Pubic Arch Angle Research Articles

Predicting mid-pelvic interspinous distance in women using height and pubic arch angle.

To predict the interspinous distance (ISD) using the relationship between female height and pelvimetric measures on magnetic resonance (MR) images. We obtained measurements of the pubic arch angle (PAA), inlet-anteroposterior (AP) distance, mid-pelvis AP distance, outlet-AP distance, ISD, and ischial tuberosity distance using 710 pelvic MR images from nonpregnant reproductive-aged (21-50 years) women from January 2014 to June 2020. Patient height was also assessed from medical records. We determined the formula for predicting ISD using multiple regression analysis. The mean ± standard deviation of the height, PAA, inlet-AP distance, mid-pelvis AP distance, outlet-AP distance, ISD, and ischial tuberosity distance were 160.0 ± 5.5 cm, 87.31 ± 6.6°, 129.7 ± 9.0 mm, 119.7 ± 8.5 mm, 111.71 ± 8.90 mm, 108.88 ± 8.0 mm, and 121.97 ± 11.8 mm, respectively. Two significant regression formulas for predicting ISD were identified as follows: ISD = 0.24973 × height - 0.06724 × inlet-AP distance + 0.12166 × outlet-AP distance + 0.29233 × ischial tuberosity distance + 0.32524 × PAA (P < 0.001, R2 = 0.9973 [adjusted R2 = 0.9973]) and ISD = 0.40935 × height + 0.49761 × PAA (P < 0.001, R2 = 0.9965 [adjusted R2 = 0.9965]). ISD is the best predictor of obstructed labor. This study predicted ISD with 99% explanatory power using only the height and PAA. The PAA can be measured by transperineal ultrasound. This formula may successfully predict vaginal delivery or cephalopelvic disproportion.

Predictive value of the trans-perineal three-dimensional ultrasound measurement of the pubic arch angle for vaginal delivery.

Numerous variables are linked to the success of vaginal delivery, including the subpubic arch angle (SPAA) during labor, the importance of which has not yet been fully elucidated. To examine the SPAA distributional characteristics and to ascertain SPAA's ability to predict the type and duration of labor. We determined the SPAA and analyzed the corresponding data. We also evaluated the relationship between the SPAA and the mode of delivery and the duration of labor by regression. The present study comprised a total of 301 pregnant women who had given birth at Beijing Tiantan Hospital of the Capital Medical University between January and December of 2021. Our analysis of 301 pregnant women revealed that the SPAA measured using three-dimensional trans-perineal ultrasound had a minimum angle of 81° and a maximum angle of 122.2°. The angle in the normal vaginal delivery group was greater than that in the labor cesarean group (P = 0.000). The SPAA was a highly significant positive predictor of normal vaginal delivery (P = 0.000) with an area under the curve of 0.782 (P = 0.000; 95%CI: 0.717-0.848). We found the length of the second stage of labor to be positively influenced by the SPAA using linear regression analysis (P = 0.045). The SPAA was a highly significant positive predictor of normal vaginal delivery. The length of the second stage of labor and normal vaginal birth were predicted by SPAA.

ASUHAN KEBIDANAN PADA IBU NIFAS DENGAN PERAWATAN LUKA PERINEUM DI UPT PUSKESMAS TANJUNG BALAI

Postpartum period is a very important period because at that time it was very proneto complications including postpartum infection. One of the factors causing childbirthinfection can come from birth canal injury which is a good medium for developing germs.emergence of infection in the perineum can spread to the bladder or in birth canalwhich can result in complications of the birth canal infection so that treatment ofperineal wounds is needed. Perineal rupture occurs almost in all first labor and is not uncommon insubsequent labor. e perineal rupture generally occurs in the midline and may become widespread ifthe fetal head is born too soon, the pubic arch angle is smaller than usual, the fetal head passes through the pelvic door that is larger in size than the subregional subreglysia of bregmatika. Perineal wound is injury to the urogenital diaphragm and the leucator ani muscle, which occurs during normal labor, or labor with the device, can occur without injury to the skin of the perineum or to thevagina, so that it is not visible from the outside.This study aims to determine whether perineal wound care can accelerate perineal wound healing. This research study using the case study method conducted at Tanjung Balai Karimun Health Center in January until February 2023. data collection method is participatory observation, interviews, measurements, documentation. Research results show that good and correct perineal wound care can help speed up the healing of perineal wounds in Mrs “M” at the TgBalaiKarimun Health Center in 2023.

Sonographic risk assessment for an unplanned operative delivery: a prospective study.

To assess the value of pre-labor maternal and fetal sonographic variables to predict an unplanned operative delivery. In this prospective study, nulliparous women were recruited at 37.0-42.0weeks of gestation. Sonographic measurements included estimated fetal weight, maternal pubic arch angle, and the angle of progression. We performed a descriptive and comparative analysis between two outcome groups: spontaneous vaginal delivery (SVD) and unplanned operative delivery (UOD) (vacuum-assisted, forceps-assisted and cesarean deliveries). Multivariate logistic regression with ROC analysis was used to create discriminatory models for UOD. Among 234 patients in the study group, 175 had a spontaneous vaginal delivery and 59 an unplanned operative delivery. Maternal height and pubic arch angle (PAA) significantly correlated with UOD. Analysis of Maximum Likelihood Estimates revealed a multivariate model for the prediction of UOD, including the parameters of maternal age, maternal height, sonographic PAA, angle of progression (AOP), and estimated fetal weight, with an area under the curve of 0.7118. Sonographic parameters representing maternal pelvic configuration (PAA) and maternal-fetal interface (AOP) improve the prediction ability of pre-labor models for a UOD. These data may aid the obstetrician in the counseling process before delivery.

Possibilities for predicting perineal birth injury

Hypothesis/aims of study. To date, intranatal injuries of the genital tract and their adverse effects on the womans body remain one of the most important issues in obstetrics and gynecology. Despite the improved management of childbirth, the frequency of the birth canal tissue injuries has no tendency to decrease and amounts to 10.239.0%. The aim of this study was to assess the possibility for predicting intranatal perineal injuries.&#x0D; Study design, materials and methods. The study included a prospective analysis of 90 cases of labor through the natural birth canal based on data obtained from Ufa and Chita perinatal centers in the years 20172019. To determine the elasticity of perineal tissues, a perineoelastomer has been developed, which allows expressing the elasticity of the vulvar ring tissues by a special conditional coefficient. Data was processed using the IBM SPSS Statistics V25.0 software package.&#x0D; Results. Based on the assessment of the obtained data, a probability coefficient of perineal injuries was developed. Its calculation is based on a nonlinear regression analysis and is expressed by the formula: T = (100 ∙ CFH) / (PAA ∙ FBD ∙ ∙ ), where CFH is the circumference of the fetal head at the level of visual tubercles (mm), PAA is the pubic arch angle (degrees), FBD is the distance from the front to the back of the adhesion of the vulvar ring (cm), is the coefficient of elastic deformation of the perineum. When the coefficient T is more than 1, perineal rupture in labor is predicted.&#x0D; Conclusion. In the development of obstetric injuries of the perineum, a major role is played by the ratio of the circumference of the fetal head and the maximum perimeter of the extension of a vulvar ring, which, together with the value of the pubic arch angle and the coefficient of elastic deformation of the perineum, may be a criterion in favor of performing surgical protection of the perineum in case of a threatening rupture.

Pubic Arch Angle Measurement by Transperineal Ultrasonography: A Prospective Cross-Sectional Study.

To evaluate the ability of the pubic arch angle (PAA) as measured by transperineal ultrasonography during labor to predict the delivery type and cephalic pole disengagement mode. The present prospective cross-sectional study included 221 women in singleton-gestational labor ≥ 37 weeks with cephalic fetuses who underwent PAA measurement using transperineal ultrasonography. These measurements were correlated with the delivery type, cephalic pole disengagement mode, and fetal and maternal characteristics. Out of the subjects, 153 (69.2%) had spontaneous vaginal delivery, 7 (3.2%) gave birth by forceps, and 61 (27.6%) delivered by cesarean section. For the analysis, deliveries were divided into two groups: vaginal and surgical (forceps and cesarean). The mean PAA was 102 ± 7.5° (range, 79.3-117.7°). No statistically significant difference was observed in delivery type (102.6 ± 7.2° versus 100.8 ± 7.9°, p = 0.105). The occipitoanterior position was seen in 94.1% of the fetuses and the occipitoposterior position in 5.8%. A narrower PAA was found in the group of surgical deliveries (97.9 ± 9.6° versus 102.6 ± 7.3°, p = 0.049). Multivariate regression analysis showed that PAA was a predictive variable for the occurrence of head disengagement in occipital varieties after birth (odds ratio, 0.9; 95% confidence interval, 0.82-0.99; p = 0.026). Ultrasonographic measurement of the PAA was not a predictor of delivery type, but was associated with the persistence of occipital varieties after birth.

Intrapartum ultrasound monitoring of malposition and malrotation during labor neuraxial analgesia: maternal outcomes

Objective: This study analyzes the important role of ultrasonography (IUS) related to the maternal outcomes in women with fetal persistent occiput posterior position (POPP) and asynclitism (A) in labor neuraxial analgesia (LNA).Study design: Prospective assessment of 148 primiparous women diagnosed with the prolonged second stage of labor. Transabdominal and transperineal IUS were used to detect fetal head position and to evaluate the angle of progression (AOP) and pubic arch angle (PAA). Statistical data about maternal aspects, modalities of delivery and maternal outcomes were observed.Results: In all parturients included in the study, the operative delivery rate was 73%. In patients delivered via cesarean section, the PAA was ≤ of 96.5°. There was statistical correlation between doses of LNA and Apgar score at first minute (r0.8).Conclusions: There is a greater frequency of Fetal POPP and asynclitism related with maternal complications. The results of our study confirmed the importance of determination of angle of progression (AoP) and PAA in the prolonged second stage of labor. Unfavorable AoP and PAA, in presence of POPP and A, are related with high percentage of operative delivery. If the prolonged labor and delivery in these patients exceed time limit proposed by American College of Obstetricians and Gynecologists guidelines, it may be viewed as a possible malpractice. In cases of POPP with asynclitism, in the second stage of labor detected by IUS it is advisable to discontinue the anesthetic drugs administration in LNA; because the labor pain is related to the dystocia, an operative delivery is necessary to avoid maternal and fetal complications.

Development of mathematical methods for calculation of the pubic arch angle

Hypothesis/aims of study. The frequency of adverse intranatal outcomes is significantly increased when the pubic arch angle (PAA) is less than 90°. The accuracy of the manual method for determining PAA depends on a large number of parameters, such as obesity of a woman, as well as stereometric sensation and the experience of a doctor. Determination of PAA using ultrasound and X-ray pelviometry is generally available and reliable; however, it requires special training. The aim of this study was to develop mathematical methods for calculation of PAA.&#x0D; Study design, materials and methods. The study included a retrospective and prospective analysis of 120 birth histories based on the Regional Clinical Hospital Perinatal Center (the Chita city, the years 2017/2018), which were divided into three equal groups. Group 1 consisted of patients with body weight deficit, group 2 included patients with normal body mass index, and group 3 comprised patients with alimentary constitutional obesity. On the eve of the birth, external pelviometry, the manual method for determining PAA, and ultrasound pelviometry by translabial access were performed.&#x0D; Results. PAA determined by the manual method was 99.6 ± 11.3° in group 1, 100.1 ± 14.2° in group 2, and 98.2 ± 10.7° in group 3. When ultrasound pelviometry was performed, the value of PAA was 97.4 ± 10.7° in group 1, 104.8 ± 13.8° in group 2, and 104.1 ± 12.3° in group 3. The error of the manual method was 2.2% in group 1, 4.5% in group 2, and 7.6% in group 3. On the basis of mathematical modeling of external pelviometry data, a pattern is defined, which is expressed by the formula: PAA = 180° – arccos (0,5 ∙ S1S2/S1P) – arccos (0,5 ∙ B1B2/(B2S1 – S1P), where PAA is the pubic arch angle (°); S1S2, Distantia spinarum; S1P, the distance between the anterior superior spine of the ilium to the lower edge of the symphysis; B2S1, the distance between the anterior superior spine of the ilium to the tuberosity of the opposite ischium; B1B2, the transverse size of the output plane. The coefficient of determination (R-squared) is 0.82. Thus, mathematical modeling allows determining PAA with a high degree of reliability.

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.

Imaging of the pubic arch angle in prolonged second stage of labour with intrapartum translabial 3D ultrasound and its clinical significance

Imaging of the pubic arch angle in prolonged second stage of labour with intrapartum translabial 3D ultrasound and its clinical significance

OP28.11: The correlation between computed tomography measurements of the pubic arch angle and the intraspinous diameter in reproductive‐age women

OP28.11: The correlation between computed tomography measurements of the pubic arch angle and the intraspinous diameter in reproductive‐age women

Variability of the pubic arch architecture and its influence on the minimal levator hiatus area

ObjectiveTo investigate the association between the minimal levator hiatus (MLH) area at rest with its surrounding soft-tissue and bony structures in nulliparous asymptomatic women with a normal levator ani muscle. MethodsA subanalysis was undertaken of a prospective study of the appearance of the levator ani in asymptomatic nulliparous women conducted between September 2010 and September 2011. The subanalysis included women with a normal levator ani muscle. Three-dimensional ultrasonography volumes were used to obtain pelvic floor measurements. ResultsThe analysis included 56 women with mean age of 43.0±13.4years. The mean MLH area was 13.1±1.8cm2 (range 9.0–17.3). The pubic arch angle had no influence on the MLH area (Pearson correlation coefficient r=0.13). Height and pubic arch length were positively correlated with the MLH area (r=0.26 [P=0.52] and r=0.50 [P<0.001], respectively). ConclusionThe MLH size of nulliparous women varied widely and was positively correlated with the height and pubic arch length of the women. Therefore, caution is warranted when interpreting the MLH area as an indicator of a levator ani defect or a predictor of pelvic organ prolapse without taking a woman’s pelvic bone characteristics into account.

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 ...

Pubic arch angle in prolonged second stage of labor: clinical significance

To evaluate the clinical significance of the pubic arch angle (PAA) measured by transperineal ultrasound during prolonged second stage of labor. We evaluated prospectively 62 women ≥ 37 weeks of gestation with failure to progress in the second stage of labor. Transperineal ultrasound (transverse plane) was used to measure the pubic arch angle. Correlations with fetomaternal characteristics, mode of delivery and perinatal outcome were evaluated. The mean PAA was 101.1° (± 13.1°; range, 80°-135°). We found a negative correlation with maternal age. Patients with an occipitotransverse fetal position had a significantly smaller angle compared with those with occipitoanterior positions (94.3° ± 5.5° vs. 103.2° ± 14.8°, P < 0.05), as did those with operative deliveries compared with those with spontaneous vaginal delivery (97.1° ± 11.5° vs. 110.1° ± 14.0°, P < 0.05). The prediction of operative delivery in prolonged second stage of labor by receiver-operating characteristics curve using PAA alone yielded an area under the curve of 0.75. The predicted probability for operative delivery increased as PAA decreased, with an odds ratio of 0.933 for each decrease in angle of 1°. Our study suggests a correlation between the PAA and mode of delivery in prolonged second stage of labor. This may be used as an adjunctive parameter when considering delivery mode.

A Cervical Cerclage Task Trainer for Maternal-Fetal Medicine Fellows and Obstetrics/Gynecology Residents

Performance of cervical cerclage is a difficult procedure for learners with limited operative experience. We present a task trainer for cervical cerclage, which can facilitate learner training in a preclinical environment. A simulated vagina is first fashioned out of polyvinyl chloride pipe material to allow an appropriately shaped pelvic structure. To simulate collapsible vaginal sidewalls, a foam covered with latex sheets is used to line the inside of the task trainer. A "cervix" is made by cutting cylinders approximately 2 in in diameter and 4 in in length in frozen cow muscle. After thawing, the cervical models are fastened to a semirigid foam disk with suture, which is used to secure the cervix inside the polyvinyl chloride pipe at the top of the simulated vagina. The full cervical cerclage task trainer is then secured in a holder to stabilize it in place. Placement of a cervical cerclage can then be practiced with standard vaginal cerclage instruments. Cervical cerclage can be practiced in a nonclinical environment using this model. Several aspects of the procedure can be modified including the amount of vaginal tissue, length and caliber of the vagina, and pubic arch angle. This model allows beginning learners sequential training of increasing difficulty. Faculty and trainees alike found the trainer to be useful and felt that it helped in the acquisition of the surgical skills needed for cerclage placement in a clinical setting. This low-cost task trainer can provide Maternal-fetal Medicine fellows and obstetric/gynecology residents the opportunity to practice cervical cerclage placement in a nonclinical environment. It may help physicians to obtain or maintain proficiency despite the relative low frequency of the procedure in modern obstetric practice.

Anatomical variation of bony pelvis from the viewpoint of transobturator sling placement for stress urinary incontinence

Introduction and hypothesisThe aim of the study was to investigate the variability of bony pelvis architecture from the viewpoint of transobturator sling placement.MethodsThe pelvimetry was performed on 122 women who underwent pelvic computed tomography. Measurements included: the distance between the interobturator foramina line and inferior pubic symphysis (IF-PS distance) as well as pubic arch angle, pubic ramus width, and pubic symphysis length.ResultsThe length of the IF-PS distance varied between 7.4 and 26.9 mm (mean 15.2 ± 4.3 mm, median 14.2 mm). The distribution of measurements was asymmetrical with a tilt of the values towards shorter distances. In 11.5% of women, the IF-PS distance was longer than 20 mm. The IF-PS distance correlated with the pubic ramus width (r = 0.37, p < 0.0001) and pubic arch angle (r = −0.22, p = 0.017).ConclusionThe IF-PS distance varies considerably in the general population of women.

Variation of the obturator foramen and pubic arch of the female bony pelvis

The purpose of this study was to determine dimensions of the obturator foramen and pubic arch of the female pelvis and to assess for variability. Ninety-six female pelvises were selected from the Cleveland Natural History Museum. The obturator foramen area, pubic arch angle, pubic ramus, pubic symphysis, and anterior urogenital triangle area were measured. Linear regression was used to evaluate independent associations. There was considerable variability of the bony architecture. The mean obturator foramen area was 12.2 +/- 2.1 cm(2) (range, 7.38-18.22 cm(2)). After controlling for height, the pubic ramus width, pubic symphysis length, and interobturator foramina distance were significantly greater in European American women compared with African American women. Obturator foramen area increased with increasing height (P = .0008) but was not associated with race. There is considerable variability in the bony architecture of the obturator foramen and pubic arch of the female pelvis. Race and height may account for some of these variabilities.