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Anthony J. Viera - One of the best experts on this subject based on the ideXlab platform.
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A Retrospective Review of Performance and Utility of Routine Clinical Pelvimetry
Family medicine, 2004Co-Authors: Charles S. Blackadar, Anthony J. VieraAbstract:Background and Objectives: Some authorities have questioned the utility of performing clinical Pelvimetry as part of routine prenatal care. This study determined the frequency with which clinical Pelvimetry is still performed at two military hospitals and whether the results of Pelvimetry influence the management of labor and delivery. Methods: We conducted a retrospective review of prenatal records at two military hospitals. One was an overseas hospital, and one was a family medicine teaching hospital in the United States. The records of 660 pregnant women were reviewed to identify documentation that Pelvimetry was performed during prenatal care and whether there was evidence that the physician managing labor and delivery altered management based on Pelvimetry results. Results: Seventy percent (461) of the 660 records reviewed had all Pelvimetry measurements documented as normal, or the provider had written “good for TOL (trial of labor),” “proven to XX pounds,” or similar annotation that Pelvimetry was normal. Nine percent (58 records) had no documentation of Pelvimetry (Pelvimetry section left blank). The remaining 21% (141 charts) had at least one Pelvimetry measurement listed as abnormal on the initial prenatal exam. No admission note, progress note, or operative note recorded during labor and delivery made reference to clinical Pelvimetry results. No abnormal Pelvimetry result was referenced in follow-up visits or appeared to make any difference in mode of delivery or treatment in labor. Two women (one at each institution) had initial visit notes indicating the need to consider radiographic Pelvimetry based on the results of clinical exam, but this test was not done in either case, and both women delivered vaginally. Conclusions: Our study indicates that clinical Pelvimetry does not change management of pregnant patients. Current practice is to allow all women a trial of labor regardless of Pelvimetry results. This makes the routine performance and recording of clinical Pelvimetry a waste of time, a potential liability, and an unnecessary discomfort for patients.
Charles S. Blackadar - One of the best experts on this subject based on the ideXlab platform.
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A Retrospective Review of Performance and Utility of Routine Clinical Pelvimetry
2015Co-Authors: Charles S. Blackadar, Md Anthony, J. VieraAbstract:Clinical Pelvimetry is the manual examination of the pelvis to determine if it is of adequate size for child-birth. The technique of clinical Pelvimetry is described in most obstetrical textbooks1-3 and taught to medical students and residents despite no evidence of interobserver agreement and poor correlation to radio-graphic Pelvimetry.4 Additionally, controlled studies have repeatedly shown that X-ray Pelvimetry, presumed to be more accurate than manual Pelvimetry, is not a successful predictor of vaginal delivery or need for operative delivery.4 Current clinical opinion expressed in obstetrical textbooks is that, except in very few sce-narios, all women should be given a trial of labor.5 If all women should be given a trial of labor, then the results of Pelvimetry would not be expected to alter labor management. This study aimed to determine, in light of current opinion and evidence, to what extent clinical Pelvimetry continues to be practiced and used. Methods We conducted a retrospective review of prenatal records in an approximately 3-month time frame at two separate military hospitals. One was an overseas hos-pital. The other was a US-based hospital at which there was a family medicine residency. The providers of pre-natal care at both locations were board-certified family physicians, obstetricians, and nurse midwives. The pro-viders had been trained at a variety of institutions (both military and civilian). No prenatal records were excluded. We reviewed the records of active duty military women and spouses of active duty men. The physicians reviewing the records had not provided any of the initial prenatal care for the subject patients. Prenatal records were reviewed to ob
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A Retrospective Review of Performance and Utility of Routine Clinical Pelvimetry
Family medicine, 2004Co-Authors: Charles S. Blackadar, Anthony J. VieraAbstract:Background and Objectives: Some authorities have questioned the utility of performing clinical Pelvimetry as part of routine prenatal care. This study determined the frequency with which clinical Pelvimetry is still performed at two military hospitals and whether the results of Pelvimetry influence the management of labor and delivery. Methods: We conducted a retrospective review of prenatal records at two military hospitals. One was an overseas hospital, and one was a family medicine teaching hospital in the United States. The records of 660 pregnant women were reviewed to identify documentation that Pelvimetry was performed during prenatal care and whether there was evidence that the physician managing labor and delivery altered management based on Pelvimetry results. Results: Seventy percent (461) of the 660 records reviewed had all Pelvimetry measurements documented as normal, or the provider had written “good for TOL (trial of labor),” “proven to XX pounds,” or similar annotation that Pelvimetry was normal. Nine percent (58 records) had no documentation of Pelvimetry (Pelvimetry section left blank). The remaining 21% (141 charts) had at least one Pelvimetry measurement listed as abnormal on the initial prenatal exam. No admission note, progress note, or operative note recorded during labor and delivery made reference to clinical Pelvimetry results. No abnormal Pelvimetry result was referenced in follow-up visits or appeared to make any difference in mode of delivery or treatment in labor. Two women (one at each institution) had initial visit notes indicating the need to consider radiographic Pelvimetry based on the results of clinical exam, but this test was not done in either case, and both women delivered vaginally. Conclusions: Our study indicates that clinical Pelvimetry does not change management of pregnant patients. Current practice is to allow all women a trial of labor regardless of Pelvimetry results. This makes the routine performance and recording of clinical Pelvimetry a waste of time, a potential liability, and an unnecessary discomfort for patients.
S Karandikar - One of the best experts on this subject based on the ideXlab platform.
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pth 319 is there a useful relationship between Pelvimetry and operative or oncological outcome after low rectal cancer surgery
Gut, 2015Co-Authors: P Waterland, G Lafaurie, D Macarthur, S KarandikarAbstract:Introduction Bony Pelvimetry varies between the sexes and has been found to be a possible factor in predicting operating time, quality of histological total mesorectal excision (TME) grade and positivity of circumferential resection margin (CRM) after rectal cancer surgery. Low pelvic dissection is anecdotally more difficult in narrow and deep pelves. This observational study aimed to identify any relationship between magnetic resonance (MR) bony Pelvimetry measurements and operative or oncological outcome in patients undergoing rectal cancer surgery. Method A prospective database of patients undergoing anterior resection was maintained including demographics, operating time, tumour characteristics and oncological outcomes. MR Pelvimetry recordings were performed by a surgeon ‘blinded’ to outcome. Chosen endpoints were local recurrence (LR), disease free survival (DFS), overall survival (OS) and operating time (OT). Binary logistic regression and Pearson’s correlation coefficient were performed for statistical analysis. Results A total of 171 patients underwent surgery (58 abdomino-perineal resection, 113 anterior resection) between 01/2009 and 05/2014. Median operating time was 318 min (range 91–421). Median follow-up was 25 months. There were 10(5.8%) patients with positive CRM, 10(5.8%) patients with LR, and 28(16.3%) deaths during follow-up period. There was no significant correlation between individual MR Pelvimetry measurements and LR, DFS, OS or OT. However, the distance between the tip of the coccyx to the sacral promentory, and the tip of the coccyx to the body of S3 were strongly correlated with operating time, with the former also being closest to significance in correlation with LR. Conclusion Our study does not demonstrate any statistically significant relationship between bony Pelvimetry and outcome after low rectal cancer surgery. A deep pelvis is correlated non-significantly with local recurrence and prolonged operating time. Further follow-up is required for complete five year oncological data. Disclosure of interest None Declared.
Robert Clive Pattinson - One of the best experts on this subject based on the ideXlab platform.
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The Cochrane Library - Pelvimetry for fetal cephalic presentations at or near term for deciding on mode of delivery
The Cochrane database of systematic reviews, 2017Co-Authors: Robert Clive Pattinson, Anna Cuthbert, Valerie VannevelAbstract:Background Pelvimetry assesses the size of a woman's pelvis aiming to predict whether she will be able to give birth vaginally or not. This can be done by clinical examination, or by conventional X-rays, computerised tomography (CT) scanning, or magnetic resonance imaging (MRI). Objectives To assess the effects of Pelvimetry (performed antenatally or intrapartum) on the method of birth, on perinatal mortality and morbidity, and on maternal morbidity. This review concentrates exclusively on women whose fetuses have a cephalic presentation. Search methods We searched Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2017) and reference lists of retrieved studies. Selection criteria Randomised controlled trials (including quasi-randomised) assessing the use of Pelvimetry versus no Pelvimetry or assessing different types of Pelvimetry in women with a cephalic presentation at or near term were included. Cluster trials were eligible for inclusion, but none were identified. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the quality of the evidence using the GRADE approach. Main results Five trials with a total of 1159 women were included. All used X-ray Pelvimetry to assess the pelvis. X-ray Pelvimetry versus no Pelvimetry or clinical Pelvimetry is the only comparison included in this review due to the lack of trials identified that examined other types of radiological Pelvimetry or that compared clinical Pelvimetry versus no Pelvimetry. The included trials were generally at high risk of bias. There is an overall high risk of performance bias due to lack of blinding of women and staff. Two studies were also at high risk of selection bias. We used GRADEpro software to grade evidence for our selected outcomes; for caesarean section we rated the evidence low quality and all the other outcomes (perinatal mortality, wound sepsis, blood transfusion, scar dehiscence and admission to special care baby unit) as very low quality. Downgrading was due to risk of bias relating to lack of allocation concealment and blinding, and imprecision of effect estimates. Women undergoing X-ray Pelvimetry were more likely to have a caesarean section (risk ratio (RR) 1.34, 95% confidence interval (CI) 1.19 to 1.52; 1159 women; 5 studies; low-quality evidence). There were no clear differences between groups for perinatal outcomes: perinatal mortality (RR 0.53, 95% CI 0.19 to 1.45; 1159 infants; 5 studies; very low-quality evidence), perinatal asphyxia (RR 0.66, 95% CI 0.39 to 1.10; 305 infants; 1 study), and admission to special care baby unit (RR 0.20, 95% CI 0.01 to 4.13; 288 infants; 1 study; very low-quality evidence). Other outcomes assessed were wound sepsis (RR 0.83, 95% CI 0.26 to 2.67; 288 women; 1 study; very low-quality evidence), blood transfusion (RR 1.00, 95% CI 0.39 to 2.59; 288 women; 1 study; very low-quality evidence), and scar dehiscence (RR 0.59, 95% CI 0.14 to 2.46; 390 women; 2 studies; very low-quality evidence). Again, no clear differences were found for these outcomes between the women who received X-ray Pelvimetry and those who did not. Apgar score less than seven at five minutes was not reported in any study. Authors' conclusions X-ray Pelvimetry versus no Pelvimetry or clinical Pelvimetry is the only comparison included in this review due to the lack of trials identified that used other types or Pelvimetry (other radiological examination or clinical Pelvimetry versus no Pelvimetry). There is not enough evidence to support the use of X-ray Pelvimetry for deciding on mode of delivery in women whose fetuses have a cephalic presentation. Women who undergo an X-ray Pelvimetry may be more likely to have a caesarean section. Further research should be directed towards defining whether there are specific clinical situations in which Pelvimetry can be shown to be of value. Newer methods of Pelvimetry (CT, MRI) should be subjected to randomised trials to assess their value. Further trials of X-ray Pelvimetry in cephalic presentations would be of value if large enough to assess the effect on perinatal mortality.
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Pelvimetry for fetal cephalic presentations at or near term for deciding on mode of delivery
Cochrane Database of Systematic Reviews, 2017Co-Authors: Robert Clive Pattinson, Anna Cuthbert, Valerie VannevelAbstract:Background Pelvimetry assesses the size of a woman's pelvis aiming to predict whether she will be able to give birth vaginally or not. This can be done by clinical examination, or by conventional X-rays, computerised tomography (CT) scanning, or magnetic resonance imaging (MRI). Objectives To assess the effects of Pelvimetry (performed antenatally or intrapartum) on the method of birth, on perinatal mortality and morbidity, and on maternal morbidity. This review concentrates exclusively on women whose fetuses have a cephalic presentation. Search methods We searched Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2017) and reference lists of retrieved studies. Selection criteria Randomised controlled trials (including quasi-randomised) assessing the use of Pelvimetry versus no Pelvimetry or assessing different types of Pelvimetry in women with a cephalic presentation at or near term were included. Cluster trials were eligible for inclusion, but none were identified. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the quality of the evidence using the GRADE approach. Main results Five trials with a total of 1159 women were included. All used X-ray Pelvimetry to assess the pelvis. X-ray Pelvimetry versus no Pelvimetry or clinical Pelvimetry is the only comparison included in this review due to the lack of trials identified that examined other types of radiological Pelvimetry or that compared clinical Pelvimetry versus no Pelvimetry. The included trials were generally at high risk of bias. There is an overall high risk of performance bias due to lack of blinding of women and staff. Two studies were also at high risk of selection bias. We used GRADEpro software to grade evidence for our selected outcomes; for caesarean section we rated the evidence low quality and all the other outcomes (perinatal mortality, wound sepsis, blood transfusion, scar dehiscence and admission to special care baby unit) as very low quality. Downgrading was due to risk of bias relating to lack of allocation concealment and blinding, and imprecision of effect estimates. Women undergoing X-ray Pelvimetry were more likely to have a caesarean section (risk ratio (RR) 1.34, 95% confidence interval (CI) 1.19 to 1.52; 1159 women; 5 studies; low-quality evidence). There were no clear differences between groups for perinatal outcomes: perinatal mortality (RR 0.53, 95% CI 0.19 to 1.45; 1159 infants; 5 studies; very low-quality evidence), perinatal asphyxia (RR 0.66, 95% CI 0.39 to 1.10; 305 infants; 1 study), and admission to special care baby unit (RR 0.20, 95% CI 0.01 to 4.13; 288 infants; 1 study; very low-quality evidence). Other outcomes assessed were wound sepsis (RR 0.83, 95% CI 0.26 to 2.67; 288 women; 1 study; very low-quality evidence), blood transfusion (RR 1.00, 95% CI 0.39 to 2.59; 288 women; 1 study; very low-quality evidence), and scar dehiscence (RR 0.59, 95% CI 0.14 to 2.46; 390 women; 2 studies; very low-quality evidence). Again, no clear differences were found for these outcomes between the women who received X-ray Pelvimetry and those who did not. Apgar score less than seven at five minutes was not reported in any study. Authors' conclusions X-ray Pelvimetry versus no Pelvimetry or clinical Pelvimetry is the only comparison included in this review due to the lack of trials identified that used other types or Pelvimetry (other radiological examination or clinical Pelvimetry versus no Pelvimetry). There is not enough evidence to support the use of X-ray Pelvimetry for deciding on mode of delivery in women whose fetuses have a cephalic presentation. Women who undergo an X-ray Pelvimetry may be more likely to have a caesarean section. Further research should be directed towards defining whether there are specific clinical situations in which Pelvimetry can be shown to be of value. Newer methods of Pelvimetry (CT, MRI) should be subjected to randomised trials to assess their value. Further trials of X-ray Pelvimetry in cephalic presentations would be of value if large enough to assess the effect on perinatal mortality.
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The Cochrane Library - Pelvimetry for fetal cephalic presentations at term.
The Cochrane database of systematic reviews, 1997Co-Authors: Robert Clive PattinsonAbstract:BACKGROUND:Pelvimetry assesses the size of a woman's pelvis by clinical examination, or by conventional X-rays, computerised tomography scanning, or magnetic resonance imaging. OBJECTIVES:The objective of this review was to assess the effects of Pelvimetry (performed antenatally, intrapartum or postpartum) on the method of delivery, and on perinatal mortality and morbidity, and on maternal morbidity. SEARCH STRATEGY:The Cochrane Pregnancy and Childbirth Group trials register was searched. SELECTION CRITERIA:Acceptably randomised comparisons of the use of Pelvimetry in cephalic presentations. DATA COLLECTION AND ANALYSIS:Trial quality was assessed and data were extracted by one author. MAIN RESULTS:Four trials of over 1000 women were included. The trials were generally not of good quality. Women undergoing Pelvimetry were more likely to be delivered by caesarean section (odds ratio 2.17, 95% confidence interval 1.63 to 2.88). No significant impact was detected on perinatal outcome. REVIEWER'S CONCLUSIONS:There is not enough evidence to support the use of X-ray Pelvimetry in women whose fetuses have a cephalic presentation.
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Pelvimetry for fetal cephalic presentations at term
Cochrane Database of Systematic Reviews, 1997Co-Authors: Robert Clive PattinsonAbstract:BACKGROUND:Pelvimetry assesses the size of a woman's pelvis by clinical examination, or by conventional X-rays, computerised tomography scanning, or magnetic resonance imaging. OBJECTIVES:The objective of this review was to assess the effects of Pelvimetry (performed antenatally, intrapartum or postpartum) on the method of delivery, and on perinatal mortality and morbidity, and on maternal morbidity. SEARCH STRATEGY:The Cochrane Pregnancy and Childbirth Group trials register was searched. SELECTION CRITERIA:Acceptably randomised comparisons of the use of Pelvimetry in cephalic presentations. DATA COLLECTION AND ANALYSIS:Trial quality was assessed and data were extracted by one author. MAIN RESULTS:Four trials of over 1000 women were included. The trials were generally not of good quality. Women undergoing Pelvimetry were more likely to be delivered by caesarean section (odds ratio 2.17, 95% confidence interval 1.63 to 2.88). No significant impact was detected on perinatal outcome. REVIEWER'S CONCLUSIONS:There is not enough evidence to support the use of X-ray Pelvimetry in women whose fetuses have a cephalic presentation.
Sebastien Aubry - One of the best experts on this subject based on the ideXlab platform.
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can three dimensional Pelvimetry using low dose stereoradiography replace low dose ct Pelvimetry
Diagnostic and interventional imaging, 2018Co-Authors: Sebastien Aubry, P Padoin, Y Petegnief, Chrystelle Vidal, D Riethmuller, E DelabrousseAbstract:PURPOSE To evaluate the reliability of pelvimetric measurements performed using stereoradiographic imaging (SRI), and to assess maternal and fetal radiation doses compared to low-dose computer tomography (CT) Pelvimetry. MATERIALS AND METHODS Thirty-five pregnant women (mean age, 29.6±5.5 [SD] years; range: 20-41 years) were prospectively included. All women underwent simultaneous frontal and lateral low-dose SRI and low-dose CT examination of the pelvis. Pelvimetry measurements were obtained from both examinations and radiation doses obtained with the two techniques were compared. RESULTS SRI-CT correlation (Pearson coefficient correlation [r]; mean bias [mb]) was strong for transverse inlet diameter (r=0.92; mb=-0.09cm), anteroposterior diameter of the pelvic inlet (r=0.92; mb = 0.47cm), maximal transverse diameter (r=0.9; mb=0.21cm), sacrum length (r=0.9; mb=0.09cm). Correlation was good. Correlation was good for the sacrum depth (r=0.75; mb=0.06cm) and Magnin's index (r=0.7; mb=0.5cm). Correlation was moderate for anteroposterior diameter of pelvic outlet (r=0.6; mb=0.52cm). The fetal dose was 13.1 times lower using SRI (87±26μGy) than CT (1140±220μGy, P<0.0001). The effective maternal dose was 3.1 times lower using SRI (97±21μSv) than CT (310±60μSv; P<0.0001). CONCLUSION Pelvic inlet measurements using SRI are reliable. Compared to CT Pelvimetry, SRI leads to a significant decrease in fetal and maternal radiation doses. These findings should prompt physicians to use SRI as the first-line approach for Pelvimetry.
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An evaluation of the EOS X-ray imaging system in Pelvimetry
Diagnostic and interventional imaging, 2014Co-Authors: M.-h. Sigmann, D Riethmuller, Eric Delabrousse, M. Runge, C. Peyron, Sebastien AubryAbstract:Abstract Objectives To demonstrate the reliability of the EOS imaging system in measuring the internal diameters of the bony pelvis. Materials and methods A prospective study comparing the results of the Pelvimetry of 18 dry pelvises carried out on the EOS imaging system to measurements taken manually and using the two current gold standard CT methods. Pelvimetric measurements of each pelvic bone were obtained using four methods and compared: direct manual measurements, spiral and sequential CT Pelvimetry, and 2D-3D low-dose biplanar X-rays. The various obstetric diameters were measured to the millimetre and compared. Results There was no significant difference in the different diameters assessed, with the exception of the interspinous diameter. There was a highly significant correlation ( P Conclusion The EOS imaging system allows for an ex vivo determination of the obstetrical diameters that is reliable enough to estimate obstetric prognosis, producing comparable measurements to CT. In view of concerns about protection from radiation, this low-dose imaging technique could become, after in vivo prospective validation, the new gold standard for Pelvimetry and therefore a good alternative to CT.