Pelvic Measurements Research Articles

Contributions of Muscle Elasticity and Lateral Slide of the Transversus Abdominis to Lumbar Stability.

Lumbar instability can cause lumbar spondylolisthesis and chronic low-back pain in sports situation. Abdominal hollowing is commonly used in clinical practice to preferentially target the transversus abdominis (TrA) to stabilize the lumbar vertebrae; however, the contribution of muscle elasticity and lateral slide of the TrA to lumbar stability has not yet been clarified. To clarify the contribution of elasticity and lateral slide of the TrA to lumbar stability and to identify an effective exercise to stabilize the lumbar vertebrae. Experimental study. Laboratory. A total of 29 healthy males participated in this study. The participants performed hollowing during measurement of muscle elasticity of TrA and both knees extension from crook lying position for pelvic stability measurement. Lumbar stability, muscle elasticity change ratio, and lateral slide amount of TrA. There was a significant correlation between elasticity of the TrA and lumbar stability; however, no relationship was observed between lateral slide and lumbar stability or elasticity of the TrA. Elasticity of the TrA and lumbar stability was significantly correlated; therefore, improving the tonicity of the TrA may stabilize the lumbar vertebrae in healthy individuals. Moreover, hollowing with maximum effort may be effective as training aimed to stabilize the lumbar vertebrae for physical dysfunction due to lumbar instability.

Pelvic obliquity associated with neuromuscular scoliosis in cerebral palsy: cause and treatment.

Literature Review. Review the etiology, clinical manifestations, diagnosis, and treatment of pelvic obliquity in cerebral palsy patients with neuromuscular scoliosis. Neuromuscular scoliosis (NMS) in cerebral palsy (CP) patients is rapidly progressive and often leads to an imbalance in musculoskeletal mechanics that extends to the pelvis. A horizontal misalignment of the pelvis in the frontal plane known as pelvic obliquity (PO) is a common finding in this population. When untreated, PO can exacerbate the back pain, postural strain, and walking difficulties experienced by these patients. Establishing the manifestation and treatment plan for PO in the setting of NMS can provide valuable insight for diagnosis and management. A comprehensive literature review was performed on the etiology, clinical manifestations, diagnosis, and treatment of pelvic obliquity in the setting of NMS in CP. The advantages and limitations of measurement and treatment options were evaluated. PO is categorized into suprapelvic, infrapelvic, and intrapelvic causes, each presenting with a unique pattern of pathology. NMS in CP with hip contractures and structural deformities fall into these categories. The Maloney and O'Brien methods of pelvic measurement have demonstrated superior utility and are recommended for clinical diagnosis. The management of PO in NMS patients is focused on the cause of malalignment, with posterior fusion, contracture release, and osteotomy encompassing the mainstay of treatment. PO is commonly found in patients with NMS in cerebral palsy. There is currently no standard method for determining the PO angle. Interventions designed to reduce scoliotic curves and release tissue contractures can level the pelvis and restore proper alignment of the spine and sacrum in the coronal plane in these patients. Further understanding of the causes of PO in NMS, as well as the establishment of a standardized measuring technique and diagnostic parameters will allow for more effective treatment options and improve outcomes in patients with CP. N/A.

Using Pelvic Areas and Linear Body Measurements in the Selection for Reduced Dystocia Rates in Sussex Heifers

Background: Dystocia in cattle is a global problem which causes many health issues and economical losses in the beef cattle industry. However, to the greatest of our knowledge, use of pelvic areas and linear body measurements in South African Sussex heifers has not yet been reported on literature. Hence, the aim of this study was to use pelvic areas and linear body measurements in the selection of replacement Sussex heifers to reduce dystocia amongst heifers, while improving ease of calving.Methods: One hundred eighty-six first calf Sussex heifers 24 months old, weighing approximately 437 kg were used for this study. A number of six, two-year-old bulls, weighing approximately 800 kg were used for mating the 135 heifers during the first trial with a bull to cow ratio of (1:35; 1:35, 1;35 and 1:30). The second trial consisted of 51 heifers with a number two, two-year-old bulls respectively, with a bull to cow ratio of (1:30 and 1:21).Result: A significant correlation between calving eases score and calf gender, r = -0.35 was revealed. The chances of a heifer to experience dystocia were more when a male calf was born. Birth weight, revealed that higher the birth weight higher the probability of a heifer to experience dystocia. It can be concluded that pelvic measurements in Sussex heifers may be a valuable tool to reduce dystocia.

Pelvimetria em cadelas S.R.D. (sem raça definida)

Pelviology means the study of the pelvis, a structure formed by bones, ligaments and muscles. One of the subjects of pelviology corresponds to pelvimetry, which deals with the measurement of pelvic measurements, and which has a close relationship with reproduction. This study aims to verify the correlation between some body parameters and pelvic measurements. We used 50 N.R.D. female canine cadavers, varying in age and size, from euthanasia or natural death from the HOVET and Veterinary Clinics of the cities of XXX. Initially the body length, body height, thoracic perimeter, and body weight parameters were measured. Then, the bony pelvis was removed from the cadaver, sectioning the spine at the level between the lumbar vertebrae 5 (L5) and 6 (L6) and the femur in its middle third. Immediately after this procedure, the excess soft tissue was removed. In pelvimetry the following diameters were measured: thigh bone; transverse; acetabular; lateral ischiatic; true conjugate and vertical. The following mean values and standard deviation were obtained: 1) Body parameters: body weight (Kg) - 8.40 ± 5.86; height (cm) – 35.50 ± 11.76; body length (cm) – 48.60 ± 13.48; and thoracic perimeter (cm) – 43.80 ± 14.24; and 2) Pelvic diameters (cm): thigh bone – 3.313 ± 0.830; transversal – 3.864 ± 0.900; acetabular – 4.326 ± 1.140; lateral ischiatic – 7.171 ± 2.140; true conjugate – 4.720 ± 1.270; and vertical – 4.697 ± 1.270. Finally, it was verified that there is a significant positive correlation between body parameters and pelvic diameters

Formulas for estimating living stature based on bony pelvic measurements reconstructed from computed tomography images

Introduction: A major challenge in anthropology is the estimation of human stature based on human bones since the stature of cadavers is slightly different from that of living humans. This study aimed to investigate the feasibility of estimating living stature in Japanese subjects based on sacral and coccygeal lengths as measured on three-dimensional (3D) models of the femur and pelvis reconstructed from cross-sectional computed tomography (CT) images. Subjects and methods: For this cross-sectional study, 106 healthy Japanese subjects (54 men and 52 women) were recruited. We measured the distances from the anterosuperior iliac spine (ASIS) to the most posterior point of the ischial spine (IS) (ASIS-IS), and from the ASIS to the most inferior point of the ischial tuberosity (IT) (ASIS-IT) on 3D bone models reconstructed from multi-slice CT images. Correlations of living stature with ASIS-IS and/or ASIS-IT on the left and right sides of the pelvis were evaluated. Multiple regression equations were derived and used as formulas for living stature estimation. Results: In men, living stature had strong correlations with ASIS-IS + ASIS-IT on both the left and right sides; Pearson's correlation coefficients were 0.717 and 0.706, respectively. In contrast, in women, living stature showed stronger correlations with all of the studied parameters; Pearson's correlation coefficients were highest for ASIS-IS + ASIS-IT on both the left and right sides (r = 0.753 and 0.744, respectively) compared with those in men. Formulas based on ASIS-IS + ASIS-IT provided the best estimation in both men and women, while ASIS-IS alone demonstrated a better estimation than ASIS-IT on both the left and right sides. Conclusions: This study revealed that ASIS-IS and ASIS-IT measured from CT images were reliable predictors of living stature in the Japanese population. Our estimation formulas were derived from measurements of living stature that were not affected by the physiological changes observed in cadavers. To the best of our knowledge, this is the first study to derive estimation formulas based on living stature. Our method may be useful in the identification of disaster victims, wherein long bones are usually not found intact but pelvic bones are. Furthermore, the findings could be relevant to the field of anthropology for estimating living stature.

Classification and regression tree analysis to predict calving ease in Sussex heifers using pelvic area dimensions and morphological traits.

Objectives:The objective of this study was to assess the relationship between pelvic measurements, namely pelvic height (PH), pelvic area (PA), and pelvic width, and linear body measurement traits, such as hindquarters width, rump length (RL), hip height (HH), body weight (BW), shoulder height, chest depth (CD), body length, and also calve birth weight (CBW) under different calving ease scores, namely no assistance, gently pull, and hard pull.Material and Methods:A total of 51 first calf Sussex heifers at 24 months old, weighing approximately 440 ± 40.26 kg, were used for this study. Two-year-old bulls (n = 2), weighing approximately 800 kg, were used for mating the 51 heifers with a bull to cow ratio of 1:30 and 1:21. The fertility of bulls was assessed by a private veterinarian before the mating season. Calving ease was scored as follows: 1 = no assistance during parturition (normal), 2 = heifer assistance as gently pull, 3 = heifer assistance as hard pull, 4 = heifer cannot calf, 5 = heifer calved a dead calf, and 6 = heifer calf with the abnormal position.Results:Descriptive statistics indicated that PH (p < 0.01) and RL (p < 0.05) were positively remarkable and different among calving ease scores. Correlation results of the no assistance Sussex heifers group revealed that CBW was positively correlated (p < 0.05) with PH. Classification and regression tree CART results demonstrated that PH, BW, CD, and HH play an important role in predicting calving ease in Sussex heifers.Conclusion:The findings suggest that there is an association among PAs and biometric traits. The present study might help farmers select animals with higher PH, BW, CD, and HH during breeding to lower dystocia incidents during parturition. However, further studies need to be carried out in CART modeling to reduce dystocia in a larger sample size of Sussex heifers or other cattle breeds.

Robotic Sacral Colpopexy Using Autologous Fascia Lata Compared with Mesh.

Objective: The objective is to compare robotic sacral colpopexy (RSC) utilizing autologous fascia lata with RSC with synthetic mesh in the treatment of pelvic organ prolapse (POP). Methods: We performed a prospective nonrandomized case comparison trial at a single institution. We compared RSC utilizing either synthetic mesh or autologous fascia lata in women with symptomatic POP, stages II through IV. The primary outcome was anatomic prolapse recurrence determined by the Pelvic Organ Prolapse Quantification (POP-Q) examination. Secondary outcomes included patient-reported outcomes such as the Urogenital Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7). Complications were also recorded and categorized using the Clavien-Dindo (CD) system. The hypothesis is that autologous fascia lata would provide equivalent anatomic and patient-reported outcomes compared with mesh while eliminating mesh-related complications. Results: Sixty-four women underwent RSC with 19 (29.7%) receiving fascia lata graft. The overall operative time was greater in the fascia lata group with mean fascia lata harvest time of 24.8 ± 7.4 minutes. Intragroup comparisons of the fascia and mesh groups demonstrated significant improvement in pelvic measurements as well as patient-reported outcomes. Intergroup comparison demonstrated equivalent success rates at 12.1 ± 8.7 months follow-up. There was one apical failure in the fascia lata RSC group; however, the difference was not statistically significant (p = 0.30). Significant complications in the fascia lata harvest group included two CD-II and one CD-IIIb. In the mesh group there was one mesh erosion requiring surgical excision (CD-IIIb). Conclusion: This is the first comparison between RSC with autologous fascia lata and mesh. Short-term anatomic outcomes were similar with autologous fascia lata use without the risk of mesh erosion. Morbidity from graft harvest site was not trivial. These results emphasize the need for a randomized controlled trial.

3D pelvimetry and biometric measurements: a surgical perspective for colorectal resections

PurposeMale sex, high BMI, narrow pelvis, and bulky mesorectum were acknowledged as clinical variables correlated with a difficult pelvic dissection in colorectal surgery. This paper aimed at comparing pelvic biometric measurements in female and male patients and at providing a perspective on how pelvimetry segmentation may help in visualizing mesorectal distribution.MethodsA 3D software was used for segmentation of DICOM data of consecutive patients aged 60 years, who underwent elective abdominal CT scan. The following measurements were estimated: pelvic inlet, outlet, and depth; pubic tubercle height; distances from the promontory to the coccyx and to S3/S4; distance from S3/S4 to coccyx’s tip; ischial spines distance; pelvic tilt; offset angle; pelvic inlet angle; angle between the inlet/sacral promontory/coccyx; angle between the promontory/coccyx/pelvic outlet; S3 angle; and pelvic inlet to pelvic depth ratio. The measurements were compared in males and females using statistical analyses.ResultsTwo-hundred patients (M/F 1:1) were analyzed. Out of 21 pelvimetry measurements, 19 of them documented a significant mean difference between groups. Specifically, female patients had a significantly wider pelvic inlet and outlet but a shorter pelvic depth, and promontory/sacral/coccyx distances, resulting in an augmented inlet/depth ratio when comparing with males (p < 0.0001). The sole exceptions were the straight conjugate (p = 0.06) and S3 angle (p = 0.17). 3D segmentation provided a perspective of the mesorectum distribution according to the pelvic shape.ConclusionSignificant differences in the structure of pelvis exist in males and females. Surgeons must be aware of the pelvic shape when approaching the rectum.

Machine Learning Predicts the 3D Outcomes of Adolescent Idiopathic Scoliosis Surgery Using Patient-Surgeon Specific Parameters.

Retrospective descriptive, multicenter study. The aim of this study was to predict the three-dimensional (3D) radiographic outcomes of the spinal surgery in a cohort of adolescent idiopathic scoliosis (AIS) as a function preoperative spinal parameters and surgeon modifiable factors. Current guidelines for posterior spinal fusion surgery (PSF) in AIS patients are based on two-dimensional classification of the spinal curves. Despite the high success rate, the prediction of the 3D spinal alignment at the follow-ups remains inconclusive. A data-driven surgical decision-making method that determines the combination of the surgical procedures and preoperative patient specific parameters that leads to a specific 3D global spinal alignment outcomes at the follow-ups can lessen the burden of surgical planning and improve patient satisfaction by setting expectations prior to surgery. A dataset of 371 AIS patients who underwent a PSF with two-year follow-up were included. Demographics, 2D radiographic spinal and pelvic measurements, clinical measurements of the trunk shape, and the surgical procedures were collected prospectively. A previously developed classification of the preoperative global 3D spinal alignment was used as an additional predictor. The 3D spinal alignment (vertebral positions and rotations) at two-year follow-up was used as the predicted outcome. An ensemble learner was used to predict the 3D spinal alignment at two-year follow-up as a function of the preoperative parameters with and without considering the surgeon modifiable factors. The preoperative and surgical factors predicted three clusters of 3D surgical outcomes with an accuracy of 75%. The prediction accuracy decreased to 64% when only preoperative factors, without the surgical factors, were used in the model. Predictor importance analysis determined that preoperative distal junctional kyphosis, pelvic sagittal parameters, end-instrumented vertebra (EIV) angulation and translation, and the preoperative 3D clusters are the most important patient-specific predictors of the outcomes. Three surgical factors, upper and lower instrumented vertebrae, and the operating surgeon, were important surgical predictors. The role of surgeon in achieving a certain outcome clusters for specific ranges of preoperative T10-L2 kyphosis, EIV angulation and translation, thoracic and lumbar flexibilities, and patient's height was significant. Both preoperative patient-specific and surgeon modifiable parameters predicted the 3D global spinal alignment at two-year post PSF. Surgeon was determined as a predictor of the outcomes despite including 20 factors in the analysis that described the surgical moves. Methods to quantify the differences between the implemented surgeon modifiable factors are essential to improve outcome prediction in AIS spinal surgery.Level of Evidence: 3.

Effectiveness of pelvic floor muscle and abdominal training in women with stress urinary incontinence

ABSTRACT The aim of this study was to investigate the effectiveness of pelvic floor muscle training and abdominal training in women with stress urinary incontinence. The study included 64 female patients (aged 18 to 49 years) with stress urinary incontinence. Patients were randomly allocated into the pelvic floor muscle training (PFMT) or pelvic floor muscle plus abdominal training (PFMT+AT) groups. Clinical data included stress test results, pelvic floor activity measurements, and Urinary Distress Inventory, and Incontinence Impact Questionnaire responses. The increase in the pelvic floor muscle activity (from the 0th to the 4th week, from the 4th to the 8th week, and from the 0th to the 8th week) was significantly greater for the PFMT+AT group than for the PFMT group (p < 0.05). The negativity rate of the stress test at the 4th week was significantly higher for the PFMT+AT group (93.7%) than for the PFMT group (53.1%) (p < 0.001). Women with stress urinary incontinence benefit more from pelvic floor muscle training plus abdominal training than from pelvic floor muscle training alone in terms of increasing their pelvic floor muscle activity and quality of life, and they also experience an earlier recovery.

Smartphone‐based pelvic movement asymmetry measures for clinical decision making in equine lameness

Smartphone‐based pelvic movement asymmetry measures for clinical decision making in equine lameness

Determination of The Relationship Between External Pelvic Measurements and Body Mass Index in Young Adults

Objective: This study was conducted to evaluate the relationship between pelvic measurements and body mass index (BMI) among pre-pregnancy young adult women in our population. Method: The sample group consisted of 83 midwifery students who agreed to participate in the study. The anthropometric pelvic measurements which are intercrestal diameter (IC), interspinous diameter (IS), intertrochanteric diameter (IT), intertuberous diameter (ITb), and Baudelocque diameter (anteroposterior diameter) was obtained by a single investigator with a pelvimeter. The program Statistical Package for Social Sciences (version 21.0) was used to create a descriptive analysis, and the Pearson correlation coefficient was performed to determine significance (p0.05). Results: The participants’ mean age was 19.72±1.16. The mean values of BMI, IC, IS, IT, ITb and Baudelocque diameter of participants were 22.71±3.26, 27.88±1.74, 25.31±2.01, 32.54±2.23, 12.41±1.51, and 20.40±1.62, respectively. Significant positive correlations were found between IC and BMI (r=0.434), IS and BMI (r=0.285), IT and BMI (r=0.051), and Baudelocque diameter and BMI (r=0.502). No significant differences were found between ITb and BMI (r=0.051 and p&amp;gt;0.05). Conclusion: The data indicates that IC, IS, IT, and Baudelocque diameter all correlate with BMI.

Reliability of pelvimetry is affected by observer experience but not by breed and sex: A cross-sectional study in beef cattle.

Pelvis size plays an important role to prevent dystocia in cattle caused by the foeto‐maternal disproportion in commonly primiparous females. The reproducibility and repeatability are two important aspects for the reliability of the measurements to use in the selection of cattle for culling. Pelvic measures were taken with a Rice pelvimeter from 224 young cattle (180 females and 44 males) of four beef breeds in South Africa. One experienced and two inexperienced observers each measured pelvic height and width twice. The proportion measurements with a maximum difference of 0.5 cm within animal compared with the first measurement by the experienced observer are around 80% and by the inexperienced observers around 50% for pelvic height and around 60% for pelvic width. Breed and sex do not affect the reliability of pelvimetry by an experienced observer. Under‐ and overestimation of pelvis size were observed in inexperienced observers, which seems to be unrelated to breed and sex.

Experimental study of the influence of the cross section of the lonnago joint on the size of the pelvis

Practice outpaced theory on the issue of symphysiotomy. Until now, this operation has not been scientifically sufficiently substantiated due to the fragmentary, incomplete and inaccurate anatomical studies. There is still a lack of accurate pelvic measurements. Fully aware of the need and importance of filling this gap, I willingly took on the proposal and under the guidance of prof. D.O. Ott for real research.

CPD article: Pre-breeding heifer examination and selection in UK beef herds

The objective of this review is to evaluate examination tools and how they can be used to assess the breeding potential of beef heifers prior to service. Reproductive tract examination techniques, pelvic measurement, and antral follicle counts (AFC) are methods that are used and could be of value to farmers where they can either identify pubescent heifers and/or those with the best reproductive potential. Reproductive tract scoring (RTS) to assess the pubertal state and therefore reproductive status of replacement heifers is explored alongside further adaptions of this method. The use of pelvic measurement is considered: first, where a small pelvic area or an abnormal shaped pelvic inlet is identified, which may result in elimination from the breeding cohort to reduce the potential risk of dystocia and poor performance; and second, since it may be advocated for use in conjunction with other methods. AFC are included since they too may help identify the reproductive potential of heifers. Evaluation of these examination tools demonstrates that the use of modified RTS methods, to include ultrasound examination to detect the absence of a corpus luteum (CL), absence of a follicle ≥ 13 mm and the uterine horn diameter as well as pelvic measurements, could add value to heifer breeding soundness examinations (HBSE) when carried out.

Functional Anatomy of the Hip Joint

BackgroundThe functional anatomy of the osteoarthritic hip joint in the sagittal plane has not been defined. The purpose of this study was to define the functional anatomy of the hip using clinical and radiographic analyses. Methods320 hips had preoperative standing and sitting lateral spine-pelvis-hip X-rays. Radiographic pelvic measurements were pelvic incidence (PI) and sacral slope (SS), and hip measurements were anteinclination (AI) and pelvic femoral angle (PFA). Pelvic tilt (PT) was calculated as PI-SS. A triangle model was created from the clinical data that illustrates the functional motion of the hip during postural changes from standing to sitting. ResultsPelvic motion was coordinated with hip motion, even with spinopelvic imbalance and stiffness. Pelvic motion (ΔSS) varied for all 5 types of imbalance, but pelvic motion (ΔSS) and acetabular motion (ΔAI) changed with a 1:1 ratio and inversely with femoral motion (ΔPFA) with a 1:1 ratio. The triangle model showed similar results with ΔSS, ΔPT, and ΔAI changing in a 1:1:1 ratio, and femur motion inversely changing with a 1:1 ratio. ConclusionThe functional anatomy of the hip joint can be visually illustrated using a triangle model. Pelvic angles SS, PT, and AI change in unison, whereas femoral motion (ΔPFA) changes inversely with pelvic motion (ΔSS) in a 1:1 ratio. This coordinated mobility explains the limitations of the Lewinnek safe zone, which include only the acetabulum.

The role of MRI pelvimetry in predicting technical difficulty and outcomes of open and minimally invasive total mesorectal excision: a systematic review.

The difficulty of performing total mesorectal excision (TME) for rectal cancer partly relies on the surgeon's subjective assessment of the individual patient's pelvic anatomy and tumour characteristics, which generally influences the choice of platform used (open, laparoscopic, robotic or trans-anal surgery). Recent studies have found associations between several anatomical pelvic measurements and surgical difficulty. The aim of this study was to systematically review existing data reporting the use of magnetic resonance imaging (MRI)-based pelvic measurements to predict technical difficulty and outcomes of TME, and determine whether pelvimetry could optimise patient-specific selection of a particular surgical approach. MEDLINE, Embase and Cochrane Library databases were systematically searched for studies reporting MRI-based pelvic measurements in patients undergoing surgery for rectal cancer, and the effect of these measurements on surgical difficulty. Eleven studies reporting the association between MRI-pelvimetry measurements and rectal cancer surgical outcomes were included. Indicators for surgical difficulty used in the included studies were involved circumferential resection margin, longer operative time, incomplete TME, higher blood loss, anastomotic leak, conversion to open surgery and overall complications. Bony pelvic measurements which were associated with increased surgical difficulty in more than one study were a smaller interspinous distance, a smaller intertubercle distance, a smaller pelvic inlet and larger pubic tubercle height. Two studies identified larger mesorectal fat area as a predictor of surgical difficulty. Bony pelvic measurements may predict surgical difficulty during TME, however, use of different indicators of difficulty limit comparison between studies. Early data suggest MRI soft tissue measurements may predict surgical difficulty and warrants further investigation.

Investigation of correlation between bony pelvis dimensions and pelvic organ prolapse in different compartments

ObjectiveTo investigate the association between bony pelvis dimensions and anterior, apical, and posterior compartment pelvic organ prolapse (POP) and explore the mechanism of different types of POP from an anatomical point of view. Study designA total of 253 patients with POP were selected as the experimental group (138 patients with anterior compartment defect, 86 with apical compartment defect, and 29 with posterior compartment defect); 253 patients with uterine myoma constituted the control group. Their demographics were recorded, and anteroposterior diameters of the pelvic inlet, intertuberous diameter, and interspinous diameter were measured. One-way analysis of variance, least significant difference t-test, and Student’s t-test were used to evaluate the pelvic measurements among the four groups. ResultsThe anteroposterior diameter of the pelvic inlet in the apical compartment POP group was smaller than that in the other groups (P < 0.05). Interspinous diameters in the anterior and apical groups were larger than those in the posterior POP and control groups (P < 0.05). Intertuberous diameter in the control group was smaller than that in the anterior and apical POP groups and larger than that in the posterior POP group (P < 0.05). ConclusionWomen with apical compartment POP are more likely to have a smaller anteroposterior diameter. Larger interspinous and intertuberous diameters were associated with anterior and apical POP, and smaller intertuberous diameter was associated with posterior POP.

Sexual dimorphism of the relationship between the gut and pelvis in humans.

Obstetric demands have long been considered in the evolution of the pelvis, yet consideration of the interaction of pregnancy, the pelvis, and the gastrointestinal tract (gut) is lacking. Here, we explore sex differences in the relationship of gut volume with body size and pelvic dimensions. Computed tomography (CT) scans of living adult Homo sapiens (46 females and 42 males) were obtained to measure in vivo gut volume (GV) and to extract 3D models of the pelvis. We collected 19 3D landmarks from each pelvis model to acquire pelvic measurements. We used ordinary least squares regression to explore relationships between GV and body weight, stature, and linear pelvic dimensions. The gut-pelvis relationship differs between males and females. Females do not exhibit significant statistical correlations between GV and any variable tested. GV correlates with body size and pelvic outlet size in males. GV scales with negative allometry relative to body weight, stature, maximum bi-iliac breadth, inferior transverse outlet breadth, and bispinous distance in males. The lack of association between GV and body size in females may be due to limits imposed by the anticipation of accommodating a gravid uterus and/or the increased plasticity of the pelvis. The pattern of relationship between GV and the pelvic outlet suggests the role of the bony pelvis in supporting the adominal viscera in females may be small relative to its role in childbirth. We conclude that gut size inference in fossil hominins from skeletal proxies is limited and confounded by sexual dimorphism.

Maternal and neonatal outcome after vaginal breech delivery of nulliparous versus multiparous women of singletons at term—A prospective evaluation of the Frankfurt breech at term cohort (FRABAT)

IntroductionThe best way to deliver a term breech infant is still a much discussed topic among obstetricians. The question whether nulliparity should be considered an exclusion criterion for an intended vaginal breech delivery is not fully answered. ObjectiveWe compared maternal and neonatal outcome of intended vaginal breech deliveries of nulliparous versus multiparous women at term. Study designWe conducted a prospective case-control study between January 2004 and December 2016. 1046 women expecting singletons at term with favorable pelvic measurements were enrolled in the study. ResultsNeonatal morbidity and mortality was not significantly different in deliveries of nulliparous (n = 647) versus multiparous (n = 399) women. Nulliparous women had a significantly higher rate of a cesarean section during labor than multiparous women. Maternal birth-injury rates and the use of epidural anesthesia were significantly higher comparing vaginal births of nulliparous (n = 384) versus multiparous (n = 331) women. ConclusionNulliparity seems not be an exclusion criterion for intended vaginal breech birth at term. It is still important to inform the women of an increased risk of a cesarean section during labor. A clinical management built on this evidence might reduce negative implications for future pregnancies.