The Anterior Pelvic Index (API) in the Classification of the Female Pelvis and Prediction of Fetopelvic Disproportion / El Índice Pelviano Anterior (API) en la Clasificación de la Pelvis Femenina y Predicción de la Desproporción Fetopélvica

SUMMARY: Measurements of the upper strait of the pelvis can be calculated using the Anterior Pelvic Index. The objective of the study was to determine the external validity and cut-off point of the API, to classify narrow pelvises from normal ones. We selected 214 women from 15 to 55 years old, 171 had vaginal delivery and 43 by caesarean section by feto-pelvic disproportion (FPD) of maternal origin, in whom the API was calculated, of which its mean difference was established with an alpha error of <0.05. Maximum values of sensitivity and specificity, ROC curve and Youden index were determined. The student's t gave a p-value =0.000 of the mean difference between the women who had vaginal delivery and those who had cesarean section by FPD of maternal origin; the value of the area under the ROC curve was 0.758 (CI 95% 0.695 - 0.814) with a p-value=0.0001. Maximum sensitivity was 74.42 % (CI 95%: 58.8 % to 86.5 %) and maximum specificity was 73.10 % (CI 95%: 65.8 % to 79.6 %), produced a Youden index of 0.475 (CI 95% 0.283 - 0.590) which is associated with the 15.44 (CI 95% 14.19 - 15.83) of the API scale. The API is a good tool for predicting women with suspected narrow pelvis and allows its classification into three types of pelvises: an API value of more than 15.83 would indicate pelvis suitable for vaginal delivery; an API value between 14.19 and 15.83 would be suspected of pelvic narrowness; an API value less than 14.19 would confirm a narrow pelvis.

Las medidas del estrecho superior de la pelvis pueden calcularse mediante el Índice Pelviano Anterior. El objetivo del estudio fue determinar la validez externa y el punto de corte del API, para clasificar pelvis estrechas de las normales. Seleccionamos 214 mujeres de 15 a 55 años, 171 tuvieron parto vaginal y 43 mediante cesárea por DFP de origen materno, en quienes se calculó el API, del cual se estableció su diferencia de medias con un error alfa de <0,05. Se determinaron valores máximos de sensibilidad y especificidad, curva ROC e índice de Youden. La t de Student dio un p-valor=0,000 de la diferencia de medias entre las mujeres de tuvieron parto vaginal y las que fueron sometidas a cesárea por DFP de origen materno; el valor del área bajo la curva ROC fue 0,758 (IC 95% 0,695 - 0,814) con un p- valor=0,0001. La máxima sensibilidad (74,42 %. IC 95%: 58,8 % a 86,5 %) y máxima especificidad (73,10 %. IC 95%: 65,8 % a 79,6 %), produjeron un índice de Youden de 0,475 (IC 95% 0,283 - 0,590) el cual está asociado al valor 15,44 (IC 95% 14,19 - 15,83) de la escala del API. El API es una buena herramienta de predicción de mujeres con sospecha de pelvis estrecha y permite su clasificación en tres tipos de pelvis: un valor de API de mas de 15,83 indicaría pelvis aptas para un parto vaginal; un valor de API entre 14,19 y 15,83 se sospecharía de estrechez pélvica; un valor de API menor a 14,19 confirmaría una pelvis estrecha.

Linear measurement of digital pelvic of normal Tibetan nationality female in Lhasa / 解剖学报

Objective To explore the range of normal female pelvic diameter lines in Tibetan nationality. Methods The subjects were Tibetan nationality female who underwent pelvic CT examination in the Radiology Department from January 2016 to December 2019 at the General Hospital of the Tibet Military Region of PLA. Ninty-six samples between the ages of 22 and 65 years, with an average age (46.06±11.42)years were recruited. Mimics 19.0 software was used to construct the digital three-dimensional model of pelvis, and to measure transverse diameter(TD), obstetric conjugate(OC), interspinous distance(ISD), sagittal midpelvic diameter(SMD), intertuberous distance(ITD), sagittal outlet diameter(SOD),diagonal conjugate diameter(DCD),sacrum length(SL), penal height(PH).Analysis of variance was used to compare different age groups, and Pearson correlation analysis was used to analyze the relationship between age and pelvic diameter. Results The linear measurement of TD was (132.08±6.15) mm, OC was (112.44±9.43) mm, ISD was (107.30±8.70), SMD was (129.06±7.73) mm, ITD was (123.02±12.08) mm, SOD was (118.80±8.87) mm, DCD was (127.49±9.80) mm, SL was (102.56±10.88) mm and PH was (36.57±4.57) mm.Cluster analysis showed that Lhasa Tibetans were closest to Uygurs. Conclusion The close clustering relationship between Tibetans and Uygurs in Lhasa suggests that there is a possibility of gene exchange between Tibetans and Uygurs in Hotan area in ancient times. The pelvic diameter of Tibetan women in Lhasa has changed significantly. Narrower OC, SL and PH make the pelvis flat, which is more and more detrimental to natural childbirth.

Pelvimetric characteristics in agoutis (Dasyprocta prymnolopha) bred under human care / Características pelvimétricas em cutias (Dasyprocta prymnolopha) criadas sob cuidados humanos

The aim of the study was to establish the pattern of the agouti pelvis by obtaining external and radiographic internal pelvimetric values. Forty-three agouti (Dasyprocta prymnolopha), females and males bred in under human care were used. The parameters measured were the external biiliac diameter; the external biischiatic diameter; right and left external ilioischiatic diameters and radiographic internal measurements (true conjugated, the diagonal conjugated; the vertical, the sacral, sagittal, coxal tuberosity, upper biiliac, lower biiliac, and biischiatic diameter. The inlet pelvic area and the outlet pelvic area were calculated, as well the height/width ratios of the entrance area of the pelvis and the pelvic outlet area were calculated. The mean values for each body measurement of females and males were: weight 1.91kg and 2.04kg, external biiliac diameter 6.32cm and 6.30cm, external biischiatic diameter 4.34cm and 4.28cm, right external ilioischiatic diameter 9.01cm and 9.33cm, left external ilioischiatic diameter 9.13cm and 9.30cm, true conjugated 3.90cm and 3.68cm, diagonal conjugated 7.13cm and 6.91cm, vertical diameter 2.59cm and 2.45cm, sacral diameter 2.63cm and 2.44cm, sagittal diameter 3.30cm and 3.09cm, coxal tuberosity diameter 2.52cm and 2.43cm, upper biiliac diameter 6.28cm and 6.24cm, lower biiliac diameter 2.98cm and 2.58cm, biischiatic diameter 2.60cm and 2.70cm, height/width ratio - vertical/ lower biiliac diameter 0.88cm and 0.95cm, sagital/coxal tuberosity diameter 1.32cm and 1.28cm, inlet pelvic area 82.38cm and 77.83cm and outlet pelvic area 24.76cm and 20.07cm. Agouti are dolichopelvic animals, demonstrating the existence of a discrete sexual dimorphism in adults and low intensity correlations between the external and internal measures studied.

O objetivo deste estudo foi estabelecer o padrão da pelve de cutia, masculina e feminina, por meio da obtenção dos valores médios da pelvimetria externa e interna radiográfica. Foram utilizadas 43 cutias (Dasyprocta prymnolopha), fêmeas e machos criadas sob cuidados humanos. Os parâmetros medidos foram o diâmetro biilíaco externo; o diâmetro biisquiático externo; diâmetros ilioisquiáticos externos direito e esquerdo e medidas internas radiográficas (diâmetros conjugado verdadeiro, diagonal conjugado, vertical, sacral, sagital, tuberosidade coxal, biilíaco superior, biilíaco inferior e diâmetro biisquiático). A área pélvica de entrada e a área pélvica de saída foram calculadas , assim como foram calculadas as razões altura/largura da área de entrada da pelve e da área de saída da pelve. Os valores médios para as medidas das fêmeas e dos machos foram, respectivamente: peso 1,91kg e 2,04kg, diâmetro biilíaco externo 6,32cm e 6,30 cm, diâmetro ilioisquiático externo 4,34cm e 4,28cm, diâmetro ilioisquiático externo direito 9,01cm e 9,33cm, diâmetro ilioisquiático externo esquerdo 9,13cm e 9,30cm, diâmetro conjugado verdadeiro 3,90cm e 3,68cm, diâmetro conjugado diagonal 7,13cm e 6,91cm, diâmetro vertical 2,59cm e 2,45cm, diâmetro sacral 2,63cm e 2,44cm, diâmetro sagital 3,30cm e 3,09cm, tuberosidade coxal diâmetro 2,52cm e 2,43cm, diâmetro biilíaco superior 6,28cm e 6,24cm, diâmetro biilíaco inferior 2,98cm e 2,58cm, diâmetro biisquiático 2,60cm e 2,70cm, relação altura/largura - vertical/diâmetro biilíaco inferior 0,88cm e 0,95cm, diâmetro sagital/coxal tuberosidade 1,32cm e 1,28cm, área pélvica de entrada 82,38cm e 77,83 cm e área pélvica de saída 24,76cm e 20,07cm. As cutias são animais dolicopélvicos, demonstrando a existência de um discreto dimorfismo sexual em adultos e correlações de baixa intensidade entre as medidas externas e internas estudadas.

Pelvimetry of multiparous Nellore cows in the cycling and early puerperal stages / Pelvimetria de vacas pluríparas da raça Nellore em estágio cíclico e início do puerpério

Pelvis is an osteoligamentous complex, which is classified as dolichopellic in ruminants. Impairments linked to incompatibility of pelvic canal and fetal size is directly related to pelvic anatomy and disposition. Heritability of pelvic area characteristics varies from moderate to high, demonstrating its importance for animal selection. Pelvimetry can be performed through direct and indirect methods that were accessed in this study aiming to establish a correlation between internal and external pelvic dimensions in multiparous Nellore cows (26 animals) at cycling and early puerperal (up to 30 days postpartum) reproductive stages. Pelvic dimensions measured by descriptive analysis were higher at early puerperal stage. Strong Pearson's correlation was determined between internal and external pelvic dimensions, between reproductive stages, and between pelvic girdle area and internal pelvic area. Significant Tukey's test differences between animals in internal and external dimensions were also found. According to the results, the pelvic anatomy of Nellore cows varies according to their reproductive stage. We detach that and provide data regarding the use of internal pelvic area for animal selection studies on this breed is determined and should be measured using the proposed formula, since it can confirm statistical differences in the areas of pelvic components between animals in the cycling and early puerperal stages.(AU)

A pelve é considerada um complexo osteoligamentoso, classificada como dolicopélvica em ruminantes. Prejuízos ligados à incompatibilidade canal pélvico/tamanho fetal relacionam-se diretamente à anatomia e disposição pélvica. A característica de área pélvica apresenta herdabilidade variando de moderada a alta, indicando sua importância na seleção animal. A pelvimetria inclui formas direta e indireta. Neste estudo utilizaram-se vinte e seis vacas multíparas, da raça Nelore, agrupadas de acordo com o estágio reprodutivo, cíclico e em início de estágio puerperal (até 30 dias pós-parto). Através deste, objetivou-se evidenciar a relação das medidas pélvicas internas e externas nos diferentes períodos reprodutivos e coletar obter dados referentes a utilização da área interna do hexágono no estudo pelvimétrico dessa espécie em estágio cíclico ou puerperal. Para tanto, realizou-se, a pelvimetria direta e indireta. Os resultados obtidos, pela análise descritiva, foram maiores para animais em início de estágio puerperal. Por meio da correlação de Pearson podem-se observar fortes correlações entre mensurações pélvicas internas e externas, também entre os grupos propostos, e forte correlação entre elipse pélvica e área interna do hexágono. Pelo teste Tukey diferenças significativas tanto em medidas internas e externas puderam ser demonstradas. Conclui-se que as condições anatômicas da pelve variam de acordo com o estágio reprodutivo do animal, que aferição da área pélvica utilizando a formula proposta para área do hexágono interno é relevante pois foi possível comprovar a diferenças estatísticas de áreas nas fases cíclica e puerperal.(AU)

Changing pelvic incidence with the anatomical morphology during adolescence / 中华骨科杂志

Objective To evaluate the changing pattern of pelvic incidence (PI) during peak skeleton growth in adolescence and to study whether PI is associated with the anatomical morphology changes of pelvis and sacrum.Methods This retrospective longitudinal study recruited adolescent idiopathic scoliosis (AIS) patients,age between 9 and 18 years with full spine images and have at least 3 times' follow-up.The radiological anatomical parameters were measured in each follow-up including PI,pelvic height (PH),pelvic width (PW),sacral width (SW),femoral head-sacrum (FH-S),sacrum-coccyx (S-C) length,sacrum-coccyx (S-C) distance and sacral curvature ratio.△Parameter and growth velocity of each parameters were calculated.According to the skeletal maturity,all subjects were divided into 3 groups:Low Risser Group (first visit at Risser 0 and follow up through Risser 0 to 1),Moderate Risser Group (first visit at Risser 1 and follow up through Risser 1 to 3) and High Risser group (first visit at Risser 3 and follow up through Risser 3 to 5).Each group has 106 patients.We increased the male ratio to detect the gender difference.A total of 318 AIS patients were included in our study and there are 117 male patients.Descriptive analysis was conducted on the sample age,gender and measured parameter values with mean and standard deviation (SD).The intra-and inter-observer reliability analysis,and the intraclass correlation coefficient (ICC) were calculated.The correlation between △PI and △parameter was evaluated by calculating Pearson correlation coefficient R value.Results The mean age of all subjects was 12.86 years and the mean Cobb angle was 26.67° at first visit.The peak growth velocity of PI was in Risser I (female 1.5°/year and male 1.6°/year).The PI was also increasing rapidly in Risser 0.5 (female 1.2°/year and male 1.5°/year) and Risser 2 (female 1.1°/year and male 1.4°/year).When the Risser grade reached 3 which was a sign of the end of skeleton growth,the PI still had increasing potential and it increased slower in Risser 4 and Risser 5.There showed significant correlation between △PI and △age in the three group(P＜0.05)and the correlation was stronger in Low Risser group and Moderate Risser group than that in High Risser group.There showed significant correlation between △PW and △PI in all groups while △PH and △PI showed correlation only in Low Risser group.There showed significant correlation between △SW and △PI,△FH-S and △PI,△S-C length and △PI (P＜0.05) except △S-C length in male Low Risser group and △FH-S in female High Risser group and the Moderate Risser group had the strongest correlation.The △S-C distance and △S-C ratio didn't show any correlation with △PI (P＜0.05) expect the male of High Risser group.Conclusion Pelvic incidence is increasing during skeleton growth at the age of 9 to 17.It has the peak growth velocity in Risser 1 and remains growth potential in Risser 5.PI growth is correlated with pelvic height,femoral head-sacrum distance,pelvic width and sacral width.

Pelvimetry in Squirrel Monkeys (Saimiri scireus Linnaeus, 1758) / Pelvimetria em macacos-de-cheiro (Saimiri scireus Linnaeus, 1758)

Saimiri sciureus is a neotropical primate widely used in research. However, there are still difficulties regarding their reproduction in vivaria due to the high incidence of dystocia. Dystocia in primates can be caused by cephalopelvic disproportion and in Squirrel Monkeys, pregnancy of large fetuses were reported. This paper describes pelvimetry data of adult females and subadults in specimens of Squirrel Monkeys, from a research colony of Para, Brazil. Pelvic radiographs were obtained in ventrodorsal projections and the following measurements were taken: superior bi-iliac diameter (SBID); inferior bi-iliac diameter (IBID); bi-iliac average diameter (BIAD); right diagonal diameter (RDD); left diagonal diameter (LDD); sacro-pubic diameter (SPD); Based on the obtained diameters, the entrance area of the pelvis (EAP) was also calculated. The average values of the pelvic diameters and EAP in adult females were SBID 1.714cm, BIAD 1.957cm, IBID 1.686cm, RDD 2.771cm, LDD 2.764cm, SPD 2.543cm and EAP 3.9056cm2; and subadult females: 1.588cm SBID, 1.850cm BIAD, 1.625cm IBID, 2.50cm RDD, LDD 2.474cm, 1.95cm SPD and 2.8293 cm2 EAP. Saimiri sciureus pelvis is characterized as dolichopelvic. There was statistical significance between the values for adult females and subadults to SBID, BIAD, RDD, LDD, SPD and EAP. The values of SBID and IBID were lower when compared to the published data for the same species. The result found on this paper will serve as a basis for future studies using pelvic measurements and dystocia prediction of neotropical primates and comparison between different vivaria.(AU)

Saimiri sciureus é uma espécie de primata neotropical muito utilizada como animal de pesquisa. No entanto ainda há dificuldades em biotérios quanto a sua reprodução devido à alta ocorrência de distocia. A distocia em primatas pode ter origem devido à desproporção cefalopélvica, sendo que em macacos-de-cheiro é relatada a gestação de fetos grandes. O presente trabalho descreve dados de pelvimetria em espécimes de macaco-de-cheiro, fêmeas adultas e subadultas provenientes de uma colônia de pesquisa do Pará, Brasil. Foram realizadas radiografias da pelve em projeção ventrodorsal e por meio destas mensurados os diâmetros biilíaco superior (DBIS); diâmetro biíliaco inferior (DBII); diâmetro biilíaco médio (DBIM); diâmetro diagonal direito (DDD); diâmetro diagonal esquerdo (DDE); diâmetro sacro-púbico (DSP); com base nos diâmetros obtidos também foi calculada a área de entrada da pelve (AEP). Os valores médios dos diâmetros pélvicos e da AEP em fêmeas adultas foram: DBIS 1,714cm, DBIM 1,957cm, DBII 1,686cm, DDD 2,771cm, DDE 2,764cm, DSP 2,543cm e AEP 3,9056cm2; e para fêmeas subadultas: 1,588cm DBIS, 1,850cm DBIM, 1,625cm DBII, 2,50cm DDD, 2,474cm DDE, 1,95cm DSP e 2,8293 cm2 AEP. Observou-se que a pelve de Saimiri sciureus é dolicopélvica. Houve diferença estatística significativa entre os valores para fêmeas adultas e subadultas para DBIS, DBIM, DDD, DDE, DSP e AEP. Em comparação com dados da literatura de pelvimetria para S. sciureus observaram-se menores valores de DBIS e DBII. O resultado deste trabalho servirá como base para futuros estudos utilizando-se mensurações pélvicas e predição de distocia em primatas neotropicais e referência para comparação entre S. sciureus de diferentes biotérios.(AU)

S2 alar-iliac screwing assisted by an individualized navigation template / 中华创伤骨科杂志

Objective To evaluate the accuracy and feasibility of S2 alar-iliac screwing assisted by an individualized navigation template in clinic.Methods Five patients underwent S2 alar-iliac screwing from March 2015 to July 2017.They were 2 men and 3 women,aged from 41 to 61 years (average,54.8 years).After their preoperative CT scan data of the pelvis were used for 3D reconstruction,their individualized navigation templates were designed,3D printed and used to assist the implantation of S2 alar-iliac screws.After operation,their postoperative CT data were reviewed and reconstructed using software Mimics.The caudal angulation on the sagittal plane (sagittal angle,SA),lateral angulation on the transverse plane (transverse angle,TA),horizontal distance to the median sacral crest (horizontal distance,HD),and vertical distance to the first posterior sacral foramen's inferior margin (vertical distance,VD) of the screws were measured and compared with the corresponding values in the preoperative design.Results In the 5 patients,altogether 10 S2 alar-iliac screws were implanted through the sacroiliac joint without piercing the iliac bone cortex.There were no significant differences between the preoperative design and postoperative measurements in terms of SA (32.22°±5.57° versus 31.95°±5.78°),TA (42.59°±4.55° versus 42.21°± 5.29°),HD (5.04 ± 0.40 mm versus 5.00 ± 0.41 mm) orVD (19.58 ± 1.49 mm versus 19.54±1.12 mm) (P ＞ 0.05).Conclusion In the adult pelvic fixation,the S2 alar-iliac screwing can be assisted by an individualized navigation template to achieve high accuracy in implantation.

Age-related trends of lesser pelvic architecture in females and males: a computed tomography pelvimetry study / 대한해부학회지

The pelvis and the spine form a system balancing human skeleton. Within this system, the pelvis adapts to age-related changes in the spine. Previous studies were predominantly focused on changes of pelvic parameters in the sagittal plane. The aim of this study was to reveal age-related changes of lesser pelvic dimensions at different levels of the pelvic cavity in the sagittal and coronal planes and to explore sexual dimorphism in age-related tendencies. The computed tomography pelvimetry was performed on the three-dimensional workstation. The research sample included 211 females aged 18 to 84 years and 181 males aged 18 to 82 years, who underwent an examination at the Riga East University Hospital, Clinical Center “Gailezers,” Latvia. Three pelvic angles and transverse and sagittal diameters of the lesser pelvis were measured at four levels: the inlet, two axial planes in the mid-cavity, and the outlet. The results demonstrated that more pronounced age-related changes occurred in the inlet and the outlet of the lesser pelvis. The mid-cavity was less changing. The transverse diameter between acetabular centers and the sagittal diameter at the level of ischial spines were independent of age. In general, the common age-related trends were observed for pelvic parameters in females and males. A single exception was the proportion of diameters at the level of ischial spines, which decreased in males only. For parameters associated with pelvic floor diseases, age-related changes occurred in the direction of pathology.

Determination of anterior pelvic index (API) to predict a narrow pelvis in adolescent girls / Determinación del índice de pelviano anterior (API) para predecir pelvis estrecha en adolescentes

Cephalopelvic disproportion in the pelvic inlet is a maternal risk factor in childbirth. A high number of dystocias are attended as emergencies and end in cesarean sections because there is no way to diagnose a narrow pelvis early on, a determination which would be easy to perform and at no cost to the patient. The aim of this study was to determine the Anterior Pelvic Index (API) as a predictive estimator of the obstetric conjugate diameter to differentiate narrow and normal pelvises. The study was conducted with 200 adolescent girls aged 14 to 19 years, from Quito, Ecuador; the parents signed the informed consent and the girls agreed to take part. The interspinous distance, height and obstetric conjugate diameter were measured by ultrasonography. Then the API was calculated and the predictive value of the obstetric conjugate diameter was obtained by simple linear regression. The average API value was 14.8 (CI 95 % 14.75 to 14.86) with a minimum value of 13.99 and a maximum value of 19.92. The association between the API and the obstetric conjugate diameter measured by ultrasonography produced a Pearson's correlation value of 0.543 (p=0.000). The simple linear regression test between the API and the obstetric conjugate diameter measured by ultrasonography was statistically significant. Therefore, it was determined that the prediction of the obstetric conjugate diameter, having the API as a predictor, can be calculated with the following formula:y=4.38+0.45*x and thus a possible narrow pelvis can be anticipated.

La desproporción feto-pélvica se puede producir en el estrecho superior de la pelvis, constituyéndose en un factor materno de riesgo en el parto. Un elevado número de partos distócicos son atendidos de emergencia y terminan en cesárea debido a que no existe un método de diagnóstico precoz de la estrechez pélvica, que sea fácil de realizar y sin costo para el paciente. El objetivo fue determinar el Índice Pelviano Anterior (API) como estimador predictivo del diámetro conjugado obstétrico para diferenciar pelvis estrechas y normales. El estudio fue realizado con 200 mujeres adolescentes de 14 a 19 años, de Quito, Ecuador, quienes cumplieron con la firma del consentimiento informado de los padres y el asentimiento de ellas. Se les midió la distancia interespinosa, la talla y el diámetro conjugado obstétrico ecográfico. Luego se calculó el Índice Pelviano Anterior y, mediante regresión lineal simple, se obtuvo el valor de predicción del diámetro conjugado obstétrico. El valor promedio del Índice Pelviano Anterior (API) fue de 14.8 (IC 95 % 14.75 a 14.86) con un valor mínimo de 13.99 y un valor máximo es de 19.92. La asociación entre el API y el diámetro conjugado obstétrico ecográfico produjo un valor de correlación de Pearson de 0.543 (p=0.000). La prueba de regresión lineal simple entre el PAI y el diámetro conjugado obstétrico ecográfico fue estadísticamente significativo. Por lo tanto, se determinó que la predicción del diámetro conjugado obstétrico, teniendo como predictor al PAI, se calculará con la siguiente fórmula : y=4.38+0.45*x y con ello se podrá pronosticar una eventual estrechez pélvica..

Pelvimetry by reformatted computed tomography in 290 female pelvis: morphometric variations regarding age / Pelvimetría mediante tomografía computadorizada reformada sobre 290 pelvis femeninas: variaciones morfométricas de acuerdo a la edad

The Mexican government passed a new reform of article 11 of the General Law in 2014 regarding Women's Access to a Life Free of Violence, which states that a cesarean section may not be performed if a vaginal birth is viable. Cesarean sections are excessively indicated in Northen Mexico, using the diagnosis of cephalopelvic disproportion due to a narrow pelvis. Currently, there is no standardized morphometry of the female pelvis in a Mexican population to establish adequate diagnostic parameter. Our study measures the pelvic diameters of the birth canal using abdominopelvic computed tomography (CT). Two hundred and ninety CT from Mexican women between the ages of 18 and 50 were collected and 3D reformatted in order to morphologically measure the pelvic diameters of clinical relevance. Measurements were conducted by two diagnostic imaging specialists. The mean and standard deviation of the measured diameters were: anatomical conjugate diameter (ACD) 11.65±0.99 cm, the obstetric conjugate diameter (OCD) 11.73±0.98 cm, diagonal conjugate diameter (DCD) 12.49±0.98 cm and Interspinous distance (ISD) 10.41±0.78 cm. Significant differences were found in all four mean diameters in between the 20­29 age groups versus the >40, as well as between the 30­39 groups versus the >40. Our study shows that as Mexican women get older, the mean pelvic diameters become narrower.

El Gobierno mexicano aprobó una nueva reforma del artículo 11 de la Ley General del 2014, relativa al acceso de las mujeres a una Vida Libre de Violencia, que establece que una cesárea no se puede realizar si un parto vaginal es viable. Los partos por cesárea son indicados excesivamente en el norte de Mexico, con el diagnóstico de desproporción céfalo-pélvica debido a una estrechez de la pelvis. Actualmente, no existe una morfometría estandarizada de la pelvis femenina en una población mexicana para establecer parámetros de diagnóstico adecuado. Nuestro estudio mide los diámetros pélvicos del canal de parto mediante tomografía compudotarizada (TC) abdomino-pélvica. Se usaron 290 TC de mujeres mexicanas entre 18 y 50 años, los que fueron reformateados en 3D para medir morfológicamente los diámetros pélvicos de relevancia clínica. Las mediciones fueron realizadas por dos especialistas en diagnóstico por imagen. La Media y DE de los diámetros medidos fueron: diámetro anatómico conjugado (DAC) 11,65±0,99 cm, diámetro obstétrico conjugado (DOC) 11,73±0,98 cm, diámetro diagonal conjugado (DDC) 12,49±0,98 cm y distancia interespinosa (DIE) 10,41±0,78 cm. Se encontraron diferencias significativas en las Medias de los cuatro diámetros entre los grupos de 20­29 años de edad frente a las >40 años, así como entre los grupos de 30­39 años frente a los >40 años. Nuestro estudio muestra que a medida que las mujeres mexicanas avanzan en edad, los diámetros pélvicos medios son más estrechos.

The influence of age and subluxation degree on pelvic parameters in patients with degenerative lumbar spondylolisthesis / 中国医师进修杂志

Objective To study the influence of age and subluxation degree on pelvic parameters in patients with degenerative lumbar spondylolisthesis.Methods One hundred and eighteen patients with degenerative lumbar spondylolisthesis (L4) were selected.The patients were divided into 3 groups according to age:group Ⅰ 38 cases,age ＜ 35 years;group Ⅱ 43 cases,age 35-50 years;and group Ⅲ 37 cases,age ＞ 50 years.The severity degree of subluxation (Meyerding degree) and sagittal pelvic parameters including pelvic incidence (PI),sacrum slope (SS) and pelvic tilt (PT) were measured according to lateral X-ray film.The sagittal pelvic parameters were compared among different age and subluxation degree.Results There were no statistical difference in PI,SS and PT among the different age (P ＞ 0.05).Meyerding Ⅰ degree was in 86 cases,and Meyerding Ⅱ degree was in 32 cases.There was no statistical difference in PI between Meyerding Ⅰ degree and Meyerding Ⅱ degree (P ＞ 0.05).The SS in Meyerding Ⅱ degree was significantly higher than that in Meyerding Ⅰ degree:(48.2 ± 4.0)° vs.(40.4 ± 3.5)°,and there was statistical difference (P＜ 0.05).But the PT in Meyerding Ⅱ degree was significantly lower than that in Meyerding Ⅰ degree:(17.3 ± 2.1)° vs.(26.6 ± 3.5)°,and there was statistical difference (P ＜ 0.01).Conclusion In patients with degenerative lumbar spondylolisthesis,the age and subluxation degree can not affect the PI,but the subluxation degree increasing can decrease PI and increase SS.

A Single Institution Study of Attitudes of Primigravidae to Routine Clinical Pelvimetry.

Background: Pelvimetry is a poor predictor of obstetric outcome. The predictive value of clinical pelvimetry remains limited except in extreme pelvic contracture or an excessively large fetus. Objective: To determine the attitudes of primigravidae to routine clinical pelvimetry. Subjects and Methods: This was a cross-sectional study of primigravidae at the University of Nigeria Teaching Hospital (UNTH), Enugu between January 1st and December 31st, 2009. Selfadministered, structured, and pre-tested questionnaires were distributed to the consenting selected women by trained medical interns. Data was analyzed using SPSS version 16. P< 0.05 was considered statistically significant. Results: A total of 195 primigravidae were selected at random for this study. One hundred and thirty eight primigravidae (138/195, 70.77%) were aware of clinical pelvimetry while 29.23% (57/195) were not aware of clinical pelvimetry. One hundred and twenty five primigravidae (90.58%, 125/138) desired clinical pelvimetry to continue while thirteen (9.42%, 13/138) did not desire clinical pelvimetry to continue. There was statistically significant difference between those who were aware and unaware of pelvimetry in their desire for pelvimetry [X2=18.903, p=0.0001, OR 5.2, 95% confidence interval=2.20 to 12.44]. Conclusion: There is profound awareness and the desire to continue clinical pelvimetry among primigravidae at the UNTH, Enugu, Nigeria, where majority of the women showed strong preference for it.

Análisis descriptivo de la asimetría pélvica en una población asintomática / Descriptive analysis of pelvic asymmetry in an asymptomatic population

Introducción: La inclinación pélvica es evaluada clínicamente por su relación con patologías espinales. Pero hay pocas evidencias sobre la población asintomática para comparaciones. Objetivo: Analizar una población asintomática según las asimetrías pélvicas por fotogrametría. Material y métodos: 92 sujetos (18-35 años) fueron marcados en las espinas ilíacas anteriores y posteriores y fotografiados. El software Alcimage midió el ángulo de báscula pélvica. La normalidad probada por Kolmogorov; la prueba t y Wilcoxon para comprobar diferencias, la correlación medida por el coeficiente Pearson. Resultados: De los varones, 11.96% presentaran anteversión y 34.78% normalidad. De las mujeres, 38.04% anteversión y 15.22% normalidad. Los ángulos entre ilíacos para báscula bilateral no presentaron diferencia, pero hubo diferencia con predominancia de lado. Para báscula unilateral hubo diferencia entre ilíacos. Hubo buena correlación de predominancia versus anteversión y pobre para los ángulos de perfil. Los demás, débiles o sin significancia. Conclusión: La báscula no puede ser usada individualmente para caracterización de disfunción o patología pélvica.

Introduction: Pelvic tilt is clinically assessed based on its relationship with spinal conditions, but there is little evidence from the asymptomatic population for comparison purposes. Objective: To analyze an asymptomatic population focusing on pelvic asymmetries using photogrammetry. Material and methods: 92 subjects (18-35 years old) underwent marking of the anterior and posterior iliac spines and were photographed. Alcimage software was used to measure the pelvic tilt angle. Other tests included: the Kolmogorov normality test, t test, Wilcoxon test, and Pearson coefficient to measure the correlation. Results: 11.96% of males had anteversion and 34.78% normality; 38.04% of females had anteversion and 15.22% normality. Angles between iliacs for bilateral tilt showed no difference, but a difference was seen with the predominance of one side. For unilateral tilt a difference between iliacs was seen. Good correlation of predominance versus anteversion was observed, and correlation was poor for side angles. The rest showed a weak or non-significant correlation. Conclusion: Tilt cannot be used individually to characterize pelvic dysfunction or pathology.

Correlation between sagittal spinal and pelvic parameters in degenerative lumbar scoliosis / 中华骨科杂志

Objective To investigate the correlation between sagittal spinal and pelvic parameters in different types of degenerative lumbar scoliosis (DLS).Methods Standing anteroposterior and lateral radiographs of the whole spine including hip joints were carried out in 70 volunteers without spinal deformity and 110 patients with DLS.The following parameters were measured:thoracic kyphosis (TK),thoracolumbar kyphosis (TL),lumbar lordosis (LL),sagittal vertical axis (SVA),pelvic incidence (PI),pelvic tilt (PT) and sacral slope (SS).According to the sagittal spinal alignment,the patients with DLS were classified into 3 types:type Ⅰ (45 cases),type Ⅱ (48 cases) and type Ⅲ (17 cases).The sagittal spinal and pelvic parameters were compared between control group and different types of DLS group,and the relationship between the sagittal spinal parameters and pelvic parameters in different groups were also investigated.Results PI in type Ⅲ patients was lower than those in other groups; PT in type Ⅱ and Ⅲ patients was higher than those in controls and type Ⅰ patients,and there was a significant difference between type Ⅱ and Ⅲ patients; SS in type Ⅱ and Ⅲ patients was lower than those in controls and type Ⅰ patients,and there was no significant difference between type Ⅱ and Ⅲ patients.Sagittal spinal imbalance was found in 17.8％ of type Ⅱ patients and 29.4％ of type Ⅲ patients.There were significant correlations in sagittal spinal parameters,pelvic parameters and spinopelvic parameters in controls and type Ⅰ patients.However,in type Ⅱ and Ⅲ patients,the correlations in sagittal spinal parameters and spinopelvic parameters decreased,even disappeared,though significant correlations were still found in pelvic parameters.In any group,SVA showed a significant correlation with LL and PT,especially with PT.Conclusion The sagittal spinal alignment has a ladder-like change in patients with DLS,and the correlations in pelvic parameters and spinopelvic parameters also change in type Ⅱ and Ⅲ patients,for whom the sagittal spinal imbalance is more likely to occur.

Clinical study on pubococcygeal line determined by dynamic magnetic resonance imaging used in evaluating pelvic organ prolapse / 中华妇产科杂志

Objective To investigate clinical value of pubococcygeal line (PCL) determined by dynamic magnetic resonance imaging (MRI) used in evaluating pelvic organ prolapse (POP), and investigate the relationship of pelvic organ prolapse quantitation (POP-Q) stage and pubococcygeal line (PCL) for the patient with POP. Methods Twenty patients with POP were evaluated by POP-Q stage and pelvic dynamic MRI examination simultaneously. Sagittal MRI images were acquired at rest and during maximal Valsalva using a fast gradient echo sequence two-dimensional fast low angle shot (FLASH) T1weighted image. The degree of prolapsed anterior vaginal wall, uterus and posterior vaginal wall were measured by PCL and compared with POP-Q system. Results There were 20 cases with cystocel diagnosed by POP-Q staging system, in which bladder neck or bladder base of 17 patients were under the PCL during maximum Valsalva. The concordance rate was 85% (17/20) between PCL and POP-Q stage. There were 19cases with rectocele diagnosed by POP-Q, in which the anorectal junction of 4 patients' PCL descent below more than 2. 5 cm. The concordance rate was 4/19 between PCL and POP-Q stage. There were 14 cases with uterine prolapse diagnosed by POP-Q staging system, in which uterine cervix of all descent below PCL. The concordance rate was 14/14 between PCL and POP-Q stage. However, it was noted that 5 cases did not reach POP-Q staging and their lowest uteri cervix were below or above PCL but less than 1 cm at maximal Valsalva. Conclusions Compared with POP-Q staging system, the reference line of PCL determined by dynamic MRI could diagnose uterine prolapse accurately and anterior vaginal wall with greater clinical value,however it was limited in diagnosing posterior vaginal wall prolapse effectively. Therefore, the clinical value of PCL should be further studied for evaluating POP.

Analysis of Factors Affecting the Degree of Difficulty in Total Mesorectal Excision for Rectal Cancer: Investigation of the Factors Affecting Incomplete Resection and the Resection Time

PURPOSE: The aim of this study was to estimate the degree of difficulty in total mesorectal excisions (TMEs) for rectal cancer by using statistical methods after analysis of factors affecting the resection time and incomplete resection. METHODS: A total of 63 patients who underwent a total mesorectal excision for rectal cancer were evaluated. MRI pelvimetry data {(transverse diameter (TD), obstetric conjugate (OC), interspinous distance (ID), sacrum length (SL), sacrum depth (SD)}, tumor size (TS), T stage, and body mass index (BMI) were prospectively analyzed. A stepwise multiple regression analysis was performed to determine the operating time prediction equation by using these variables, and the differences in the mean operating time hased on gross evaluations of each specimen were analyzed. RESULTS: A stepwise multiple regression with the operating time as a dependent variable led to the following equation: Operation time (min)=35.726-2.162xTD (cm)-2.324 x OC (cm) + 2.671 x SL (cm) + 1.274 x TS (cm), with r2=0.533 and SEE=5.438. The mean operating time according to a gross evaluation of the TME specimen was 20.0 +/- 7.3 min in complete TME cases (n=42) and 27.9 +/- 7.2 min in incomplete TME cases (n=21) (P<0.001). CONCLUSIONS: MRI pelvimetry data (TD, OC, SL) and tumor size were factors affecting the operation time in TMEs for rectal cancer, and the operating time could be predicted by using the equation of the present study. Also, the mean operating time in incomplete TME cases was longer than that in complete TME cases. Thus, the degree of difficulty of an operation for rectal cancer can be predicted by using these factors.

The methods and clinical values of obstetric conjugata measured by ultrasonography / 中华超声影像学杂志

Objective To evaluate the methods and predictive values of obstetric conjugata measured by ultrasound.Methods A total of 200 women at 37～42 week's gestation,delivering a singleton infant and having an ultrasound examination within three days before delivery were studied.The obstetric conjugata,fetal biparietal diameter(BPD),fetal clavicula were measured by ultrasound,and compared with the obstetric conjugata measured in operation,newborn BPD,and newborn clavicula.Results The parameters such as obstetric conjugata,BPD and clavicula had no significant difference between ultrasonic measurement and actual measurement.When the obstetric conjugata and BPD difference