Pelvimetry by magnetic resonance imaging as a diagnostic tool to evaluate dystocia

To test the clinical value of magnetic resonance imaging (MRI) pelvimetry for the diagnosis of cephalopelvic disproportion.

All deliveries from January 1993 through December 1994 were reviewed to identify 42 nulliparas at term with vertex presentation and cesarean delivery due to dystocia. Complete data were available for 41 women, and subjects were divided into the following two subgroups, according to clinical data: "cephalopelvic disproportion" (n = 28) and "failure to progress" (n = 13). Ten nulliparous women with uncomplicated vaginal delivery served as controls. Pelvimetry data from postpartum MRI were correlated with fetal and neonatal dimensions to evaluate various criteria for the diagnosis of cephalopelvic disproportion.

Comparing both the fetal head volume derived from antepartum ultrasound assessment and the neonatal head volume (postpartum measurement) with maternal pelvic capacity determined by MRI, cephalopelvic disproportion (head volume exceeding pelvic capacity) indicated that 25 and 27, respectively, of the 28 women had been clinically diagnosed correctly with cephalopelvic disproportion, corresponding to sensitivities of 89% and 96%, respectively. Fetal head volume was not larger than pelvic capacity in any of the women in the control group. In seven of the 13 women diagnosed as "failure to progress," the fetal head volume exceeded the pelvic capacity.

A fetal head volume estimate exceeding MRI-measured pelvic capacity is a frequent finding in nulliparas with cesarean birth due to cephalopelvic disproportion. An appropriate prospective study to determine the benefits of an antepartum diagnosis of cephalopelvic disproportion in high-risk nulliparas is warranted.