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Re: pelvimetryFrom: Malcolm Griffiths (Malcolm@mgriff22.demon.co.uk)Sat Oct 19 07:59:51 1996
In message <1.5.4.32.19961018020203.006cc2f0@pop.atl.mindspring.com>, "Garry E. Siegel" <garrys@atl.mindspring.com> writes >I would only use pelvimetry for an attempted vaginal breech delivery. Two >questions for the list readers? > >My hospital's radiologists are more in tune with CT pelvimetry (fine by me), >and, in fact, no one can find the Colcher-Sussman forms, or the metal ruler >used for X ray pelvimetry. What are ya'll doing if pelvimetry is needed? >(I'm Atlanta born and bred, and ya'll is not only good english, but *great* >english) > >I have read about the feto-pelvic index, in which a CT is done for >pelvimetry, and a BPD is done by ultrasound. Apparently, you can predict >CPD with this, and I have contemplated, but never used this, for women >desiring VBAC who were sectioned previously for CPD when 10 cm, etc. Does >anyone really use this? > Generally speaking in UK obstetricians are increasinly using MRI in this setting. I think this is deteremined by radiologists who do MRI ( as its "not radiation" ) rather than CT or plain X-ray pelvimetry. ( at least where this is available ) In terms of costs MRI = 2x CT, which in turn is ~ 5x plain X-ray. Theoretically one advantage of CT ( as well as lower radiation ) is the capacity to rotate the image such that the picture is true and non- rotated, my experience is the films ( and thus measurements ) are often rotated and so flawed ! It seems perverse that the callipers on CT/MRI measure to the nearest 1/100 of a cm. This quasi-accuracy gives a misplaced security. Who cares if the inlet is 11.00 or 11.01 ? I often seem to be on my own in suggesting that a single lateral view only allows measurement of the inlet, not the outlet ( as the lateral view gives no real anterior limit to this part of the canal, it being dependent on the sub-pubic angle ). ( If any woman ever gets "FULL PELVIMETRY", with "inlet views" some idiot measures the distance between the ischial tuberosities - finds its less than 10.5cm and so assumes this indicates absolute CPD, whereas the fetal engaging diameter never actually traverses this irrelevant diameter. ) Finally as we rarely know any of the relevant fetal diameters, and even if we did we can't allow for either- * dynamic changes in pelvic diameters ( Mc Robert's manouevre may increase AP diameter of inlet by >2.5cm ); * skull moulding ( in cephalic labours ). Just in case anyone has not guessed I don't do clinical or X-ray pelvimetry EVER !
--
Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt
Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK.
Tel: 01582-497459 (office)
01525-222849 (home)
Fax: 01582-497424
email: Malcolm@mgriff22.demon.co.uk
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