The Pelvic Outlet: A Comparison Between Clinical Evaluation and Radiologic Pelvimetry

Floberg, Jan; Belfrage, Patrick; Carlsson, Monica; Ohlsèn, Hans

doi:10.3109/00016348609157352

Cited by 17 publications

(14 citation statements)

References 10 publications

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“…Prior studies have demonstrated the difficulties with utilizing clinical pelvimetry in clinical management, including its low sensitivity for defining a contracted pelvis and low influence on clinical management. 15, 16 Studies of maternal short stature (defined as <155-cm) demonstrate an increased risk for cesarean, but the vast majority (>75%) of these women still deliver vaginally. 17–19 Several studies of maternal foot size have found no correlation to mode of delivery.…”

Section: Commentmentioning

confidence: 99%

Radiographic measures of the mid pelvis to predict cesarean delivery

Harper

Odibo

Stamilio

et al. 2013

American Journal of Obstetrics and Gynecology

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Objective To determine whether x-ray measures of the mid-pelvis can be used to predict cesarean delivery. Study Design Women were enrolled prospectively and x-ray pelvimetry was performed post-partum, with readers blinded to the outcome. Groups were determined by mid-pelvis measures (transverse diameter [TD], anterior-posterior diameter [APD], and circumference [MC]) ≤10th percentile. The primary outcome was cesarean delivery. Univariable, stratified, and multivariable analyses were performed to estimate the effect of midpelvis measures on cesarean delivery. Receiver operator characteristics (ROC) curves were created to estimate the predictive value of mid-pelvis measures of cesarean delivery. Results 426 women were included. Subjects with APD or MC ≤10th percentile were at greater risk of cesarean (risk ratio (RR) for APD 4.8, 95% confidence interval (CI) 3.9–5.8, RR for MC 3.8, 95% CI 3.1–4.8). TD ≤10th percentile was not associated with an increased risk of cesarean delivery. The area under the ROC curves for APD, MC and TD were 0.88, 0.85, and 0.69, respectively (p<0.01). Conclusion Simple radiographic measures of the mid-pelvis on x-ray can provide a useful adjunct to clinical information in determining who should attempt a vaginal delivery.

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Section: Commentmentioning

confidence: 99%

Radiographic measures of the mid pelvis to predict cesarean delivery

Harper

Odibo

Stamilio

et al. 2013

American Journal of Obstetrics and Gynecology

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“…Although the pelvic inlet becomes contracted in response to nutritional stress during development, it is the pelvic midplane (Fig. l ) , the narrowest point in the birth canal, that interferes with the birth process in most populations (Sibley et al, 1992;Oxorn-Foote, 1986;Floberg et al, 1986Floberg et al, , 1987. The distance between the ischial spines, or bispinous diameter (BSD), defines the obstetric "plane of least dimensions" (Oxorn-Foote, 1986).…”

mentioning

confidence: 99%

Sexual dimorphism in the pelvic midplane and its relationship to Neandertal reproductive patterns

Walrath¹,

Glantz²

1996

Am. J. Phys. Anthropol.

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The fragmentary nature of the fossil record has limited the analysis of the Neandertal pelvis to the superior pubic ramus and the pelvic inlet. From an obstetric viewpoint, the pelvic midplane or "plane of least dimensions," defined by the distance between the ischial spines, must be considered in the analysis of hominid reproduction. We examined the relationship between BSD and weight in a mixed sex hospital population undergoing diagnostic computed tomography (CT) scans (41 females and 40 males). Because femoral head diameter squared (FH(2)) has been used as a proxy for weight in skeletal populations, it was also analyzed with respect to BSD and weight. Bivariate regression analysis of BSD with other body dimensions indicates the presence of significant sex differences. In females, but not in males, weight is a statistically significant predictor of BSD. FH(2) is an even better predictor of BSD in females while nonsignificant in males. Although weight and FH(2) are significantly correlated with BSD in females, FH(2) does not predict weight in females as well as it does in males. The positive correlation between skeletal frame size and BSD in females is indicative of an evolutionary pattern that must take into account the pressures of reproduction. Our results indicate that critical dimensions of the pelvis must increase as the maternal skeleton becomes larger. These results provide a context for the interpretation of the reproductive patterns of a relatively robust hominid population like the Neandertals.

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“…Chalmers et al (1990) found a vaginal delivery rate of 66 to 94 per cent in women with adequate pelvimetry measurements. Parsons and Spellacy (1985) and Floberg et al (1986) found a correlation between clinical and radiological pelvimetry in up to 77 per cent of patients. Our vaginal delivery rate of 60 per cent with undiagnosed breech presentation confirms the usefulness of clinical assessment and does not support the case for routine immediate caesarean section.…”

Section: Discussionmentioning

confidence: 95%

Undiagnosed breeches presenting in labour—should they be allowed a trial of labour?

Cockburn

Foong

Cockburn³

1994

Journal of Obstetrics and Gynaecology

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We studied 24 women who had an undiagnosed breech presentation in labour and compared them to a control population of 48 women where the breech was diagnosed and assessed antenatally, to determine if there were any factors important in deciding the mode of delivery of an undiagnosed breech presentation, and to compare outcomes for mother and baby. Women in the study group achieved a 60 per cent vaginal delivery rate where clinical assessment allowed a trial of labour. The maternal morbidity for all women achieving a vaginal delivery was lower than that for caesarean section hut was lowest where the breech was also diagnosed antenatally. Clinical assessment of fetal size was accurate in identifying all fetuses weighing > 3 . 8 kg. No significant difference in the fetal outcome was found if the breech was diagnosed or undiagnosed, or in relation to the eventual mode of delivery. The practice of individual assersment for optimum mode of delivery of women with undiagnosed breech presentations in Iahour should continue with vaginal delivery as an acceptable option.

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The Pelvic Outlet: A Comparison Between Clinical Evaluation and Radiologic Pelvimetry

Cited by 17 publications

References 10 publications

Radiographic measures of the mid pelvis to predict cesarean delivery

Radiographic measures of the mid pelvis to predict cesarean delivery

Sexual dimorphism in the pelvic midplane and its relationship to Neandertal reproductive patterns

Undiagnosed breeches presenting in labour—should they be allowed a trial of labour?

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