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[Chairi pelvic osteotomy in adults. Technique, biomechanical study and early results in 21 cases].

The authors have reviewed 14 cases of Chiari pelvic osteotomy performed in adults and followed up during more than one year. They describe the bio-mechanical properties of this procedure, and a surgical technique with some original modifications. They conclude that this operation may be contra-indicated in young women for obstetrical reasons. It is indicated in degenerative arthritis of the hip at an early stage when acetabulum is dysplasic or the femoral head subluxated.

Adolescent↗

Utility of dorsal pits and pubic tubercle height in parity assessment.

Parity indicators in human skeletal material are highly desirable yet elusive. In this study, the relationships of dorsal pits and pubic tubercle elongation to parity are investigated in a sample of 148 modern female sets of pubic bones with associated birth information. The elongation of the pubic tubercle shows no significant correlation with number of births, but instead is associated with the distance this feature is from the pubic symphysis (p < 0.01) and the size of the arcuate angle (p < 0.05). Dorsal pits show a strong association with increasing numbers of births (p < 0.01), especially in younger women. However, in women over 50 years old, dorsal pitting is correlated with BMI (p < 0.05) and is not significantly correlated with number of births. While this study lends support to the correlation of dorsal pitting and parity, it currently does not reach the level of accuracy needed for forensic applications at the level of the individual.

Adolescent↗

Assessing the impact of pelvic obliquity in post-operative neuromuscular scoliosis.

The goal of this pilot study was to explore the relationship between pelvic obliquity and patient pain, sitting tolerance, pressure sores, and function. Five neuromuscular patients who underwent spinal surgery 6-26 weeks prior to assessment took part in this on-going study (4F; 1M); age at surgery (14.6 +/- 2.6 years). Pelvic obliquity was measured from pre- and post-operative anterior-posterior radiographs. A force-sensing pad with a grid of sensors was placed on a flat surface and the weight distribution pattern was recorded. The pressures were divided into left and right sides and peak levels were noted on each side. The parents or caregivers completed a questionnaire on their child's pain, sitting tolerance, pressure sores, and functional abilities. Pelvic obliquity was reduced after surgery by approximately 50% depending on the method used to assess pelvic obliquity. The major curve was reduced from 64 degrees(10 degrees) to 39 degrees (10 degrees). Post operatively, the average pressure (left/right side) ranged from 1.2 to 2.0 (average 1.6). The peak pressure ratio ranged from 1.1 to 1.9 (average 1.4). The ratio of left/right pressure correlated with improvement in pelvic obliquity (r2=0.9). Pain was moderate/severe in the 2 patients with the least correction as measured with the Cobb angle from surgery; both improved following surgery. Two patients suffered pressure sores pre-operatively and one post-operatively. Only 3/5 felt sitting endurance had increased. All parents felt their child sat straighter after surgery. The outcome measures of pain, pressure sores, sitting tolerance, and function were not well related to the amount of pelvic obliquity. More candidates and a longer follow-up may shed light on the many relationships.

Activities of Daily Living↗

Morphological characteristics of the acetabulum.

The aim of this research was to accurately measure the surface of the semi lunar articular surface of the pelvis (facies lunata acetabuli) and the variability of the acetabular geometry, as well as to determine the correlation between measured parameters. 30 macerated anatomical specimens of pelvic bones were measured. The radius and depth were measured in the classical way, while cartilaginous surface area was measured using small fragments of measuring paper to avoid errors in measurement due to the curvature of the surface. Computerized calculations provided accurate surface values. In our research, facies lunata acetabuli measured 2294+/-329 mm2. Diameter of the opening of the acetabulum measured 25.8+/-1.9 mm. Acetabular depth was 30+/-3.2 mm. Correlations between the surface area of the facies lunata acetabuli and the radius of the acetabular opening curvature (r=0.71), surface area of the facies lunata acetabuli and the depth of the acetabulum (r=0.80) and the radius of the acetabular opening curvature and the depth of the acetabulum (r=0.80) were confirmed. For precise assessment of the facies lunata acetabuli surface area, the simplest and the cheapest method is the method of measurement using small fragments of measuring paper and software analysis. There is a significant correlation between the depth, opening of the acetabulum and surface area of the facies lunata.

Acetabulum↗

[Giving birth to medical instruments: forceps and pelvimeters among obstetricians of the 19th century in Mexico].

Up until the mid-19th century, Mexican obstetricians associated forceps and other surgical instruments with risky operations, considering them artefacts whose use was to be avoided at all cost. This article asks why by the century's end these same instruments had come to be seen as life-saving surgical utensils. To this end, I analyzed clinical narratives that defined the norms and practices of their use, discovering that although forceps were redefined by male-midwives' norms of prudence, they also introduced medically-based ideas of gender and race and attributed to Mexican women's pelvises a supposedly pathological nature.

Equipment and Supplies↗

[Changes in pelvic anatomy in 8 decades--computerized tomography study of obstetrically relevant pelvic measurements].

An increasing proportion of obstetric operative procedures due to cephalopelvic disproportion gave raise to the question, whether there has been a change in pelvic anatomy during the past decades. In a retrospective evaluation of 467 computerized pelvic tomograms of patients aged between 18 and 88 years relevant parameters of pelvic proportion were determined. As these parameters are not subject to age-conditioned changes, the values may be viewed as representative for the time of patients' birth or fertility period respectively. Changes in pelvic anatomy turned out to be complex: The transverse elliptic shape of pelvic inlet changed into sagittal elliptic form, the pelvic midplane is contracted progressively, sacral concavity is reduced. Obviously, this obstetrically adverse development is influenced by the fact, that unfavourable pelvic conformation can be transmitted more intensively by the generous indication for cesarean section. This development is contrasted by the circumstance of fetal acceleration. Therefore, an increase in cephalopelvic disproportion has to be expected. For the sake of a safe obstetrical management in these situations the generous use of ante partum pelvimetric diagnosis seems to be advisable.

Adolescent↗

[Management of the scarred uterus].

On the basis of 899 cases of uterine scarring following cesarean section, the authors carried out a prophylactic cesarean in 42% of cases. Labor ended in childbirth by the genital tract in 44% of cases. The very low incidence of uterine rupture since segmental hysterotomy has become widespread and the improved fetal and maternal prognosis are all reasons to prefer delivery by the genital tract. One of the factors in choosing the method of childbirth is radiopelvimetry and estimation of the fetal weight; however, the suspicion of a threshold pelvis is not a contraindication to the labor test which was successful in 70% of the authors cases. On condition that strict obstetrical monitoring is possible, oxytocic drugs can be used to induce labor or correct hypokinesia and to administer a peridural analgesic. Routine extraction is no longer necessary during the expulsion phase but the authors remain faithful to uterine revision. In general, the labor test should be suggested as often as possible and should receive the same monitoring and treatment methods as for an intact uterus.

Birth Weight↗

[Prognostic significance of Bishop's pelvic score for the continuity and the final outlet of induction of labor].

Aim of the present mixed prospective and retrospective study is to determine the prognostic significance of the pelvic score of Bishop for the continuity and the final outlet of induction of labor and to determine the optimal score in the beginning of the induction related with a successful outlet. Based on the given results the authors conclude that the pelvic score of Bishop has a good prognostic value for the continuity and the final outlet of induction of labor with a various values of the separate parameters. Pelvic score > or = 5 is related with a shorter and more successful inductions of labor.

Delivery, Obstetric↗