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Re: pelvimetryFrom: Malcolm Griffiths (Malcolm@mgriff22.demon.co.uk)Sat Oct 19 08:19:48 1996
In message <3267EF7E.3E14@anv.net>, Harrison Sheld <hsheld@anv.net> writes >In the beginning, possibly before dirt, therefore definitely before >managed care (but there may be a connection), it was possible during >one's residency to follow patients in labor unencumbered by electronic >gear. Under the guidance of seasoned attending physicians, young doctors >in training could evaluate the capacity of a parturient's pelvis and >eventually predict with reasonable accuracy chances for vaginal >delivery. Thus, clinical pelvimetry came into being as an adjuvent for >those who were trained in it, for anticipating the development of >dystocia. Contrary to what those who have not developed the expertise in >this clinical skill say, it does not replace a trial of labor nor does >it increase the cesarean section rate when used in trained hands because >those people who have been judged to be at high risk for CPD (or FTP) >would be sectioned anyway. I'm not convinced this is true. I wonder if there is any evidence to support this assertion. If such an experienced clinician judges the pelvis inadequate it then becomes a self-fulfilling prophesy. The evidence about X-ray pelvimetry is that the adequacy/inadequacy as derived from pelvimetry are only predictive of outcome where the data were available to clinicians. Where clinicans remain blind to results of ( X-ray ) pelvimetry there is no prognostic value - many babes deliver through "inadequate" pelvises, where clinicians aren't blinded "inadequate" pelvis results in failed trial and higher rate of CS. I strongly suspect the same relationship with clinical pelvimetry.
--
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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