Klemt Anna-Sophia, Schulze Sally, Brüggmann Dörthe, Louwen Frank
Department of Gynecology and Obstetrics, Goethe-University, Frankfurt, Germany.
Department of Gynecology and Obstetrics, Goethe-University, Frankfurt, Germany.
Eur J Obstet Gynecol Reprod Biol. 2019 Jan;232:10-17. doi: 10.1016/j.ejogrb.2018.09.033. Epub 2018 Oct 22.
The purpose of this study was to investigate the role of the maternal pelvis, assessed by MRI pelvimetry in nulliparous women expecting a term fetus in breech presentation, to predict a successful and safe vaginal birth.
In this monocentric and anonymized cohort study, we enrolled 367 nulliparous women with breech presentation at 39 to 41 weeks of gestation during a period of 8 years at the University Women's Hospital in Frankfurt/Main. Pelvic measurements were obtained by standard MRI imaging. We correlated the obstetric conjugate, the pubic angle and the distance between the ischial tuberosities (intertuberous distance) with the maternal and fetal outcomes of vaginally intended breech births. The data was evaluated using logistic regression analysis.
241 of 367 participants (65.7%) experienced a successful vaginal delivery whereas 126 patients (34.3%) were subjected to secondary cesarean section. An increasing obstetric conjugate was significantly associated with an increasing rate of successful vaginal deliveries. No significant correlation of the intertuberous distance and the pubic angle with the mode of delivery could be shown. Although statistically not significant, we were able to define cut-off values of 10.9 cm in the intertuberous distance and 70° in the pubic angle; below these values, no successful vaginal delivery was recorded. No significant differences in the short-term outcomes were seen between the neonates of the vaginal delivery and the cesarean section groups. Inter- and intraobserver variability showed excellent reproducibility for all MRI parameters.
The obstetric conjugate correlates with the rate of vaginal deliveries in nulliparous women at term and can be used as a useful criterion for pre-selection and counseling of women with breech presentation and the desire for a vaginal delivery.
本研究旨在探讨通过MRI骨盆测量评估初产妇骨盆在足月臀位胎儿分娩中对预测成功、安全阴道分娩的作用。
在这项单中心、匿名队列研究中，我们在法兰克福/美因河畔大学妇女医院的8年期间纳入了367名在妊娠39至41周时为臀位的初产妇。通过标准MRI成像获得骨盆测量值。我们将产科结合径、耻骨角和坐骨结节间距离（结节间距离）与计划经阴道臀位分娩的母婴结局进行关联。使用逻辑回归分析评估数据。
367名参与者中有241名（65.7%）成功经阴道分娩，而126名患者（34.3%）接受了二次剖宫产。产科结合径增加与成功经阴道分娩率增加显著相关。未显示结节间距离和耻骨角与分娩方式有显著相关性。尽管在统计学上不显著，但我们能够确定结节间距离的临界值为10.9 cm，耻骨角的临界值为70°；低于这些值，未记录到成功的阴道分娩。阴道分娩组和剖宫产组新生儿的短期结局未见显著差异。观察者间和观察者内的变异性显示所有MRI参数具有良好的可重复性。
产科结合径与足月初产妇的阴道分娩率相关，可作为臀位且希望经阴道分娩的女性进行预筛选和咨询的有用标准。
