Obstetric Conjugate Research Articles

MRI-based pelvimetric measurements as predictors for a successful vaginal breech delivery in the Frankfurt Breech at term cohort (FRABAT)

ObjectivesThe purpose of this study was to investigate the role of the maternal pelvis, assessed by MRI pelvimetry in nulliparous women expecting a term fetus in breech presentation, to predict a successful and safe vaginal birth. Study designIn this monocentric and anonymized cohort study, we enrolled 367 nulliparous women with breech presentation at 39+0 to 41+0 weeks of gestation during a period of 8 years at the University Women's Hospital in Frankfurt/Main. Pelvic measurements were obtained by standard MRI imaging. We correlated the obstetric conjugate, the pubic angle and the distance between the ischial tuberosities (intertuberous distance) with the maternal and fetal outcomes of vaginally intended breech births. The data was evaluated using logistic regression analysis. Results241 of 367 participants (65.7%) experienced a successful vaginal delivery whereas 126 patients (34.3%) were subjected to secondary cesarean section. An increasing obstetric conjugate was significantly associated with an increasing rate of successful vaginal deliveries. No significant correlation of the intertuberous distance and the pubic angle with the mode of delivery could be shown. Although statistically not significant, we were able to define cut-off values of 10.9 cm in the intertuberous distance and 70° in the pubic angle; below these values, no successful vaginal delivery was recorded. No significant differences in the short-term outcomes were seen between the neonates of the vaginal delivery and the cesarean section groups. Inter- and intraobserver variability showed excellent reproducibility for all MRI parameters. ConclusionThe obstetric conjugate correlates with the rate of vaginal deliveries in nulliparous women at term and can be used as a useful criterion for pre-selection and counseling of women with breech presentation and the desire for a vaginal delivery.

A study of lesser pelvic parameters and their correlation with age by reformatted computed tomography in western Indian Gujarati female population

Abstract Background & aims: Pelvic parameters vary according to age, race and population. The study is aimed at assessing female pelvic parameters using reformatted 3D CT images, compare the obtained values with other studies and correlate these parameters with age. Material & Methods: Reformatted three-dimensional CT images were obtained from stored abdominopelvic computed tomography [CT] scan images. Image analysis software was used to determine various diameters of the lesser pelvis. Data were analysed to derive mean ± SD, SE, 95% Cl, paired t test and Pearson correlation test were used for comparison and correlation of variables. Results: Mean± standard deviation of obstetric conjugate diameter was 10.94±1.18 cm, transverse diameter of inlet was 12.46±0.81 cm, sagittal diameter of midplane wasl 1.74±0.80 cm, interspinous diameter was 9.78±0.75 cm, sagittal diameter of outlet was 8.99±1.02 cm and intertuberous diameter was 10.69±0.86. All the parameters except sagittal diameter of midplane and interspinous diameter showed correlation with age. Conclusion: The present study provides reference values for various pelvic parameters in western Indian Gujarati female population. Parameters obtained in present study vary greatly from previous studies from other populations. The results demonstrated that significant age-related changes occurred in pelvic inlet and outlet parameters.

The birth canal: correlation between the pubic arch angle, the interspinous diameter, and the obstetrical conjugate: a computed tomography biometric study in reproductive age women

Background: Assessment of pelvic configuration is an important factor in the prediction of a successful vaginal birth. However, manual evaluation of the pelvis is practically a vanishing art, and imaging techniques are not available as a real-time bed-side tool. Unlike the obstetrical conjugate diameter (OC) and inter spinous diameter (ISD), the pubic arch angle (PAA) can be easily measured by transperineal ultrasound.Objectives: Three-dimensional computed tomography bone reconstructions were used to measure the three main birth canal diameters, evaluate the correlation between them, and establish the normal reference range for the inlet, mid-, and pelvic outlet.Study design: Measurements of the PAA, obstetric conjugate (OC), and ISD were performed offline using three-dimensional post processing reconstruction in bone algorithm application of the pelvis on examinations performed for suspected renal colic in nonpregnant reproductive age woman. The mean of two measurements was used for statistical analysis which included reproducibility of measurements, regression curve estimation between PAA, OC, and ISD, and calculation of the respective reference range centiles for each PAA degree.Results: Two hundred ninety-eight women comprised the study group. The mean ± SD of the PAA, ISD, and OC were 104.9° (±7.4), 103.8 mm (±7.3), and 129.9 mm (±8.3), respectively. The intra- and interobserver agreement defined by the intraclass correlation coefficient (ICC) was excellent for all parameters (range 0.905–0.993). A significant positive correlation was found between PAA and ISD and between PAA and OCD (Pearson’s correlation = 0.373 (p < .001), and 0.163 (p = .022), respectively). The best regression formula was found with quadratic regression for inter spinous diameter (ISD): 34.122778 + (0.962182*PAA − 0.002830*PAA2), and linear regression for obstetric conjugate (OC): 110.638397 + 0.183156*PAA. Modeled mean, SD, and reference centiles of the ISD and OCD were calculated using the above regression models as function of the PAA.Conclusions: We report significant correlation between the three pelvic landmarks with greatest impact on the prediction of a successful vaginal delivery: the PAA which is easily measured sonographically and the ISD and OC which are not measurable by ultrasound. This correlation may serve as a basis for future studies to assess its utility and prognostic value for a safe vaginal delivery.

Three-dimensional magnetic resonance pelvimetry: A new technique for evaluating the female pelvis in pregnancy

ObjectiveTo describe three-dimensional (3D) magnetic resonance imaging (MRI) pelvimetry methods and to establish the pelvimetric reference in a large population of Chinese females at term pregnancy. MethodsThree-hundred one pregnant women at term who underwent MRI were included. Three-dimensional pelvic models were reconstructed using Mimics. 10.0 software based on MRI data sets, and measurements of these models were made. Pelvimetric results according to delivery modality were presented. Additionally, the previously described CT 3D pelvimetry method for predicting cephalopelvic disproportion (CPD) was used to validate its accuracy. ResultsTwo hundred ten women underwent vaginal delivery, and 13 underwent caesarean delivery for CPD. 3D modelling of the pelvis of pregnant women was feasible using MR data sets. Pelvimetric parameters in the vaginal delivery group were as follows: transverse diameter, 134.7 mm ± 7.5; obstetric conjugate, 126.9 mm ± 8.3; interspinous distance, 113.4 mm ± 8.2; sagittal midpelvis, 117.8 mm ± 8.1; intertuberous distance, 127.1 mm ± 10.4; sagittal outlet, 110.2 mm ± 8.9, and posterior sagittal outlet, 59.7 mm ± 8.1. According to the previously described CT 3D pelvimetry method for predicting CPD, 67.6% (142/210) of women in the vaginal delivery group were diagnosed with CPD. Conclusion3D MR pelvimetry is a novel method for determining pelvic dimensions at term pregnancy. A prospective trial is needed to establish a useful value for predicting CPD in Chinese females at high risk of CPD.

Pelvimetry in nulliparous and primiparous women using 3 Tesla magnetic resonance imaging.

To perform pelvimetry in nulliparous and primiparous women using 3 Tesla magnetic resonance imaging (3T MRI). Twenty-five nulliparous volunteers and 25 primiparous women underwent pelvic 3T MRI within one week after vaginal childbirth in a prospective clinical single-center trial. The pelvimetric parameters interspinous distance (ISD), intertuberous distance (ITD), sagittal outlet (SO), obstetric conjugate (OC), and coccygeal curved length (CCL) were adapted from anthropometric measurements as well as from sonographic and computed tomography-based pelvimetry performed on high-resolution T2-weighted images. We compared the results of the two study groups to one another, recent literature and postpartum-diagnosed levator ani muscle (LAM) injuries. The mean values for primipara/nullipara were ISD 107 ± 8.3/105 ± 8.4 mm, ITD 119.8 ± 10.2/118.4 ± 13.1 mm, OC 129.4 ± 10/130.8 ± 6.9 mm, SO 114.3 ± 7.8/112.5 ± 8.9 mm, and CCL 37.3 ± 7.4/39 ± 8 mm. Significant differences (P < 0.05) were found between the results for OC, SO, and CCL (primipara) and ISD, ITD and OC (nullipara) and the values in the literature. No significant difference in pelvimetric values was found between the groups. A significant correlation was found between the pelvimetric parameters and five types of LAM injuries. Two-dimensional 3T MRI combines high-resolution images with objective pelvimetric measurements applicable in a postpartum setting. Our results provide a good foundation for further MRI-based studies evaluating the bony pelvis and its relation to LAM injuries during vaginal childbirth.

Influence of pelvic volume on surgical outcome after low anterior resection for rectal cancer.

Low anterior resection (LAR) for rectal cancer is a potentially challenging operation due to limited space in the pelvis. CT pelvimetry allows to quantify pelvic space, so that its relationship with outcome after LAR may be assessed. Studies investigating this, however, yielded conflicting results. We hypothesized that a small pelvis is associated with a higher rate of incomplete mesorectal excision, anastomotic leakages, and increased rate of urinary dysfunction in patients operated for rectal cancer. In a single-center retrospective analysis, we studied 74 patients that underwent LAR for rectal cancer with primary anastomosis. Thin-layered multi-slice CT datasets were used for slice by slice depiction of the inner pelvic surface, and the inner pelvic volume was automatically compounded. The primary outcome was quality of total mesorectal excision (TME; Mercury grading); secondary outcomes were anastomotic leakage and urinary dysfunction with regard to pelvic dimensions. Univariate analyses and multiple logistic regression analyses were performed for the primary and the secondary outcomes. Shorter obstetric conjugate diameters were associated with a higher probability of a worse TME quality (110.8±10.2 vs. 105.0±8.6mm; OR 0.85; 95% CI 0.73-0.99; p=0.038). Short interspinous distance showed a trend towards an increased risk for deteriorated TME quality (OR 0.88; 95% CI 0.76-1.0; p=0.06). Anastomotic leakage was associated with anemia (OR 2.77; 95% CI 1.0-7.7; p=0.047). Association between pelvic diameters or pelvic volume and anastomotic leakage or urinary dysfunction was not observed. Perioperative blood transfusions were administered more often in patients with postoperative urinary dysfunction (OR 17.67; 95% CI 2.44-127.7; p=0.004). Shorter obstetric conjugate diameter might be a risk factor for incompleteness of total mesorectal excision. Anastomotic leakage seems to be influenced more by clinical factors such as anemia rather than pelvic dimensions. Further studies have to prove the influence of pelvic diameter on local recurrence of rectal cancer after LAR.

A study of sagittal pelvic diameters and their variations with advancing age in Gujarati female population by reformatted computed tomography

CONTEXT: Pelvic diameters are found to be race and age dependent. Gradual horizontalization of sacrum with the advancement of age causes changes in the sagittal pelvic diameters. AIMS: The aim of the present study is to derive values of sagittal pelvic diameters in Gujarati females, analyze these data to find out changes with regard to the age, and compare the same with other studies. SETTINGS AND DESIGN: This was an observational, retrospective study. MATERIALS AND METHODS: A total of 100 stored abdominopelvic computed tomography (CT) scan images were used for the present study. Pelvic parameters were analyzed on reformatted three-dimensional CT images. Sagittal diameters of inlets including anatomical, obstetric, and diagonal conjugate and at level of the pelvic cavity and pelvic outlet were measured. STATISTICAL ANALYSIS USED: Medcalc version 14 was used for statistical analysis. Data were compared and analyzed to determine the significance of difference between the two age groups. RESULTS: Mean ± standard deviation of anatomical conjugate was 11.07 ± 1.12 cm, obstetric conjugate was 11.00 ± 1.13 cm, diagonal conjugate was 12.04 ± 1.05 cm, pelvic cavity was 11.53 ± 0.86 cm, outlet at the level of lower end of sacrum was 10.56 ± 0.82 cm, and outlet at the level of tip of coccyx was 8.97 ± 0.99 cm. These parameters analyzed with regard to the age showed that the sagittal diameters at level of inlet decrease with increasing age and at level of cavity and outlet increase with increasing age. CONCLUSIONS: The present study concluded that various sagittal pelvic diameters vary in different races and populations. All the sagittal pelvic diameters show changes with increase in age, but changes in pelvic inlet diameters are found to be more significant.

Which Foetal-Pelvic Variables Are Useful for Predicting Caesarean Section and Instrumental Assistance

Objective: To assess the variables useful to predict caesarean delivery (CD) and instrumental assistance, through the analysis of a large number of foetal-pelvic variables, using discriminant analysis. Materials and Methods: One hundred and fourteen pregnant women were included in this single-centre prospective study. For each mother-foetus pair, 43 pelvic and 18 foetal variables were measured. Partial least squares-discriminant analysis was performed to identify foetal-pelvic variables that could statistically separate the 3 delivery modality groups: spontaneous vaginal delivery (SVD), CD, and instrument-assisted delivery (IAD). Results: For the SVD versus CD model, voluminous foetuses and women with a narrow pelvic inlet had a greater risk for requiring CD. The most efficient variables for discrimination were the transverse diameter and foetal weight. The antero-posterior inlet and obstetric conjugate were considered in this model, with the former being a useful variable but not the latter. For the SVD versus IAD model, the most important variables were the foetal variables, particularly the bi-parietal diameter. Women with a reduced antero-posterior outlet diameter and a narrow pubic arch were more at risk of requiring an IAD. Conclusion: The antero-posterior inlet was an efficient variable unlike the obstetric conjugate. The obstetric conjugate diameter should no longer be considered a useful variable in estimating the arrest of labour. Antero-posterior inlet diameter was a sagittal variable that should be taken into account. The comparison of sub-pubic angle and bi-parietal and antero-posterior outlet diameters was useful in identifying a risk of requiring instrumental assistance.

Female pelvic dimensions relevant to labour process in a black Kenyan population

Introduction: Maternal pelvic dimensions are key to determining progress and outcome of labour. In addition, the size of the pelvis is a crucial reference point in attempting to predict cephalopelvic disproportion. There is paucity of data regarding pelvic dimensions amongst black Kenyan population despite the central significance of such data in local obstetrics practice. Methods: A cross-sectional study of 50 female pelvic osteology specimens was performed at the National Museums of Kenya, Nairobi. Data were collected using a structured study instrument and were analyzed using Statistical Pack age for Social Sciences version 21. Results: At the pelvic inlet, the true conjugate was 10.37 ± 1.02cm, the diagonal conjugate was 11.72 ± 1.07cm and the obstetric conjugate was 11.44 ± 0.78cm. The transverse diameter was 11.42 ± 0.96cm. In the mid-cavity, the anteroposterior diameter was 10.64 ± 1.00cm, while the interspinous diameter was 8.49 ± 0.92cm. At the outlet, the anteroposterior diameter was 9.66 ± 1.16cm, while the intertuberous diameter was 9.04 ± 0.92cm. The subpubic angle was 74.54 ± 9.72 degrees. The posterior depth was 9.95 ± 1.11cm, while the anterior depth was 3.24 ± 1.41 cm. Conclusion: The average pelvic dimensions in this population are smaller than what has been observed in other populations. Of significance is that some morphometric dimensions were ominously smaller than what has been implicated in cephalopelvic disproportion. Imaging and clinical studies would help shed more light on correlation of the dimensions and obstetric outcomes in black Kenyan population.

CT-based measurement of the inner pelvic volume.

Background Surgery in the lesser pelvis is associated with a high complication rate as surgeons are spatially limited by solid anatomic structures and soft tissue borders. So far, only two-dimensional (2D) parameters have been used for risk stratification. Purpose To precisely measure the inner pelvic volume a computed tomography (CT)-based three-dimensional (3D) approach was established and compared to approximations by 2D parameter combinations. Material and Methods Thin-layered multi-slice CT datasets were used retrospectively for slice by slice depiction of the inner pelvic surface. The inner pelvic volume was then automatically compounded. Combinations of two to four 2D dimensions determined in 3D volume rendered reconstructions were correlated with the inner pelvic volume. Pearson's correlation coefficient and Chi square test were used for statistical calculations. Significance level was set at P < 0.05. Results In total 142 patients (91 men, 51 women) aged 64.8 ± 10.6 years at surgery were included in the study. Mean calculated pelvic volume was 1031.13 ± 180.06 cm3 (men, 996.57 ± 172.43 cm3; women, 1093.34 ± 178.39 cm3). Best approximations were obtained by combination of the 2D measurements transverse inlet and pelvic height for men (r = 0.799, P < 0.05) as well as transverse inlet, obstetric conjugate, interspinous distance and pelvic depth for women (r = 0.855, P < 0.05). Conclusion We describe a precise and reproducible CT-based method for pelvic volumetry. A less time consuming but still reliable approximation can be achieved by combination of two to four 2D dimensions.

Pelvimetry by Three-Dimensional Computed Tomography in Non-Pregnant Multiparous Women Who Delivered Vaginally

SummaryBackgroundWe assessed retrospectively the reference values of pelvic dimensions by 3D CT performed for non-obstetrical indications in non-pregnant multiparous women with a successful vaginal delivery. We further aimed to evaluate the impact of maternal short stature on these parameters.Material/MethodsThe 3D CT pelvimetry was performed retrospectively in 203 non-pregnant women selected consecutively if they had at least one singleton term delivery with head presentation and if there was no history of maternal or fetal birth trauma or cerebral palsy after childbirth. With standard sagittal and reformatted axial-oblique views, anteroposterior including three conjugates of pelvic inlet, transverse, posterior sagittal diameters of pelvic inlet, the plane of greatest diameter, the plane of least diameter, and pelvic outlet were measured. Selected obstetric parameters were collected.ResultsOverall, the pelvises had transverse oval appearance in inlet and size of the female pelvis. The diagonal conjugate was at least 15 mm longer than the obstetric conjugate. Women with short stature had lower maximal birth weight, and this was in accordance with their somewhat lower pelvic diameters.ConclusionsThe findings of this study present the reference values of the main planes of the true pelvis by 3D CT pelvimetry in a relatively large group of multiparous women who passed a trial of labor successfully. Overall, the pelvises had features of female pelvic bony structure although pelvic diameters were somewhat lower in multiparous women with short stature. The 3D pelvimetry with CT applications may be used as an adjunct to clinical and ultrasonographic examinations to rule out cephalopelvic dystocia in selected cases.

Pelvimetry by Reformatted Computed Tomography in 290 Female Pelvis: Morphometric Variations Regarding Age

The Mexican government passed a new reform of article 11 of the General Law in 2014 regarding Women's Access to a Life Free of Violence, which states that a cesarean section may not be performed if a vaginal birth is viable. Cesarean sections are excessively indicated in Northen Mexico, using the diagnosis of cephalopelvic disproportion due to a narrow pelvis. Currently, there is no standardized morphometry of the female pelvis in a Mexican population to establish adequate diagnostic parameter. Our study measures the pelvic diameters of the birth canal using abdominopelvic computed tomography (CT). Two hundred and ninety CT from Mexican women between the ages of 18 and 50 were collected and 3D reformatted in order to morphologically measure the pelvic diameters of clinical relevance. Measurements were conducted by two diagnostic imaging specialists. The mean and standard deviation of the measured diameters were: anatomical conjugate diameter (ACD) 11.65±0.99 cm, the obstetric conjugate diameter (OCD) 11.73±0.98 cm, diagonal conjugate diameter (DCD) 12.49±0.98 cm and Interspinous distance (ISD) 10.41±0.78 cm. Significant differences were found in all four mean diameters in between the 20–29 age groups versus the >40, as well as between the 30–39 groups versus the >40. Our study shows that as Mexican women get older, the mean pelvic diameters become narrower.

Quantitative assessment of new MRI-based measurements to differentiate low and high stages of pelvic organ prolapse using support vector machines.

The objective of this study was to quantitatively assess the ability of new MRI-based measurements to differentiate low and high stages of pelvic organ prolapse. New measurements representing pelvic structural characteristics are proposed and analyzed using support vector machines (SVM). This retrospective study used data from 207 women with different types and stages of prolapse. Their demographic information, clinical history, and dynamic MRI data were obtained from the database. New MRI measurements were extracted and analyzed based on these reference lines: pubococcygeal line (PCL), mid-pubic line (MPL), true conjugate line (TCL), obstetric conjugate line (OCL), and diagonal conjugate line (DCL). A classification model using SVM was designed to assess the impact of the features (variables) in classifying prolapse into low or high stage. The classification model using SVM can accurately identified anterior prolapse with very high accuracy (>0.90), and apical and posterior prolapse with good accuracy (0.80 - 0.90). Two newly proposed MRI-based features were found to be significant in the identification of anterior and posterior prolapse: the angle between TCL and MPL for anterior prolapse, and the angle between DCL and PCL for posterior prolapse. The overall accuracy of posterior prolapse identification increased from 47% to 80% when the newly proposed MRI-based features were taken into consideration. The proposed MRI-based measurements are effective in differentiating low and high stages of pelvic organ prolapse, particularly for posterior prolapse.

Sonopelvimetry: An Innovative Method for Early Prediction of Obstructed Labour

Aim: To evaluate an innovative sonopelvimetry method for early prediction of obstructed labour. Methods: A prospective study was conducted in two centers.GPS-based sonopelvimetry, laborProTM (Trig Medical Inc., Yoqneam Ilit, Israel) devise, was used prior to labour in nulliparous women at 39 - 42 weeks gestation remote from labor. Maternal pelvic parameters, including inter-iliac transverse diameter, obstetric conjugate and interspinous diameter were evaluated. Fetal parameters included head station, biparietal diameter and occipitofrontal diameter. Data on delivery and outcome were collected from the electronic files. Results: The innovative use of sonopelvimetry was applied to 154 consecutive women, none of the participants complained of discomfort or complications observed. The mean time of examination was 15 + 2 minutes. Mean time of examination to delivery interval was 4.8 days (range 0 - 16 days). Small interspinous diameter and high head station were the best predictors for obstructed labour. Analysis indicated 87% sensitivity and 61% specificity for birth weight fetal head station and ISD combined in predicting obstructed labour with an area under the curve of 0.77. Conclusions: Our results indicate that GPS-based sonopelvimetry combined with fetal estimated weight is a valuable tool in the risk assessment of obstructed labour. Parameters obtained by sonopelvimetry combined with birth weight may be useful.

Association Between Obstetric Conjugate Diameter Measured by Transabdominal Ultrasonography During Pregnancy and the Type of Delivery

BackgroundNormal morphological features of the maternal pelvis are an important prerequisite to vaginal delivery.ObjectivesWe aimed to evaluate the association between obstetric conjugate diameter (OCD) measured by ultrasonography and the type of delivery, vaginally (V) or by cesarean (C) section.Patients and MethodsPelvimetry was performed in 200 primigravid women for fetal cephalic presentation. The OCD was measured twice by transabdominal ultrasonography during 25-30 weeks and 30-35 weeks of pregnancy.ResultsThe mean OCD of both sonographies in groups V and C was 125.51± 8.35 mm (105-144.5) and 112.99 ± 8.53 mm (96-134.5), respectively, which was significantly lower in group C (P<0.001). The values of OCD between the first and second measurements were not different significantly (P=0.065). C-section was indicated in 65 (32.5%) mothers. The optimal cut-off point for the OCD in the prediction of vaginal delivery was ≥ 119.75 mm, with a sensitivity and specificity of 80% and 78.5%, respectively.ConclusionThe US measurement of OCD might be an accurate method that almost always remains constant during late pregnancy; it is easy to measure and might be confidentially employed for predicting C-section, but needs more precise studies to be used widely.

1845 COMPARISON OF PELVIC ANATOMY AFTER CHILDBIRTH AND MENOPAUSE TO BEFORE CHILDBIRTH USING PELVIC MRI. AND NALYSIS OF PREDICTORS OF CYSTOCELE

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology (II)1 Apr 20131845 COMPARISON OF PELVIC ANATOMY AFTER CHILDBIRTH AND MENOPAUSE TO BEFORE CHILDBIRTH USING PELVIC MRI. AND NALYSIS OF PREDICTORS OF CYSTOCELE Mitsuharu Iwasaki, Nobuhiro Haga, Junya Hata, Yuuichi Satoh, Kouji Sagawa, Norio Takahashi, and Yoshiyuki Kojima Mitsuharu IwasakiMitsuharu Iwasaki Fukushima, Japan More articles by this author , Nobuhiro HagaNobuhiro Haga Fukushima, Japan More articles by this author , Junya HataJunya Hata Fukushima, Japan More articles by this author , Yuuichi SatohYuuichi Satoh Fukushima, Japan More articles by this author , Kouji SagawaKouji Sagawa Fukushima, Japan More articles by this author , Norio TakahashiNorio Takahashi Fukushima, Japan More articles by this author , and Yoshiyuki KojimaYoshiyuki Kojima Fukushima, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2264AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We measured various parameters representing the levator ani muscle and pelvic morphology from MRI images of Japanese female pelvis to clarify the changes due to aging and childbirth. Finally we analyzed statistically relevance to occurrence of cystocele and its grade. METHODS As levator ani muscle parameters, we measured levator ani muscle volume and the levator hiatus longitudinal and transverse diameter from MRI. As pelvic morphology parameters, we measured the distance between the ischium, pubic arch angle, the distance of obstetrical conjugate, and the distance between lower edge of the pubic bone and coccyx from MRI. Using these data, we compared the differences between the three groups, postmenopausal parous women with cystocele:GROUP1 (n= 29), postmenopausal parous women without cystocele:GROUP2 (n=26), and young nulliparous women:GROUP3 (n= 26). Furthermore, in addition to the Body Mass Index we analyzed the predictors of occurrence of cystocele and its grade. RESULTS Volume decrease of levator ani muscle and the increase in levator hiatus longitudinal and transverse diameter thought to be due to childbirth and aging was observed. It was thought the levator ani muscle volume reduction and increased levator hiatus transverse diameter were the risk factor for cystocele occurrence and its grade. Pelvic morphology and Body Mass Index, was not involved in the cystocele occurrence and its grade. CONCLUSIONS In Japanese women, it was found that the levator ani muscle volume reduction and increased levator hiatus transverse diameter were the risk factor for cystocele occurrence and its grade. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e757-e758 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mitsuharu Iwasaki Fukushima, Japan More articles by this author Nobuhiro Haga Fukushima, Japan More articles by this author Junya Hata Fukushima, Japan More articles by this author Yuuichi Satoh Fukushima, Japan More articles by this author Kouji Sagawa Fukushima, Japan More articles by this author Norio Takahashi Fukushima, Japan More articles by this author Yoshiyuki Kojima Fukushima, Japan More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Risk Factors Analysis and Scoring System Application of Conversion to Open Surgery in Laparoscopic Colorectal Surgery

To analyze the risk factors of laparoscopic colorectal surgery conversion rate, and establish the scoring system, retrospective study was performed and 429 patients who underwent laparoscopic colorectal surgery were analyzed. Conversion rate was 15.58%, and the risk factors include age, body mass index (BMI), operation number, abdominal operation history, invasion or metastasis, and tumor size. Scoring system established with age (≥ 65: 7, <65: 0), weight (BMI ≥ 25: 11, BMI <25: 0), operation number ≤ 25 (yes: 5, no: 0), abdominal operation history (yes: 12, no: 0), tumor size (≥ 6 cm: 22<6 cm: 0), and invasion or metastasis (yes: 34, no: 0). 18.5 uses to predict the conversion. Conversion rate below 18.5 is 5.21%, and above 18.5 is 42.62%. We concluded that scoring system is simple, convenient, and applicable.

Factors Affecting the Outcome of Extraperitoneal Laparoscopic Radical Prostatectomy: Pelvic Arch Interference and Depth of the Pelvic Cavity

PurposeTo determine the effect of pelvic arch interference and the depth of the pelvic cavity, as shown on preoperative magnetic resonance imaging (MRI), on the performance of extraperitoneal laparoscopic radical prostatectomy (ELRP).Materials and MethodsIn 115 patients, pelvic bone images were obtained at the time of prostate MRI before ELRP. In the reconstructed sagittal plane, we measured the true conjugate diameter, the obstetric conjugate diameter, the difference between the true and obstetric diameters, and the distance between the true conjugate and the prostate apex (pelvic depth). We analyzed which factors were associated with operative time (OT), estimated blood loss (EBL), and positive surgical margins (PSMs).ResultsThe difference between the true and obstetric conjugate diameters was 12.7±3.7 mm, and the pelvic depth was 59.9±6.0 mm. The OT, EBL, and the rate of PSMs were 260.1±91.1 minutes, 633.3±524.7 ml, and 19% (22/115), respectively. According to multiple linear regression analysis, predictors of a higher EBL included pelvic depth (3.0% higher per 1 mm increase in diameter difference, p=0.01) and prostate volume (1.5% higher per 1 cc increase in prostate volume, p=0.002). Factors associated with a longer OT were pelvic depth (p=0.04), serum prostate-specific antigen (p=0.04), prostate volume (p=0.02), and Gleason score (p=0.001). For PSMs, only pT2 was an independent factor.ConclusionsOur results suggest that the depth of the pelvic cavity and prostate volume may increase surgical difficulty in patients undergoing ELRP.

Compare the architectural differences in the bony pelvis of Korean women and their association with the mode of delivery by computed tomography

Methods This study was conducted on 175 women who underwent CT between March of 2006 and May of 2008. For making an objective assessment, one specialist in obsterics and gynecology measured the obstetrical conjugate, the true conjugate and the diagonal conjugate on the sagittal plane and the transverse diameter, the intertuberous diameter and the interspinous diameter on the coronal plane. The patients who underwent total hysterectomy or those who had a disease of the uterus were excluded from the current analysis.

Three-dimensional pelvimetry by computed tomography

This study was undertaken to assess the agreement of computed tomography (CT) pelvimetry with different postprocessing techniques. CT data sets of 25 patients were retrospectively analysed. There were no CT examinations performed solely for pelvimetry, and there was no radiation exposure for study purposes. Six pelvimetric measurements were obtained by two independent observers in four data sets of each patient, i.e. on biplanar topograms, multiplanar reconstructions of 1-mm slices, volume-rendered images of the same data and volume-rendered images based on 5-mm-thick images. Interobserver agreement and variability were determined by Bland-Altman analysis. A human skeleton was also scanned and measured with the same techniques and by ruler as reference. With a correlation coefficient of 0.98, interobserver agreement was best for assessing 3D volume-rendered images reconstructed from 1-mm-thick slices. Interobserver variability was very good for sagittal outlet and midpelvic diameter, transverse inlet diameter and obstetric conjugate (correlation coefficients 0.96-0.99) but limited for intertuberous and interspinous distance. CT and ruler measurements of the skeleton showed excellent agreement. Pelvimetry can be obtained with low interobserver variability on 3D volume-rendered CT reconstructions. Thus, CT pelvimetry is suitable to gain exact knowledge of pelvic anatomy to identify relevant parameters for dystocia in retrospective studies.