus and the maternal gonads. Since the introduction of digital radiography, there is the alternative of digital pelvimetry. We performed dosimetry comparing digital and conventional radiography with the new high amplifying screens (Quanta III, Dupont) using an ionization dosimeter and a wax phantom. The radiation dose of digital radiography was 24 mu Gy. This corresponds to about 15% of a comparable conventional exposure (177 mu Gy). A further advantage of digital radiography is a standardized and rapid exposure technique; furthermore pelvic dimensions can be measured directly. The disadvantages are the poorer spacial resolution and poor image quality in obese patients. Digital radiography because of its lower radiation dose is suitable for pelvimetry for special indications.

Computers↗
PubMed1991

CT pelvimetry: the foveae are not an accurate landmark for the level of the ischial spines.

The most important distance measured during CT pelvimetry is the interspinous diameter of the pelvis as seen on axial scans, because most cases of obstructed labor occur at the level of the ischial spines. As the spines are difficult to identify on the anteroposterior digital scout radiograph, the fovea of the femoral head has been used as a landmark to determine the level of the appropriate axial slice. We assessed the accuracy of this landmark on CT scans in 23 women undergoing CT pelvimetry and in 20 nonpregnant women having pelvic CT scans. In each case the relationship between the level of the foveae and the level of the ischial spines was determined. True interspinous distances were measured and compared with the apparent interspinous distances at the level of the foveae. In none of the women were the ischial spines above the foveae. In 15 (65%) of 23 pregnant women and in seven (35%) of 20 nonpregnant women, the ischial spines were below the foveae. An incorrect scanning level led to an overestimation of interspinous distance by an average of 1.0 cm. We conclude that for CT pelvimetry, the fovea as seen on the anteroposterior digital radiograph is an inaccurate landmark for the level of the ischial spines.

Breech Presentation↗
PubMed2003

[CT pelvimetry: a new approach using multi detector CT and volume rendering].

The authors describe a new technique of CT pelvimetry, using multi detector CT. This protocol is able to provide an anatomic view of the bony pelvis as well as classical measurements for pelvimetry. The acquisition is made using low technical parameters allowing the radiation dose to remain similar to that of conventional CT. Helical acquisition with thin slices and interleaved reconstruction provides adequate material for Volume Rendering reconstruction. Presets of the software may give readily available images within seconds, saving time for the radiologist. Although this technique might be performed using single slice helical CT, multi detector CT makes it faster and more accurate as the acquisition time is shorter. Final images are more easily understood by obstetricians and midwives, leading to a better understanding of dystocias. This anatomical information is obviously superior to that of conventional CT. Because it is simple to perform, has no medical time cost for the radiologist if a Volume Rendering software is available, and does not require additional radiation, we believe that this technique should replace conventional CT or conventional pelvimetry.

Female↗
PubMed2003

[Helical CT pelvimetry: advantages of a low dose volume acquisition technique].

The authors evaluate the accuracy of a new CT pelvimetry technique that allows faster and low dose acquisition, and provides an axial view of the true conjugate as well as a 3D view of the maternal pelvis. Made possible by the availability of MDCT, this new technique may be a good alternative to standard CT pelvimetry even if MR pelvimetry still appears as the gold standard.

Adolescent↗
PubMed1991

[Obstetrical prognosis by x-ray pelvimetry].

For a period of 44 months 87 deliveries were analyzed by roentgenological pelvimetry, performed by a method, improved by the authors (1982). The relative part of pregnant women with roentgenological pelvimetry was 1.1%. Coefficients of obstetric prognosis were defined in groups retrospectively on the basis of a large material with roentgenological pelvimetry: "compatibility", "conditioned compatibility" and "noncompatibility" as a result of the ratio of the sum of pelvic diameters to the biparietal diameter of the fetus. In the group of "compatibility" of the fetus with the bony pelvis the women, who delivered operatively, had reduced pelvic dimensions with over 0.5 sm in vertex presentations and over 0.3 sm in breech presentations as well as larger weight of the fetus (respectively 4000 and 3500 g). The obstetric prognosis of the groups "compatibility" and "noncompatibility" was exact in 88.9% of the vertex presentations and in 81.5% of the breech presentations.

Birth Weight↗
PubMed1990

[Comparison of classic and digital pelvimetry for measuring the medial transverse diameter in 50 female patients].

The medial transverse diameter (MTD) has been measured in 50 female patients using both CT and classical pelvimetry. Comparison between these two matched series allows to confirm (p less than 0.001) that the measurement obtained by CT is on the average smaller than that obtained by classical pelvimetry. The relative mean deviation is 3%, the means differ by 4 mm. Management of obstetrical patients taking into account measurements obtained by pelvimetry (Magnin indices) should then be modified depending on the results obtained by this new technique of scanopelvimetry, that will soon become the technique of reference.

Female↗
PubMed1989

[Dosimetry comparison of pelvimetry methods using conventional radiologic technic and x-ray scanner].

The aim of this study is to compare conventional and CT-scan X-ray pelvimetry. Doses have been measured on the surface and in deep tissues as well as total doses received by the patients. With CT the fetus and the mother were exposed to 1/10th of the total dose delivered using conventional X-rays. The method is acceptable and the high quality of the films achieved make CT-scanning pelvimetry safer than X-ray pelvimetry.

Female↗
PubMed1989

[The place of x-ray pelvimetry in obstetrical practice].

The frequency of roentgenological pelvimetry, its changes in accordance with obstetric management of labour and its place in the obstetric practice were studied at the Research institute of Obstetric and Gynecology for the period of 1979-1988. It was established that its mean frequency for the investigated period was 7.0%, but its highest frequency--11.1% during 1982. During the following years its frequency gradually diminished and it was stabilized within the ranges of 3.5 to 5.0% during the last three years. It is indicated that roentgenological pelvimetry should be made compulsory in women with secondary deformed pelvis and in women with fetal breech presentation, whose parturition should be managed per vias naturales. It is stressed that the roentgenological pelvimetry has its place in the obstetric practice and it is a valuable diagnostic method.

Bulgaria↗
PubMedDate not supplied

[New aspects of radiologic pelvimetry. Digital image intensification radiography: preliminary results of validation possibilities and results in various types of pelvic disproportion].

Within 1 year with 1325 births 54 cases necessitated operative obstetric intervention due to a disproportion between fetal head and maternal pelvis. In 40 cases radiologic pelvimetry was performed, using the conventional technique. 75% of cases turned out to be due to a midplane or outlet contraction. As, on the one hand, this type of pelvic disproportion seems to be of increasing importance, on the other hand generously adoperated radiologic diagnosis is not well accepted by the patients due to X-ray burden, Digital Image Intensifier Radiography (DIR) has been introduced for pelvimetry. X-ray burden amounts to only 5% of that of the conventional technique. Enhanced postprocessing and interactive measurement possibilities are further advantages of DIR. Using the appropriate softwear, interactive measurement results are characterized by the lack of mistakes due to X-ray divergence, if only the distance between measurement level and desk surface is known. By analyzing 30 computer tomograms measurement levels of the most important pelvic distances could be calculated in relation to the position of the anterior iliac spine. These relations show a very low interindividual variation. Thus, possible errors in measurement amount to a maximum of only 3.5%. The evaluation of our cases reveals the necessity to reassess the normal ranges for pelvic parameters, for the use of those deriving from conventional pelvimetry failed to describe correctly the anatomy of birth channel. For this sake, additional measurements, esp. of sacral and pelvic outlet anatomy have to be performed. Based upon these measurements, a computer aided modelling of the birth channel and a simulation of the birth could be achieved.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Simulation↗
PubMed1986

Computed tomographic pelvimetry in the evaluation of breech presentation.

The purpose of this investigation was to assess computed tomographic (CT) pelvimetry in the evaluation of breech presentation for trial of labor. Thirty-two patients with singleton term breech deliveries formed the study group. Seventeen of the 32 (53.1%) patients fulfilled the criteria for attempted vaginal delivery. Fourteen of the 17 (82.4%) delivered vaginally. All infants so delivered had five-minute Apgar scores greater than or equal to 7. Three of the 17 patients required abdominal delivery: one for fetal distress and two for arrest of dilation. These results compare favorably with studies using conventional x-ray pelvimetry. The advantages of CT over conventional pelvimetry include ease of performance, ease of interpretation, and decreased radiation dose to the fetus.

Breech Presentation↗
PubMed1982

X-ray pelvimetry in primiparas. I: Role of physiological maturity.

X-ray pelvimetry offers an accepted, objective, and reproducible method for evaluation of pelvic capacity. One hundred-thirty primiparous parturients, 16 years of age and younger, who had had x-ray pelvimetries when admitted for delivery at term were studied. These findings were contrasted with the findings on 150 primiparous parturients who were 20 years of age and older at term.The mean age for the adolescents was 15.4 years and for the older group, 24.1. The most common indication for pelvimetry was suspected disproportion (A = 60.8 percent, O = 65.3 percent). Contrary to expectations, many similarities were noted in the women of both groups. Four of the six diameters compared were similar when adolescents were contrasted with older women. Both diameters of the inlet were smaller among the adolescents as contrasted with the older women, who had a higher proportion of larger than average diameters. The clinical implications of these findings are presented.

Adolescent↗
PubMed1981

A prospective evaluation of X-ray pelvimetry.

One hundred four consecutive patients undergoing x-ray pelvimetry were analyzed prospectively in an attempt to evaluate the efficacy of this procedure. Comparison was made between prepelvimetry and post-pelvimetry clinical management plans. Roentgenographic pelvic measurements led to prompt and significant alterations in clinical management plans in only one of 67 patients with vertex presentation and one of 37 with breech presentation. In 98% of patients, no change in immediate clinical management plan was made on the basis of x-ray pelvimetry findings.

Cesarean Section↗
PubMed1993

The predictive value of pelvimetry in beef cattle.

To elucidate reasons for failure of pelvimetry to predict dystocia, we collected data from 1146 heifers and 210 cows in five beef cow herds in Saskatchewan. We assessed the reliability of pelvic area measurements, the generalizability of findings, various modifications of the technique, and the statistical association between pelvic area measurements and dystocia. The repeatability (kappa) of pelvic area measurements between and within veterinarians for the Rice and Krautmann pelvimeters were low to moderate, indicating pelvic area measurements were imprecise. The positive predictive values and sensitivities of pelvic area measurements were consistently poor across herds, years of study, breeds of heifers, times of measurement, various pelvic area cut-off points, and sires. Various modifications of the technique, including pelvic area/calf birth weight ratios, pelvic area/heifer weight ratios, and Ko's calving prediction equation were also poor on-farm tests for predicting dystocia. Although the mean pelvic area in heifers with dystocia was smaller than those without dystocia, there was a large overlap in the distribution of their measurements. Far too many heifers with a small pelvic area had no dystocia (false positives) and far too many heifers with a large pelvic area had dystocia (false negatives) for pelvimetry to be useful. We conclude there is little evidence to justify the continued use of pelvimetry as an on-farm test to reduce dystocia in beef cattle.

Animals↗
PubMed1993

Erect lateral pelvimetry and the outcome of labor in Lagos.

The erect lateral radiograph pelvimetry measurements was related to the outcome of labor in 173 patients. The most common indication for pelvimetry was one previous caesarean section in 90 (52%) patients. Sixty-nine (39.9%) pelvimetry measurements were performed because of suspected cephalopelvic disproportion, while 20 (11.6%) were done because of breech presentation. In patients with a cephalic presentation at delivery, the mean +/- standard deviation (SD) obstetric conjugate for the 87 women who delivered vaginally (group 1) was 11.42 +/- 1.5 cm, while that of the 45 women who had emergency caesarean section (group 2) was 10.77 +/- 1.5 cm. The mean +/- SD anteroposterior outlet diameter for groups 1 and 2 were 12.24 +/- 1.9 cm and 11.84 +/- 1.7 cm respectively. Both differences were found to be statistically significant (p < 0.001 and p < 0.05 respectively). The mean +/- SD birthweight of the babies in groups 1 and 2 were 3.34 +/- 0.79 kg and 3.42 +/- 0.86 kg respectively. There was no statistically significant difference between the two groups (p < 0.05). The critical obstetric conjugate for safe vaginal delivery was 9.88 cm while the corresponding value for the anteroposterior pelvic outlet diameter was 10.24 cm.

Cesarean Section↗
PubMed1981

In vivo pelvimetry in buffaloes (Bos bubalus).

The comparison of external and internal, pelvimetry measurement was performed on 79, buffalo heifers, and a high, positive correlation (r=0.90) between the two methods was revealed. The pelvic area of the buffalo heifers increased progressively with the advancing age and with the increase in body weight. The convenience with which external pelvimetry could be performed, the simplicity of the equipment which was used and the accuracy of the method would certainly favor the application of external pelvimetry for routine use.

Journal Article↗
PubMed1998

Breech delivery: the value of X-ray pelvimetry.

OBJECTIVE: The study was conducted to compare maternal and neonatal outcome of two groups of nulliparae with breech presentations, who were selected for vaginal delivery by protocols differing only in their use of X-ray pelvimetry. STUDY DESIGN: We reviewed all term singleton breech deliveries of nulliparous patients who were eligible for vaginal trial of labour in our Centre between 1992 and 1994. In Group A (n=85) X-ray pelvimetry was performed, and in Group B (n=70) it was not. Obstetric management was otherwise similar. Admission to the two departments was on alternate days. RESULTS: The rate of caesarean section was similar in both groups (Group A, 36.4% vs. Group B, 42.8%; P>0.05), however, the indications for caesarean section differed. Neonatal outcome was similar in both groups. Maternal febrile morbidity was higher in Group B patients, especially those who underwent caesarean section after a trial of labour. CONCLUSION: X-ray pelvimetry in nulliparae with breech presentation is associated with reduced maternal febrile morbidity, but does not improve neonatal outcome.

Birth Injuries↗
PubMed1981

The predictability of labor outcome from a comparison of birth weight and x-ray pelvimetry.

The value of x-ray pelvimetry in labor has recently been questioned by many, although few morphometric data on the fetopelvic relationship have been presented. Fifty-one women who had dysfunctional labor, in whom both x-ray pelvimetry and oxytocin were used during clinical management, were studied. Twenty-seven were delivered by cesarean section, while 24 were delivered vaginally. Regression equations were developed for multiple pelvic indices versus birth weight. The analysis revealed no differences between the vaginal group and the cesarean section group. The design of this study suggests that the variables of pelvic measurements and birth weight do not provide a predictive tool for delivery outcome. The approximately 15% margin of dimensional differences between a successful outcome and a failed outcome is too small to be detected by current diagnostic methods.

Adult↗