Pelvimetry

{{Short description|Measurement of the female pelvis}} {{Infobox diagnostic | name = Pelvimetry | image = | alt = | caption = | pronounce = | purpose =measurement of female pelvis | test of = | based on = | synonyms = | reference_range = | calculator = | DiseasesDB =  | ICD10 =  | ICD9 = | ICDO = | MedlinePlus =  | eMedicine =  | MeshID = | OPS301 =  | LOINC =  }} '''Pelvimetry''' is the measurement of the female pelvis.<ref>{{DorlandsDict|six/000079744|pelvimetry}}</ref> It can theoretically identify cephalo-pelvic disproportion, which is when the capacity of the pelvis is inadequate to allow the fetus to negotiate the birth canal. However, clinical evidence indicate that all pregnant women should be allowed a trial of labor regardless of pelvimetry results.<ref name="Blackadar2004"/>

==Indication== Theoretically, pelvimetry may identify cephalo-pelvic disproportion, which is when the capacity of the pelvis is inadequate to allow the fetus to negotiate the birth canal. However, a woman's pelvis loosens up before birth (with the help of hormones).

A Cochrane review in 2017 found that there was too little evidence to show whether X-ray pelvimetry is beneficial and safe when the baby is in cephalic presentation.<ref name="pmid28358979">{{cite journal | vauthors = Pattinson RC, Cuthbert A, Vannevel V | title = Pelvimetry for fetal cephalic presentations at or near term for deciding on mode of delivery | journal = The Cochrane Database of Systematic Reviews | volume = 3 | article-number = CD000161 | date = March 2017 | issue = 12 | pmid = 28358979 | pmc = 6464150 | doi = 10.1002/14651858.CD000161.pub2 }}</ref>

A review in 2003 came to the conclusion that pelvimetry does not change the management of pregnant women, and recommended that all women should be allowed a trial of labor regardless of pelvimetry results.<ref name="Blackadar2004">{{cite journal | vauthors = Blackadar CS, Viera AJ | title = A retrospective review of performance and utility of routine clinical pelvimetry | journal = Family Medicine | volume = 36 | issue = 7 | pages = 505–7 | date = 2004 | pmid = 15243832 }}</ref> It considered routine performance of pelvimetry to be a waste of time, a potential liability, and an unnecessary discomfort.<ref name="Blackadar2004"/>

==Components== The terms used in pelvimetry are commonly used in obstetrics. Clinical pelvimetry attempts to assess the pelvis by clinical examination. Pelvimetry can also be done by radiography and MRI.

Low-dose 3D-rendered CT scans can be used for estimating the main pelvimetry parameters:<ref name=Cetin2016>{{cite journal | vauthors = Salk I, Cetin A, Salk S, Cetin M | title = Pelvimetry by Three-Dimensional Computed Tomography in Non-Pregnant Multiparous Women Who Delivered Vaginally | journal = Polish Journal of Radiology | volume = 81 | pages = 219–27 | date = 2016 | pmid = 27231494 | pmc = 4865272 | doi = 10.12659/PJR.896380 }}</ref> {|class="wikitable" !colspan=2| Parameter !! Maximum intensity projections<ref>{{cite journal|last1=Salk|first1=Ismail|last2=Cetin|first2=Ali|last3=Salk|first3=Sultan|last4=Cetin|first4=Meral|title=Pelvimetry by Three-Dimensional Computed Tomography in Non-Pregnant Multiparous Women Who Delivered Vaginally|journal=Polish Journal of Radiology|volume=81|year=2016|pages=219–227|issn=0137-7183|doi=10.12659/PJR.896380|pmid=27231494|pmc=4865272}}</ref> !! Thin slices !! End points !! Normal measures |- !rowspan=2| Pelvic inlet !Transverse diameter of the pelvic inlet | 170px | 170px<br />Coronal plane | The '''iliopectineal lines''', at widest transverse distance. || 13 to 14.5 cm.<ref name=Cetin2016/> |- ! Obstetric conjugate | 120px <br />Median plane, 20 mm thick | Same, but may require minor side-to-side scrolling to visualize both end points. | The line between the closest bony points of the '''sacral promontory''' and the '''pubic bone''' next to the symphysis | 10 to 12 cm.<ref name=Cetin2016/> |- ! colspan=2| Interspinous distance | 170px | 170px<br />Axial plane | The line between the closest bone points of the '''ischial spines''' | 9.5 to 11.5 cm.<ref name="pmid21509231">{{cite journal | vauthors = Gowri V, Jain R, Rizvi S | title = Magnetic resonance pelvimetry for trial of labour after a previous caesarean section | journal = Sultan Qaboos University Medical Journal | volume = 10 | issue = 2 | pages = 210–4 | date = August 2010 | pmid = 21509231 | pmc = 3074700 }}</ref> |- ! rowspan=2| Pelvic outlet ! Sagittal pelvic outlet diameter | 120px | Same, but may require minor side-to-side scrolling to visualize both end points. | The closest bony points of the '''sacrococcygeal joint''' and the '''pubic bone''' next to the symphysis. This is also called the ''obstetric anteroposterior diameter of the pelvic outlet'', to distinguish from the ''anatomic'' one which includes the coccyx.<ref>[https://books.google.com/books?id=M9k0UMTAGAIC&pg=PA94 Page 94] in: {{cite book|title=Hacker & Moore's Essentials of Obstetrics and Gynecology|author=Neville F. Hacker, Joseph C. Gambone, Calvin J. Hobel|edition=5|publisher=Elsevier Health Sciences|year=2009|isbn=978-1-4377-2516-2}}</ref> However, the coccyx is normally pushed away during childbirth by laxity in the sacrococcygeal joint.<ref>[https://books.google.com/books?id=oMfGQylCBMsC&pg=PT239 Page 239] in: {{cite book|title=Labor and Delivery Care: A Practical Guide|author=Wayne R. Cohen, Emanuel A. Friedman|publisher=John Wiley & Sons|year=2011|isbn=978-1-119-97154-2}}</ref> | 9.5 to 11.5 cm.<ref name="pmid21509231"/> |- ! Intertuberous diameter | 150px | 170px<br />Axial plane | The closest bony points of the '''ischial tuberosities''' | 10 to 12 cm.<ref name="pmid21509231"/> |}

==History== thumb|150px|Pelvimeter {| class="wikitable" width="400" align="right" |center|200x200px|Male pelvis |center|200x200px|Female pelvis |- | colspan="2" |Comparison between an android (left) and a gynecoid pelvis (right). |} Traditional obstetrical services relied heavily on pelvimetry in the conduct of delivery in order to decide if natural or operative vaginal delivery was possible or if and when to use a cesarean section.<ref>{{cite journal|title=Yale - The Pelvic Survey|journal=The Yale Journal of Biology and Medicine|volume=19|issue=2|pages=171–179|author=Herbert Thoms|year=1946|pmc=2602099|pmid=20285601}}</ref> Women whose pelvises were deemed too small received caesarean sections instead of birthing naturally.{{cn|date=February 2022}}

Traditional obstetrics have characterized four types of pelvises:{{cn|date=February 2022}} * '''Gynecoid''': Ideal shape, with round to slightly oval (obstetrical inlet slightly less transverse) inlet. * '''Android''': triangular inlet, and prominent ischial spines, more angulated pubic arch. * '''Anthropoid''': the widest transverse diameter is less than the anteroposterior (obstetrical) diameter. * '''Platypelloid''': Flat inlet with shortened obstetrical diameter.

==References== {{reflist}}

Category:Obstetrical procedures Category:Pelvis