Antepartum evaluation of the obstetric conjugate at transabdominal 2D ultrasound: A feasibility study.
labor dystocia
obstetric conjugate
obstructed labor
pelvimetry
ultrasound
Journal
Acta obstetricia et gynecologica Scandinavica
ISSN: 1600-0412
Titre abrégé: Acta Obstet Gynecol Scand
Pays: United States
ID NLM: 0370343
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
revised:
30
06
2021
received:
28
02
2021
accepted:
01
07
2021
pubmed:
10
7
2021
medline:
28
9
2021
entrez:
9
7
2021
Statut:
ppublish
Résumé
The obstetric conjugate represents the shortest anteroposterior diameter of the birth canal and it reflects the capacity of the pelvic inlet to allow the passage and the engagement of the fetal head. The antepartum evaluation of this parameter may be attempted at digital examination to predict the risk of cephalopelvic disproportion, but the accuracy of clinical pelvimetry is notoriously poor. The aim of our study was to describe the sonographic measurement of the obstetric conjugate at transabdominal 2D-ultrasound and to assess its reproducibility. This is a prospective cohort study conducted at a tertiary University hospital. A non-consecutive series of pregnant women with uncomplicated singleton pregnancies attending the antenatal clinic for routine booking from 34 weeks of gestation onward were included. The ultrasound probe was longitudinally placed above the level of the symphysis and the interpubic fibrocartilaginous disk was visualized. Then the promontory was identified as the most prominent segment of the sacral vertebral column. The obstetric conjugate was measured as the distance between the inner edge of the interpubic disk and the promontory. The inter- and intraobserver repeatability of this measurement was calculated using the intraclass correlation coefficient (ICC) and the Bland-Altman method. In all, 119 women were considered eligible for the study; of these, 111/119 (93.3%) women were included in the analysis with a median gestational age of 36.0 (35.0-37.0) weeks. The mean obstetric conjugate measurement was 11.4 ± 0.93 mm for the first operator and 11.4 ± 0.91 mm for the second operator. The overall interobserver ICC was 0.95 (95% [confidence interval] CI 0.92-0.96) and the overall intraobserver ICC was 0.97 (95% CI 0.96-0.98). Limits of agreement ranged from -0.84 to 0.80 for interobserver measures and from -0.64 to 0.62 for intraobserver measures. The degree of reliability was also analyzed for women with a body mass index ≥30 and for women with a gestational age ≥37 weeks. The inter- and intraobserver ICCs were respectively 0.97 (95% CI 0.90-0.98) and 0.98 (0.95-0.99) in the former group and 0.96 (95% CI 0.93-0.98) and 0.97 (95% CI 0.95-0.98) in the latter group. Our study demonstrated that among pregnant women at term gestation, sonographic measurement of the obstetric conjugate is feasible and reproducible.
Types de publication
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1917-1923Informations de copyright
© 2021 Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). Published by John Wiley & Sons Ltd.
Références
Maharaj D. Assessing cephalopelvic disproportion: back to the basics. Obstet Gynecol Surv. 2010;65:387-395.
Baskett TF, Calder AA, Arulkumaran S. Munro Kerr’s Operative Obstetrics. , 12th edn. Edinburgh: Saunders Elsevier; 2014.
Suonio S, Saarikoski S, Räty E, Vohlonen I. Clinical assessment of the pelvic cavity and outlet. Arch Gynecol. 1986;239:11-16.
Adinma JI, Agbai AO, Anolue FC. Relevance of clinical pelvimetry to obstetric practice in developing countries. West Afr J Med. 1997;16:40-43.
Benjamin SJ, Daniel AB, Kamath A, Ramkumar V. Anthropometric measurements as predictors of cephalopelvic disproportion: can the diagnostic accuracy be improved? Acta Obstet Gynecol Scand. 2012;91:122-127.
Rozenholc AT, Ako SN, Leke RJ, Boulvain M. The diagnostic accuracy of external pelvimetry and maternal height to predict dystocia in nulliparous women: a study in Cameroon. BJOG. 2007;114:630-635.
Liselele HB, Tshibangu CK, Meuris S. Association between external pelvimetry and vertex delivery complications in African women. Acta Obstet Gynecol Scand. 2000;79:673-678.
Rozenberg P. Quelle place pour la radiopelvimétrie au XXI(e) siècle? [Is there a role for X-ray pelvimetry in the twenty-first century?] (in French). Gynecol Obstet Fertil. 2007;35:6-12.
Keller TM, Rake A, Michel SCA, et al. Obstetric MR pelvimetry: reference values and evaluation of inter- and intraobserver error and intraindividual variability. Radiology. 2003;227:37-43.
Raman S, Samuel D, Suresh K. A comparative study of X-ray pelvimetry and CT pelvimetry. Aust N Z J Obstet Gynaecol. 1991;31:217-220.
Pattinson RC, Cuthbert A, Vannevel V. Pelvimetry for fetal cephalic presentations at or near term for deciding on mode of delivery. Cochrane Database Syst Rev. 2017;(3):CD000161.
Badr I, Thomas SM, Cotterill AD, et al. X-ray pelvimetry-which is the best technique? Clin Radiol. 1997;52:136-141.
Sharma V, Colleran G, Dineen B, Hession MB, Avalos G, Morrison JJ. Factors influencing delivery mode for nulliparous women with a singleton pregnancy and cephalic presentation during a 17-year period. Eur J Obstet Gynecol Reprod Biol. 2009;147:173-177.
Sibony O, Alran S, Oury JF. Vaginal birth after cesarean section: X-ray pelvimetry at term is informative. J Perinat Med. 2006;34:212-215.
Katanozaka M, Yoshinaga M, Fuchiwaki K, Nagata Y. Measurement of obstetric conjugate by ultrasonic tomography and its significance. Am J Obstet Gynecol. 1999;180:159-162.
Perlman S, Raviv-Zilka L, Levinsky D, et al. 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. J Matern Fetal Neonatal Med. 2019;32:3255-3265.
Bland JM, Altman DG. Applying the right statistics: analyses of measurement studies. Ultrasound Obstet Gynecol. 2003;22:85-93.
Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999;8:135-160.
Drukker L, Droste R, Chatelain P, Noble JA, Papageorghiou AT. Safety indices of ultrasound: adherence to recommendations and awareness during routine obstetric ultrasound scanning. Ultraschall Med. 2020;41:138-145.
Ayres-de-Campos D, Stones W, Theron G, et al. FIGO safe motherhood and newborn health committee. Affordable and low-maintenance obstetric devices. Int J Gynaecol Obstet. 2019;146:25-28.
Ghi T, Eggebø T, Lees C, et al. ISUOG practice guidelines: intrapartum ultrasound. Ultrasound Obstet Gynecol. 2018;52:128-139.
Ghi T, Youssef A, Martelli F, et al. New method to measure the subpubic arch angle using 3-D ultrasound. Fetal Diagn Ther. 2015;38:195-199.
Sherer DM, Abulafia O. Intrapartum assessment of fetal head engagement: comparison between transvaginal digital and transabdominal ultrasound determinations. Ultrasound Obstet Gynecol. 2003;21:430-436.
Youssef A, Salsi G, Cataneo I, et al. Agreement between two 3D ultrasound techniques for the assessment of the subpubic arch angle. J Matern Fetal Neonatal Med. 2016;28:1-5.
Youssef A, Ghi T, Martelli F, et al. Subpubic arch angle and mode of delivery in low-risk nulliparous women. Fetal Diagn Ther. 2016;40:150-155.
Gilboa Y, Kivilevitch Z, Spira M, et al. Pubic arch angle in prolonged second stage of labor: clinical significance. Ultrasound Obstet Gynecol. 2013;41:442-446.
Ghi T, Youssef A, Martelli F, et al. Narrow subpubic arch angle is associated with higher risk of persistent occiput posterior position at delivery. Ultrasound Obstet Gynecol. 2016;48:511-515.
McMaster-Fay RA. Managing the breech presentation at term: the place of pelvimetry. Aust N Z J Obstet Gynaecol. 2015;55:99.
WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: World Health Organization; 2018.
Pavličev M, Romero R, Mitteroecker P. Evolution of the human pelvis and obstructed labor: new explanations of an old obstetrical dilemma. Am J Obstet Gynecol. 2020;222:3-16.
Ferguson JE 2nd, Sistrom CL. Can fetal-pelvic disproportion be predicted. Clin Obstet Gynecol. 2000;43:247-264.
Zaretsky MV, Alexander JM, McIntire DD, Hatab MR, Twickler DM, Leveno KJ. Magnetic resonance imaging pelvimetry and the prediction of labor dystocia. Obstet Gynecol. 2005;106:91926.
Floberg J, Belfrage P, Ohlsén H. Influence of pelvic outlet capacity on labor. A prospective pelvimetry study of 1,429 unselected primiparas. Acta Obstet Gynecol Scand. 1987;66:121-126.
Harper LM, Odibo AO, Stamilio DM, Macones GA. Radiographic measures of the mid pelvis to predict cesarean delivery. Am J Obstet Gynecol. 2013;208(460):e1-e6.
Macones GA, Chang JJ, Stamilio DM, Odibo AO, Wang J, Cahill AG. Prediction of cesarean delivery using the fetal-pelvic index. Am J Obstet Gynecol. 2013;209(431):e1-e8.
Hampel F, Hallscheidt P, Sohn C, Schlehe B, Brocker KA. Pelvimetry in nulliparous and primiparous women using 3 Tesla magnetic resonance imaging. Neurourol Urodyn. 2018;37:1950-1956.