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At least 793 records · Page 44Linked to original sources
PubMed1990

Vaginal birth after cesarean: a meta-analysis of indicators for success.

The cesarean birth rate has continued to climb despite efforts to counteract this trend. A major reason for this rise is the practice of doing an elective repeat cesarean. Our study used a statistical model of meta-analysis to analyze the findings of 29 individual studies that looked at the association between the success of a trial of labor and various preexisting conditions. We hypothesized that various preexisting factors, including cephalopelvic disproportion, previous breech, previous vaginal delivery, more than one previous cesarean, use of oxytocin, and the length of labor and extent of dilatation in the previous cesarean, would affect the prediction of the outcome of a trial of labor. After determining odds ratios for the individual preexisting factors from the individual studies, we calculated overall odds ratios which incorporated the findings from all of the studies. For previous cephalopelvic disproportion, the odds were 0.5 for a successful trial of labor; for prior breech, 2.1; for women with a previous vaginal delivery, 2.1; for women who had had more than one cesarean, 0.7; and for women receiving oxytocin, 0.3. We were unable to analyze other preexisting factors because the data were not available, but short discussions of some of these other factors are offered. Even though the success rates do vary with the different preexisting factors, the clinician may anticipate a greater than 50% chance for success in any individual labor.

Breech Presentation↗
PubMed1978

Are current rates of Cesarean justified?

Cesarean section is associated with increased maternal and fetal risks. It should not be done except for direct and positive indications. Current emphasis on early conduction anesthesia, the use of the fetal monitor in low-risk patients, section approach to breech delivery, and overemphasis on tests and roentgenograms contribute to excessive cesarean sections. Aggressive obstetrics is also expensive and compares unfavorably with a more conservative approach.

Anesthesia, Conduction↗
PubMed2001

Morphometry of the supra sciatic notch intrailiac implant anchor passage.

STUDY DESIGN: Anatomic study of human ilia. OBJECTIVE: To determine the anatomic dimensions influencing intrailiac anchor placement and design. SUMMARY OF BACKGROUND DATA: The development of the Galveston intrailiac implant anchor markedly improved results of spinal instrumentation to the pelvis. Better quantification of the passage dimensions is needed for the design of anatomically specific implants. METHODS: The length and outer diameter of two intrailiac anchor passages were determined from randomly selected, disease-free pairs of ilia from 129 white skeletons belonging to the Hamann-Todd Osteological Collection (Cleveland, OH, Museum of Natural History). RESULTS: Path B, an anchor passage running from the posterior superior iliac spine to the anterior inferior iliac spine, was significantly longer than path A, proceeding from the posterior superior iliac spine to the superior rim of the acetabulum, in adult and teenage males and females. For example, in adult females path B measured 141.2 +/- 7.5 mm versus 124.9 +/- 7.1 mm, P = or < 0.0001. The absolute minimum path A length available for an intrailiac post or screw anchor, following the required posterior superior iliac spine removal, was 80 mm in adults and male teenagers and 70 mm in female teenagers. For path B the hip joint was not at risk, and a safe anchor passage of at least 90 mm in teenagers and 110 mm in adults was available. The minimum thickness of the paths occurred directly above the sciatic notch. It was significantly larger in path A than path B, 20.2 +/- 2.4 mm versus 14.4 +/- 3.2 mm, P < 0.0001. CONCLUSION: Of the two supra sciatic intrailiac paths studied, the path passing from the posterior superior iliac spine toward the anterior inferior iliac spine provided a longer and potentially safer anchor site. These studies suggest techniques for accessing longer anchor paths and the need for larger diameter anchors in order to achieve optimum intra iliac anchor stiffness and strength.

Adolescent↗
PubMed2003

Determination of sex and race from the subpubic angle in Ugandan subjects.

The accurate determination of sex and race are important tools to forensic and physical anthropologists. In this study, the sex and race of 205 adult Ugandans were determined from the antero-posterior radiographs of the pelvis by measuring their subpubic angles. The angle ranged from 50 to 140 degrees with a mean of 93.86 degrees and standard deviation (SD) of 21.12 degrees for males and 75 to 155 degrees with a mean of 116.11 degrees (SD, 17.79 degrees) for females. The angle was significantly wider in women than men (P < 0.05), as indeed has previously been shown in other population groups studied. Using the demarking point method, 31.82% of Ugandan men and 10.53% of Ugandan women could be accurately sexed. However, more Malawians of both sexes previously studied had lower values for the angle and could be more accurately sexed. This study has also documented regional and racial variability of this angle among different population groups previously documented. Using the watershed subpubic angle derived from the means of this study and those of previously documented studies, 63% of Ugandans and 71% of Malawians could be accurately assigned to the black race. This method is recommended to physical and forensic anthropologists in the developing world.

Adolescent↗
PubMed1984

The windblown hip syndrome in total body cerebral palsy.

Windblown hips in patients with cerebral palsy are difficult to treat and predispose to poor, unstable sitting. In an attempt to identify the temporal sequence between dislocation of the hip, scoliosis, and pelvic obliquity, an in-depth clinical and radiological review of 22 teenage children was undertaken. The most common temporal sequence was dislocation of the hip, followed by pelvic obliquity, and finally scoliosis. It is recommended that the hip be closely monitored in infancy and that an aggressive treatment approach be undertaken if hip subluxation occurs. This is greatly facilitated by a good orthotic, therapy, and seating program to maintain the hips in the correct position. The maintenance of hip stability will facilitate seating as well as minimize the effects of the windblown hip syndrome.

Adolescent↗
PubMed2005

MRI assessment of the bony pelvis may help predict resectability of rectal cancer.

OBJECTIVE: The outcome after surgical treatment of rectal cancer may be influenced by the technical difficulty of the operation, which is thought to be affected by pelvic size. The aim of this study was to examine the association between bony pelvic dimensions and CRM involvement. PATIENTS AND METHODS: All patients with primary rectal cancer between December 1999 and January 2002 were studied. Staging was performed by pelvic MRI. Nine pelvic dimensions were measured from the MR images on a workstation. Pathology reports were obtained for all patients and the mesorectal specimen was examined. Technical difficulty was assessed by circumferential resection margin (CRM) involvement. RESULTS: Of 126 patients with primary rectal cancer, 88 had staging MRI and rectal excision; there were significant differences between the sexes in all 9 pelvic dimensions (P < 0.05). In females, the interspinous diameter was significantly shorter in patients with CRM involvement compared with patients with a negative CRM. In female patients predicted to have a negative CRM, the anteroposterior diameter of the inlet, the anteroposterior diameter of the midplane and the transverse diameter of the midplane (interspinous distance) were significantly shorter in patients who actually had a positive CRM compared with those in whom the CRM was negative. In male patients, there was no correlation between pelvic dimensions and CRM status. CONCLUSIONS: In certain patients with rectal cancer, CRM positivity may be predicted from pre-operative MRI pelvic measurements. This may influence the choice of adjuvant therapy.

Aged↗