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

Bello A. *

Department of Anatomy, Faculty of Basic Medical Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria.

Usman J. D.

Department of Anatomy, Faculty of Basic Medical Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria.

*Author to whom correspondence should be addressed.


Abstract

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.

Keywords: Pelvimetry, vaginal delivery, cesarean delivery


How to Cite

Bello A., and Usman J. D. 2023. “The Utility of Mid-Pelvic Dimensions Via Plain Radiography in Predicting Cesarean Delivery”. Asian Journal of Medicine and Health 21 (11):102-14. https://doi.org/10.9734/ajmah/2023/v21i11924.

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References

WHO: The World Health Report: Make Every Mother and Child Count. Geneva. World Health Organization. 2005;230.

Zhang J, Troendle J, Reddy UM, Laughon SK, Branch DW, Burkman R, Landy HJ, Hibbard JU, Haberman S, Ramirez MM, Bailit JL, Hoffman MK, Gregory KD, Gozalez-Quintero VH, Kominiarek M, Learman LA, Hatjis CG, Veldhuisen P. Consortium on Safe Labor: Contemporary Cesarean Delivery Practice in the United States. Am j Obstet Gynecol. 2010b;203:326.e1 – 326.e10.

Mahler H. The Safe Motherhood Initiative: A Call to Action. Lancet. 1987;1: 668–70.

Maharaj D. Assessing Cepahlopelvic Disproportion: Back to the Basics.” Obstetrical & Gynecological Survey. 2010;65(6):387 – 395.

Awonuga AO, Merhi Z, Awonuga MT, Samuels TA, Waller J, Pring D. Anthropometric Measurements in the Diagnosis of Pelvic Size: An Analysis of Maternal Height and Shoe Size and Computed Tomography Pelvimetric Data.” Archives of Gynecology and Obstetrics. 2007;276 (5):523 – 528.

Ferguson JE, Newberry YG, DeAngelis GA, Finnerty JJ, Agarwal S, Turkheimer E. The Fetal-Pelvic Index Has Minimal Utility in Predicting Fetal-Pelvic Disproportion. American Journal of Obstetrics and Gynecology. 1998;179 (5):1186 – 1192.

Mathelier AC. Radiopelvimetry After Cesarean Section. Journal of Reproductive Medicine. 1996;41:427 – 430.

Sporri S, Thoeny HC, Raio L, Lachat R, Vock P, Schneider H. MR Imaging Pelvimetry: A Useful Adjunct in the Treatment of Women at Risk for Dystocia? AJR Am J Roentgenol. 2002;179(1): 137 – 44.

Lao TT, Robert KHC, Belinda FHL. Is X-Ray Pelvimetry Useful in a Trial of Labor After Cesarean Section? Eur. J. Obstet. Gynecol. Reprod. Biol. 1987;24:277 – 283.

Sibony O, Alran S, Jean-Francois O. Vaginal Birth After Cesarean Section: X-Ray Pelvimetry at Term is Informative. J. Perinat. Med. 2006;34(3):212 – 215.

Von Bismarck A, Ertl-Wagner B, Stoecklein S, et al. MR pelvimetry for breech presentation at term- interobserver reliability, incidental findings and reference values. Fortschr Röntgenstr. 2019;191(5):424-432. DOI: 10.1055/a-0715-2122.

Nathalie Roux, Diane Korb, Cécile Morin, Olivier Sibony, Trial of labor after cesarean and contribution of pelvimetry in the prognosis of neonatal morbidity, Journal of Gynecology Obstetrics and Human Reproduction. 2020;49(3):101681.

ISSN 2468-7847, https://doi.org/10.1016/j.jogoh.2020.101681.

Grunstra NDS, Betti L, Fischer B, Haeusler M, Pavlicev M, Stansfield E, Trevathan W, Webb NM, Wells JCK, Rosenberg KR, Mitteroecker P. There is an obstetrical dilemma: Misconceptions about the evolution of human childbirth and pelvic form, American Journal of Biological Anthropology. 2023;181(4):535-544.

DOI:10.1002/ajpa.24802

Klemt A, Schulze S, Brüggmann D, Louwen F. MRI-based pelvimetric measurements as predictors for a successful vaginal breech delivery in the Frankfurt Breech at term cohort (FRABAT). European Journal of Obstetrics & Gynecology and Reproductive Biology. 2018;232:10-17. https://doi.org/10.1016/j.ejogrb.2018.09.033

Harper LM, Odibo AO, Stamilio DM, Macones GA. Radiographic Measures of the Mid Pelvis to Predict Cesarean Delivery. Am J Obstet Gynecol. 2013;208:460.e1-6.

Jiang XX. Clinical Pelvimetry. Available from: http//www.gfds.com; retrieved on 13th June 2017.

Al lakkany AM, Badawy AM, Bassiouni BA. Can the Fetal-Pelvic Index Predict Fetal-Pelvic Disproportion During Vaginal Breech Delivery? Journal of Obstetrics and Gynaecology. 2002;22 (2):140-142.

Ma′aji SM, Adetiloye VA, Ayoola OO. Normal pelvic dimensions of Nigerian women in Ile Ife by computed tomographic pelvimetry. Nigerian Postgraduate Medical Journal. 2007;14(2):109-113.

Macones GA, Chang JJ, Stamilio DM, Odibo AO, Wang J, Cahill AG. Prediction of Cesarean Delivery Using Fetal-Pelvic Index.” American Journal of Obstetrics and Gynecology. 2013;209 (5):431.e1 – 8.

Sigmann MH, Delabrousse E, Reithmuller D, Runge M, Peyron C, Aubry S. An Evaluation of the EOS X-Ray Imaging system in Pelvimetry. Diagnostic and Interventional Imaging. Editions Francaise de Radilogie. Published by Elsevier Masson SAS. 2014;95: 833-838.

Sule ST, Matawal BI. Antenatal Clinical Pelvimetry in Primigravidae and Outcome of Labour: Annals of African Medicine. 2005;4(4):164-167.

Korhonen U, Taipale P, Heinonen S. The diagnostic accuracy of pelvic measurements: threshold values and fetal size. Arch Gynecol Obstet. 2014;290(4): 643-648.

Hernandez E, Rosenshein NB, Goldberg E, King TM. Roentgenographic Pelvimetry in Single Vertex Pregnancies. South Med J. 1982;75:439-42.

Gabbe SG, Niebyl JR, Simpson JL. Obstetrics: Normal and problem pregnancies. Philadelphia: Churchill Livingstone/Elsevier; 2012.

Colcher AE, Sussmann W. Changing Concepts of X-Ray Pelvimetry.” American Journal of Obstetrics and Gynecology. 1949;57(3):510 – 519.

Kelly KM, Madden DA, Arcarese JS, Barnett RF. The Utilization and Efficacy of Pelvimetry. Am J Roentgenol Radium Ther Nucl Med. 1975;125(1):66 – 74.

Ince JGH, Young MK. The Bony Pelvis and its Influence on Labour: Radiological and Clinical Study of 500 Women. Journal of Obstetrics and Gynaecology of the British Empire. 1940;47: 130 – 190.

Todd WD, Steer CM. Term Breech: Review of 1006 Term Breech Deliveries. Obstetrics and Gynaecology. 1963;22:583 – 595.

Beischer NA. Pelvic Contraction in Breech Presentation. Journal of Obstetrics and Gynaecology of the British Commonwealth. 1966;73:421 – 427.

Humphrey GEA. The Clinical Value of X-Ray Pelvimetry. Postgraduate Medical Journal. (Downloaded on May 3, 2015- published by group.bmj.com from http://pmj.bmj.com/.

Mengert WF. Estimation of pelvic capacity. Journal of the American Medical Association. 1948;138 (3):169 – 174.

Morgan MA, Thurnau GR. Efficacy of the Fetal-Pelviic Index in Nulliparous Women at High Risk for Fetal-Pelvic Disproportion. American Journal of Obstetrics and Gynecology. 1992;166 (3): 810 – 814.

Van Loon AJ, Mantingh A, Serlier EK, Kroon G, Mooyaart EL, Huisjes HJ. Randomised Controlled Trial of Magnetic Resonance Imaging Pelvimetry in Breech Presentation at Term. Lancet. 1997;350: 1799 – 1804.

Ikhena SE, Halligan AWF, Naftalin NJ. Has Pelvimetry Role in Current Obstetric Practice? Journal of Obstetrics and Gynaecology. 1999;19(5):463 – 466.

Harper LM, Stamilio DM, Odibo AO, Macones GA. Vaginal Birth After Cesarean for Cephalopelvic Disproportion: Effect of Birth Weight Differences on Success.” Obstetrics and Gynecology. 2011;117 (2 Pt 1):343 – 348.