MR pelvimetry: prognosis for successful vaginal delivery in patients with suspected fetopelvic disproportion or breech presentation at term

Franz, Marie; Bismarck, Amanda von; Delius, Maria; Ertl‐Wagner, Birgit; Deppe, C; Mahner, Sven; Hasbargen, Uwe; Hübener, Christoph

doi:10.1007/s00404-016-4276-6

Cited by 26 publications

(24 citation statements)

References 32 publications

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“…18 Moreover, MR pelvimetry has been shown to be beneficial in suspected fetopelvic disproportion or breech presentation at term. 19,20 One of the limitations of this study is that the measurements were performed after the birth. This prevented from detecting pelvic changes due to the relaxing hormone secreted during pregnancy and identifying the effect of the pelvis on delivery.…”

Section: Discussionmentioning

confidence: 99%

Relationship of Three-Dimensional Tomographic Pelvimetry with the Type of Delivery in Patients from Different Nations

Yıldırım¹,

Özkocak²

2018

JCOG

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he rate of cesarean delivery has seen a recent surge in our country and worldwide, leading to an increase in the maternal and neonatal morbidity and mortality rates. 1,2 No methods to identify prolonged delivery, predict delivery complications, and foresee the need for the cesarean section have so far been found. Such a method would help in decreasing maternal and neonatal mortality and morbidity.Various models have been identified for predicting delivery types and outcomes. These include BISHOP scores and various antepartum and intrapartum examination methods. However, these kinds of models generally have limited capacity to predict the delivery outcomes. 3,4 Sometimes, these methods could be complicated, and they might not be practical during clinical implementations. 5,6 A Cochrane database assessment found that women undergoing pelvimetry were more likely to have a cesarean section. Also, pelvimetry was observed to increase the cesarean rates. 7 JCOG 2018;28(4):157-62 157 A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Pelvimetry is defined as the measurement of the female pelvis that helps decide the type of delivery-vaginal or cesarean. Thus, the decision to opt for a cesarean section by the physician depends on the maternal pelvic structure. The present study identified, using three-dimensional (3D) pelvis tomography, whether any relationship existed between the type of delivery and pelvic structure in mothers who had cesarean delivery and vaginal delivery. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : The study included participants who underwent 3D tomography for any reason. The first group of patients consisted of mothers who had a vaginal delivery (n=89), and the second group had a cesarean section after labor started (n=19). Pelvimetry was performed retrospectively on a 3D workstation by a researcher who was blind to the clinical data. The measurements were performed in the diameter between ischial spines (ISD), extending from the top sacral promontory to the superior border of the pubic symphysis (conjugata anatomica [CA]), diameter from the top symphysis pubis in pelvic direction to the top promontory (conjugate obstetrica [CO]), and lower border of symphysis pubis and promontory (conjugate diagonalis [CD]). Tomography resulted in an elliptical shape that was formed by the interspinal diameter extending into the sacrum (approximately S3 vertebra) and was tangent to the top symphysis pubis in the direction of the pelvis (area X). R Re es su ul lt ts s: : No statistically significant differences were found between the CD, CO, CA, and area × values of the Turkish and foreign participants (p=0.858, 0.867, 0.451, and 0.374, respectively). The median of the Turkish participants' ISD measurements was found to be higher. No significant differences were found between the participants who had a vaginal delivery and cesarean section in terms of CD, CO, CA, ISD, and area × values (p=0.093, 0.984, 0.124, 0.243, 0.796, respectively). C Co on nc cl lu us si io on n: : The present study did n...

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Section: Discussionmentioning

confidence: 99%

Relationship of Three-Dimensional Tomographic Pelvimetry with the Type of Delivery in Patients from Different Nations

Yıldırım¹,

Özkocak²

2018

JCOG

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“…We did not explore the role of maternal factors and techniques such as sonographic pelvimetry in the need for Cesarean delivery in our patient cohort. Some recent studies have suggested a role for pelvimetry, measured using computed tomography or magnetic resonance imaging, for identification of those at high risk of cephalopelvic disproportion 26,27 . Combining maternal sonographic pelvimetry with fetal adiposity in an effort to assess risk of unplanned intrapartum Cesarean delivery could form the basis of future work.…”

Section: Discussionmentioning

confidence: 99%

Sonographic markers of fetal adiposity and risk of Cesarean delivery

Hehir

Burke

et al. 2019

Ultrasound in Obstet & Gyne

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Increased fetal size is associated with labor dystocia and subsequent need for assisted delivery. We sought to investigate if increased fetal adiposity diagnosed sonographically was associated with increased risk of operative delivery. METHOD: The Genesis Study recruited 2,392 nulliparous patients with a vertex presentation in a prospective multicenter study to examine prenatal and intra-partum predictors of cesarean delivery. Participants had ultrasound and clinical evaluation performed between 39 0/7 and 40 6/7 weeks' gestation. Data on fetal biometry was not revealed either to patients or their managing clinicians. A fetal adiposity composite of fetal thigh adiposity and fetal abdominal thickness was compiled for each infant in order to clarify if fetal adiposity >90th centile was associated with an increased risk of cesarean or instrumental delivery. RESULTS: After exclusions data were available for 2,330 patients. Patients with a fetal adiposity composite >90 th centile had a higher maternal BMI (24±4 vs. 25±5; p=0.005), birthweight (3872 ± 417g vs. 3585 ± 401g; p<0.0001) and rate of induction of labor (47% [108/232] vs. 40% [834/2098]; p=0.048) than those patients with an adiposity composite d90 th centile. Fetuses with adiposity composite >90th centile were more likely to require cesarean delivery than fetuses with adiposity <90th centile (p<0.0001). After adjusting for birthweight, maternal BMI, and onset of labor, fetal adiposity >90th centile remained a risk factor for cesarean delivery (p<0.0001). A fetal adiposity composite >90 th centile was found to be more predictive of the need for unplanned cesarean delivery than an estimated fetal weight >90 th centile (OR= 2.20 [95%

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“…The use of MR is generally limited by its availability, higher cost, and longer examination time compared to manual examination and ultrasound. However, previous studies indicated that prepartal MR pelvimetry is associated with lower rates of unplanned CS [11,18]. Therefore, it could be argued that MR pelvimetry is justified when supposedly unnecessary CS and associated morbidity can be avoided.…”

Section: Discussionmentioning

confidence: 99%

“…MR pelvimetry was performed as previously described [18]. The woman was placed in a supine position in a 1.5-Tesla MR system with a body coil.…”

Section: Mr Pelvimetrymentioning

confidence: 99%

MR Pelvimetry for Breech Presentation at Term– Interobserver Reliability, Incidental Findings and Reference Values

Bismarck

Ertl‐Wagner²,

Stöcklein³

et al. 2018

Fortschr Röntgenstr

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MR pelvimetry: prognosis for successful vaginal delivery in patients with suspected fetopelvic disproportion or breech presentation at term

Abstract: In our cohort, MR pelvimetry was a useful tool for prepartal assessment of the female pelvis in the selection of TOL candidates. Yet, it does not seem to yield additional predictive value for women with a previous vaginal delivery.

Cited by 26 publications

References 32 publications

Relationship of Three-Dimensional Tomographic Pelvimetry with the Type of Delivery in Patients from Different Nations

Relationship of Three-Dimensional Tomographic Pelvimetry with the Type of Delivery in Patients from Different Nations

Sonographic markers of fetal adiposity and risk of Cesarean delivery

MR Pelvimetry for Breech Presentation at Term– Interobserver Reliability, Incidental Findings and Reference Values

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