The Utilization and Efficacy of Pelvimetry

Kelly, Kevin M.; Madden, Dale A.; Arcarese, Joseph S.; Barnett, Mark A.; Brown, Reynold F.

doi:10.2214/ajr.125.1.66

Cited by 28 publications

(1 citation statement)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The shortcomings of clinical pelvimetry, especially in the assessment of pelvic inlet, have given way to the use of imaging techniques [18]. In fact, the use of imaging to prevent and control the risks during delivery has profoundly changed obstetric prognoses [26]. Since its introduction in the 1940s, obstetricians have used X-ray pelvimetry as a method to predict successful vaginal delivery in cases of suspected cephalopelvic disproportion and breech presentations [27,28,29].…”

Section: Discussionmentioning

confidence: 99%

The Utility of Mid-Pelvic Dimensions Via Plain Radiography in Predicting Cesarean Delivery

Bello A.,

Usman J. D.

2023

AJMAH

View full text Add to dashboard Cite

Introduction: Studies on the role of pelvimetry in predicting the mode of delivery have yielded mixed results. The aim of this study is to determine utility of the mid-pelvic measurement in predicting the mode of delivery in a cohort of women attempting vaginal delivery. Study Design and Methods: With this prospective cohort study, we evaluated the use of x-ray in predicting the delivery outcome of women attempting to deliver vaginally. Women were recruited before labor at >36 weeks gestational age and X-ray pelvimetry was performed after delivery. The exposures of interest were mid pelvic measures including anteroposterior diameters, transverse diameters and circumferences. The outcome measures were whether the women delivered via vaginal route or had cesarean delivery. We estimated the distribution and calculated measures of central tendency and spread of each pelvic dimension. Area under the receiver-operating characteristics curve (AUC) was used to estimate the overall predictive ability for each pelvic dimension and the optimal cut-point was estimated using the method of Liu. Logistic regression analysis was used to identify independent predictors for mode of delivery. The Hosmer – Lemeshow goodness-of-fit test was used to estimate the overall fit while the AUC was used to estimate the overall prediction of the final model. Results: A total of 426 women met the inclusion criteria. The mean gestational age at delivery was 40 (±6.0) weeks and the majority were black parturient (62.6%0. A slight majority were nulliparous (52.1%). In all, 127 women (29.8%) were delivered by cesarean delivery. All the pelvic inlet and mid pelvic dimensions were approximately normally distributed. The AUC ranged from 0.62 to 0.86. While the pelvic inlet and mid pelvic diameters had equivalent AUC, the optimal cut-point of the mid pelvic anteroposterior diameter (10.8cm) had both higher sensitivity and specificity than the pelvic inlet anteroposterior diameter (10.2cm) (95% and 85% versus 90% and 80%, respectively). There was an inverse relationship between the mid pelvic anteroposterior diameter and mode of delivery by cesarean section, with a 100% risk among women with a diameter of 9cm or less. However, the multivariable model developed had an AUC of 0.90, indicating overall good and higher predictive ability than the mid-pelvic anteroposterior diameter alone. Conclusions: In this large cohort study, the mid pelvic anteroposterior diameter best predicted mode of delivery by cesarean section.

show abstract

Section: Discussionmentioning

confidence: 99%

The Utility of Mid-Pelvic Dimensions Via Plain Radiography in Predicting Cesarean Delivery

Bello A.,

Usman J. D.

2023

AJMAH

View full text Add to dashboard Cite

show abstract

A Prospective Evaluation of X-ray Pelvimetry

Laube

Varner

Cruikshank

1981

JAMA

View full text Add to dashboard Cite

One hundred four consecutive patients undergoing x-ray pelvimetry were analyzed prospectively in an attempt to evaluate the efficacy of this procedure. Comparison was made between prepelvimetry and post-pelvimetry clinical management plans. Roentgenographic pelvic measurements led to prompt and significant alterations in clinical management plans in only one of 67 patients with vertex presentation and one of 37 with breech presentation. In 98% of patients, no change in immediate clinical management plan was made on the basis of x-ray pelvimetry findings.

show abstract

A Randomized Trial of Medical Quality Assurance

Chassin¹

1986

JAMA

View full text Add to dashboard Cite

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.

show abstract

The Utilization and Efficacy of Pelvimetry

Cited by 28 publications

References 0 publications

The Utility of Mid-Pelvic Dimensions Via Plain Radiography in Predicting Cesarean Delivery

The Utility of Mid-Pelvic Dimensions Via Plain Radiography in Predicting Cesarean Delivery

A Prospective Evaluation of X-ray Pelvimetry

A Randomized Trial of Medical Quality Assurance

Contact Info

Product

Resources

About