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At least 19 recordsLinked to original sources

PubMed1991

A comparative study of X-ray pelvimetry and CT pelvimetry.

In this study 24 patients who had conventional erect lateral X-ray pelvimetry had a CT pelvimetry done after delivery to complete the pelvimetry views. The erect lateral pelvimetry was read independently by a Consultant Radiologist, Consultant Obstetrician and a Medical Officer training in Obstetrics and Gynaecology. Using CT pelvimetry as the 'gold standard' (as the error of measurement was known with the machine used) the 3 readings were compared. There was no statistical difference in the values suggesting that X-ray pelvimetry is comparable to CT pelvimetry. However CT pelvimetry is preferred, if available, because of the lower dose of radiation involved, more comfort for the patient and shorter time in performing the procedure. Measurements done are easily read directly from the CT console.

Adolescent↗

PubMed1990

Pelvimetry by magnetic resonance imaging in breech presentation.

Evaluation of the pelvis by pelvimetry plays an important role in selecting patients with term breech presentation for possible vaginal delivery. X-ray pelvimetry involves the disadvantage of fetal exposure to ionizing radiation. Computed tomography reduces the amount of radiation markedly, but there is still a risk. Ten patients with breech presentation at term underwent antepartum pelvimetry with magnetic resonance imaging, following by postpartum magnetic resonance pelvimetry and x-ray pelvimetry. Measurements with magnetic resonance imaging are as reliable as those obtained with x-ray pelvimetry and the contrast of the magnetic resonance images is even better. The advantages of magnetic resonance pelvimetry are clear: no ionizing radiation and reliable pelvimetry results in cases of term breech presentation in which a normal pelvis is a prerequisite for safe vaginal delivery.

Breech Presentation↗

PubMed1990

Vaginal breech delivery: a five-year prospective evaluation of a protocol using computed tomographic pelvimetry.

In 1983 a protocol was established at our institution that used computed tomographic pelvimetry to evaluate patients presenting with a singleton term frank breech fetus for an attempt at vaginal delivery. The criteria for a trial of labor were singleton fetus, term gestation (37 to 42 weeks' gestation from the first day of the last menstrual period), frank breech presentation, estimated fetal weight 2000 to 4000 gm, non-extended fetal head, and adequate computed tomographic pelvimetry. Two digital radiographs and a tomographic cross-section were taken of each patient, i.e., an anteroposterior view, a lateral view, and an axial section through the femoral head at the level of the fovea capitalis. Adequate pelvimetry was defined as: anteroposterior diameter of the inlet greater than or equal to 10.0 cm, transverse diameter of the inlet greater than or equal to 11.5 cm, transverse (interspinous) diameter of the midpelvis greater than or equal to 9.5 cm, and posterior sagittal diameter of the midpelvis greater than or equal to 4.0 cm. The purpose of this prospective analysis was to determine the obstetric and perinatal outcome of those breech fetuses that were evaluated with these criteria during the study period of January 1984 through July 1989. During this period the incidence of breech deliveries at our institution was 2.71% (394/14,542). Of these 394 breech deliveries, 122 patients underwent computed tomographic pelvimetry. Eighty-five patients had adequate pelvimetry, fulfilling the protocol criteria, and formed the study group. Eighty-one percent (69/85) of the study group had successful vaginal deliveries (group 1). Nineteen percent (16/85) required cesarean delivery after a trial of labor (group 2) (10 with fetal distress and six with arrested labor disorders). Of the 37 patients who had inadequate computed tomographic pelvimetry and underwent cesarean delivery without a trial of labor (group 3), 54% (20/37) had an extended fetal head, 21.6% (8/37) had an inadequate transverse diameter of the inlet, 13.5% (5/37) had an inadequate midpelvic posterior sagittal measurement, and 10.8% (4/37) had an inadequate interspinous diameter. Perinatal outcome including Apgar scores, cord gases, length of hospital stay, neonatal complications, was evaluated. No difference in infant complications was noted between the group delivered vaginally and the groups delivered abdominally. The only maternal complications in our study group were chorioamnionitis, endomyometritis, and postpartum anemia. There were no significant differences in the incidence of chorioamnionitis among the three groups of patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1975

Role of pelvimetry in active management of labour.

All cases referred for pelvimetry in 1970-1 and all breech presentations referred for pelvimetry in 1972-4 were reviewed. Indications for pelvimetry fell into four main categories: high head in the antenatal clinic (47-8%); high head in labour (13-9%); breech presentation (20-9%); and previous caesarean section (14-8%). In the first two categories pelvimetry rarely if ever influenced management, and it should not be performed routinely. In breech presentation and cases of caesarean section pelvimetry seemed to be of value, but in the latter group it should be performed puerperally to avoid the known radiation hazard to the fetus. A fairly close correlation between obstetric conjugate and pelvic capacity was shown, which suggested that a 3400-g baby might pass through a pelvis of obstetric conjugate of 10 cm as a cephalic trial of labour, but would need an obstetric conjugate of 11-7 cm for safe vaginal breech delivery.

Birth Weight↗

PubMed1986

The pelvic outlet. A comparison between clinical evaluation and radiologic pelvimetry.

A random sample of 798 primiparas was screened with clinical evaluation and radiologic low-dose pelvimetry of the pelvic outlet. The purpose was to study the accuracy of clinical evaluation in comparison with X-ray pelvimetry and to determine whether clinical evaluation could reveal any other factor influencing labor. A significant agreement between clinical and X-ray pelvimetry was found, but the sensitivity of clinical evaluation was low and as many as half the patients with a contracted pelvis, according to pelvimetry, were not detected. Delivery outcomes in two matched groups with similar pelvic outlet measurements but different clinical evaluation did not differ, indicating that clinical evaluation did not detect any other factor not revealed by X-ray pelvimetry.

Delivery, Obstetric↗

PubMed1990

[The importance of x-ray pelvimetry for the prognosis of pelvic dystocia].

The frequency of roentgenological pelvimetry at the Research Institute of Obstetric and Gynecology during 1988 is 4.79%. Thirty-five pelvimetries out of 276 (12.68%) were urgent, but the remaining 241 (87.32%) were planned. Pelvimetries showed normal measurements in 113 of pregnant women (40.94%), but there was shortening in one or more diameters of the single planes of the pelvis in 163 women (59.06%). The measures of the diameters of the pelvic cavity were shortened most frequently, more rarely at the pelvic inlet and most rarely at the pelvic outlet. Changes in the bony pelvis were indicated after secondary traumatic deformity of the pelvis. The role of roentgenological pelvimetry in taking decision for delivery of breech presentation of the fetus was analyzed. It is pointed out that the roentgenological pelvimetry is the single, easy, convenient, safe and available method for determination of pelvic diameters, respectively for prognosis of pelvic dystocia.

Dystocia↗

PubMedDate not supplied

Low dose pelvimetry with biplane digital radiography.

The digital moving slit technique as used by most CT scanners for overview images, was used for antero-posterior and lateral views of the pelvis for pelvimetry. The method was evaluated in phantom experiments and clinical examinations were performed in 23 patients. The method was compared with conventional pelvimetry in 14 patients. Estimated ovarian dose was reduced by a factor of 14.2. The discrepancy in measurements of the pelvic diameters by computed tomography compared with conventional pelvimetry was considered to be without practical importance from an obstetric point of view. Digital pelvimetry is easier for the patient, faster and the need for repeated exposures is eliminated. Based on these facts it is suggested that digital pelvimetry should replace the conventional method whenever possible.

Female↗

PubMed1992

[Obstetric pelvimetry using nuclear magnetic resonance tomography (MRI): clinical experiences with 150 patients].

Between Oct. 1987 and Oct. 1991 150 patients of the Frauenklinik Freiburg were examined by MR pelvimetry (MRI), 135 of which were "ante partum", i.e. just before delivery. The indications were: earlier operative or strongly protracted delivery, clinical suspicion of disproportion between head and pelvis, or obstetrical "problem pelvis" indicated by manual pelvic examination or ultrasonic foetometry. Previous experimental measurements with a phantom and the comparison with conventional radiograms by Guthmann and Martius of 10 patients in puerperium have shown, that the mean divergence was +/- 2 mm, the maximum divergence 5 mm. The MRI method for pelvimetry "ante partum" or in childbed, proved to be a method of high accuracy and a very good option to judge the pelvic shape, whilst being well accepted by the patients. Furthermore, it allows to determine the foetal BIP (biparietal head-diameter), to judge the pelvic soft-tissue, as well as the visualisation of the birth canal, all without any exposure to radiation. MR pelvimetry is thus part of today's clinical routine. The disadvantages are still the high costs as well as the fact, that only few centres have access to MRI equipment. Nevertheless, the pelvimetry "post partum" can be safely practised radiologically due to the very low radiation exposure.

Female↗

PubMed1985

[Obstetric pelvimetry using digital radiography (CT topogram)].

Radiographic examination during pregnancy and pelvimetry before pregnancy are still required for particular indications. The use of digital radiography (lateral topogram on CT) reduces the radiation dose to the foetus and ovaries by a factor of 10 to 100, as compared with conventional pelvimetry, as described by Guthmann. The accuracy of this method is satisfactory, the technique is simple, it is rapid and is easy for the patient, particularly for pregnant women. As long as pelvimetry is not possible without ionising radiation, we consider pelvimetry with digital radiography, when strictly indicated, to be acceptable. In order to determine the transverse diameter of the pelvis, a single additional CT cut through the narrowest part of the pelvis is suggested.

Female↗

PubMed1975

The utilization and efficacy of pelvimetry.

Data from non random groups of deliveries with some identical clinical factors were compared and certain conclusions are suggested. Most x-ray examinations which cause significant fetal exposure are pelvimetries. There appears to be no uniform set of indications for performing pelvimetry. Instead, the criteria seem to vary from hospital to hospital and even from physician to physician within the same hospital. A normal pelvimetry gives the physicina little confidence that a cesarean section will not be necessary. The duration of labor is not significantly altered by pelvimetry in those cases needing a cesarean section for cephalopelvic disproportion or following unsuccessful oxytocin stimulation.

Cesarean Section↗

PubMed1986

Reliability of radiographic pelvimetry. A methodological study.

The purpose of this study was to assess the reliability of radiographic pelvimetry. 48 radiologists were asked to estimate the pelvic inlet and outlet diameters from copies of 20 pelvimetry radiographs. We found that every third patient will have the sum of her pelvic outlet over- or underestimated by at least 4 mm, and 3% by more than 10 mm. The random measurement error of the sum of the pelvic outlet is about four times greater than the systematic error. The random error of the sagittal outlet diameter contributes to almost half of the total measurement error of the pelvic outlet sum. The measurement values of radiographic pelvimetry are often expressed in mm, which may give an impression of exactness that is obviously not well founded. Only in a few cases where the measurements suggest a severe feto-pelvic disproportion is it justified to do an elective cesarean section on the basis of radiographic pelvimetry only.

Clinical Competence↗

PubMed1992

MR pelvimetry--a practical alternative.

Pelvimetry remains a useful technique as part of the assessment of the term breech pregnancy where vaginal delivery is planned. MR pelvimetry is accurate, well tolerated and shows soft-tissue structures as well as bone. It avoids the potentially carcinogenic effects of ionising radiation and is thought to be completely safe for mother and fetus. A technique of MR pelvimetry is described which uses gradient-echo sequences. This quick, practical method makes minimal inroads into valuable scanning time, and may therefore be considered a potentially cost-effective alternative to conventional pelvimetry.

Adolescent↗

PubMed1988

[Indications of radio-pelvimetry at a university hospital and a district general hospital].

Studies carried out on the phantom have shown how reliable transverse diameter measurements of the pelvis are when carried out by X-Ray scanning pelvimetry compared with conventional X-Ray pelvimetry. The practice of scanning radiopelvimetry (digital radiography) depends on the availability of the machine and of an induced, secondary circuit. The arrival of this new technique makes it necessary for the sake of economy to limit the indications for the investigation. We have studied the indications for the examination in a population of pregnant women in a University Hospital Service as well as pregnant women in a District General Hospital. Since the conditions under which obstetrics are carried out in general hospitals are more precarious, more radiological examinations are carried out in them. Frequently investigations were carried out on primiparous women who have normal pelves. It appeared difficult to lower the number of indications. Digital X-Rays will therefore cost a lot. In university hospitals the indications for carrying out the investigations were studied critically. It seems to be possible to reduce the numbers to 6% of all patients who are delivered. Rationalizing the indications will make it possible to avoid the extra cost which results from carrying out scanning X-Ray pelvimetries more reliably and delivering a lesser dose of X-Rays than ordinary conventional X-Ray pelvimetries deliver.

Female↗

PubMedDate not supplied

A randomized trial of medical quality assurance. Improving physicians' use of pelvimetry.

The capacity of educational programs to improve physician performance remains doubtful despite many evaluative efforts. This is especially true for programs sponsored by the federal government. We tested the efficacy of an educational program conducted by Professional Standards Review Organizations in reducing the inappropriate use of x-ray pelvimetry. This procedure may cause harm to the fetus, and there is little evidence that it is efficacious. We randomly assigned 120 hospitals in six Professional Standards Review Organizations to study and control groups. Physicians with delivery privileges at each study hospital participated in an educational program that discussed acceptable indications for x-ray pelvimetry. Pelvimetry use was similar in study and control hospitals before the program. However, after the program, pelvimetry was performed by physicians at study hospitals less than one third as often as by physicians at control hospitals. We conclude that educational programs can improve physician performance substantially and that such programs can be effectively conducted by federally sponsored physician organizations.

Education, Medical, Continuing↗

PubMed1986

Computed tomographic pelvimetry.

Pelvimetry can be performed on a computed tomographic (CT) scanner using anteroposterior and lateral scanned projection radiographs (Scout View) plus a single CT slice through the low pelvis. This technique yields accurate measurements of the maternal pelvis that do not need compensation for magnification. The fetal lie and presentation can be easily assessed, along with the fetal neck for hyperextension. In addition, the total radiation dose to both mother and fetus is significantly lower than with routine plain film pelvimetry. Since the procedure is quick, easy to perform and competitive in cost, CT pelvimetry should be the procedure of choice in those rare instances in which pelvimetry is indicated.

Female↗

PubMed1985

Prospective randomized study of x-ray pelvimetry in the primigravida.

A prospective randomized study was performed to determine the usefulness of x-ray pelvimetry before oxytocin induction or augmentation. Two hundred primiparous women were entered into this study. Agreement on pelvic size by the clinical and radiologic assessment occurred in 76.5% of the cases. When the total groups were compared, there were no differences in pregnancy outcome. In the induction of labor subgroups there were less forcep deliveries and lower five-minute Apgar scores in the pelvimetry group. In the augmentation subgroups there were no differences. The subgroup of patients diagnosed clinically to have a borderline pelvis, had a higher incidence of cesarean section (P less than .05) if they had x-ray pelvimetry. These results suggest that the elimination of x-ray pelvimetry in primigravida women does not lead to a compromise in infant outcome when electronic fetal monitoring is used.

Adult↗

PubMed1991

[A technic of magnetic resonance tomographic pelvimetry in obstetrics].

Magnetic resonance imaging (MRL) allows for the first time direct determination of maternal pelvic dimensions without ionising radiation. Phantom measurements and the correlation with traditional pelvimetric measurements in 10 patients after Caesarean section have shown mean differences of +/- 2 mm, with a maximum of 5 mm. The evaluation of pelvic configuration is obtained analogous to the conventional roentgenogram. In addition to conventional or digital x-ray pelvimetry, the soft tissues of the maternal pelvis and the presenting part of the foetus is delineated with high contrast. Positioning in the body coil can be accomplished even late in pregnancy or in impending labour, acceptance by the pregnant women being high. Whereas in a given indication after delivery conventional x-ray pelvimetry continues to be performed, antenatally MRI pelvimetry has now been established in our Departments as the method of choice--based on meanwhile 107 examinations. Present drawbacks are the relatively high cost and the limited availability of MR units.

Evaluation Studies as Topic↗

PubMed1986

[Vaginosonographic pelvimetry as a new method of the sonographic determination of internal pelvic measurements].

Up to now sonographical pelvimetry has been performed by employing compound scanners. The development of a new vaginal scanner (panorama scanner) offers the possibility of using modern real-time ultrasound equipment for pelvimetry. Measurements were performed by vaginal scanner, compound scanner and after delivery by x-ray examination in 48 patients. Evaluation of our data showed a good correlation of all three methods. In contrary to the compound scanner vaginosonographical pelvimetry is not affected by the gestational week. Furthermore this method allows also the measurement of the transversal pelvic diameter.

Female↗