X-ray pelvimetry-reappraisal

Area of Science:

• Obstetrics and Gynecology
• Radiology
• Maternal-Fetal Medicine

Background:

• Cephalopelvic disproportion (CPD) is a common indication for Cesarean section.
• Accurate diagnosis of CPD is crucial for safe delivery outcomes.
• Pelvic dimensions play a significant role in the mechanism of labor.

Purpose of the Study:

• To evaluate the utility of antenatal X-ray pelvimetry in diagnosing CPD.
• To compare pelvic inlet dimensions between elective and emergency Cesarean sections in primigravidas.
• To assess the relationship between parity, pelvic capacity, and Cesarean section rates in multigravidas.

Main Methods:

• Antenatal erect lateral X-ray pelvimetry was performed on 116 primigravidas and 53 multigravidas with suspected CPD.
• Multigravidas were stratified by parity (4 and >4).
• Anteroposterior diameter (APD) of the pelvic inlet was measured and analyzed in relation to delivery mode and parity.

Main Results:

• No significant difference in mean APD was found between elective and emergency Cesarean sections in primigravidas.
• In multigravidas, mean APD decreased significantly with increasing parity.
• Cesarean section rates were 74% for APD <10.5 cm and 12% for APD >11.5 cm in multigravidas.

Conclusions:

• CPD in primigravidas requires an adequate trial of labor for diagnosis.
• X-ray pelvimetry is recommended for suspected CPD in multiparous patients, particularly grand multiparas, before attempting vaginal delivery.
• Pelvic capacity is a primary determinant of delivery mode in multiparous women.