Department of Obstetrics and Gynecology, Barzilai Medical Center, Ashkelon, Affiliated with Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Department of Radiology, Barzilai Medical Center, Ashkelon, Affiliated with Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Fetal Diagn Ther. 2021;48(11-12):840-848. doi: 10.1159/000521115. Epub 2021 Dec 8.
Cephalopelvic disproportion (CPD) is one of the most common obstetric complications. Since CPD is the disproportion between the fetal head and maternal bony pelvis, evaluation of the head circumference (HC) relative to the maternal bony pelvis may be a useful adjunct to pre-labor CPD evaluation. The aim of the present study was a proof-of-concept evaluation of the ratio between HC and pelvic circumference (PC) as a predictor of CPD.
Of 11,822 deliveries, 104 cases that underwent an abdominopelvic CT for any medical indication and who underwent normal vaginal deliveries (NVDs) (n = 84) or cesarean deliveries (CD) due to CPD (n = 20) were included retrospectively. Maternal pelvis dimensions were reconstructed and neonatal HC, as a proxy for fetal HC, was measured. The correlation between cases of CPD and cephalopelvic circumference index (CPCI), which represents the ratio between the HC and PC in percentage (HC/PC × 100), was evaluated.
The mid-pelvis CPCI (MP-CPCI) was larger in CD groups as compared to the NVD group: 103 ± 11 versus 97 ± 8%, respectively (p = 0.0003). In logistic regression analysis, the MP-CPCI was found to be independently associated with CD due to CPD: each 1% increase in MP-CPCI increased the likelihood of CD for CPD by 11% (adjusted odds ratio [aOR] 1.11, 95% CI, 1.03-1.19, p = 0.004). The aOR for CD due to CPD increased incrementally as the MP-CPCI increased, from 3.56 (95% CI, 1.01-12.6) at MP-CPCI of 100 to 5.6 (95% CI, 1.63-19.45) at 105, 21.44 (95% CI, 3.05-150.84) at 110, and 28.88 (95% CI, 2.3-362.27) at MP-CPCI of 115.
The MP-CPCI, representing the relative dimensions of the fetal HC and maternal PC, is a simple tool that can potentially distinguish between parturients at lower and higher risk of CPD. Prospective randomized studies are required to evaluate the feasibility of prenatal pelvimetry and MP-CPCI to predict the risk of CPD during labor.
头盆不称（CPD）是最常见的产科并发症之一。由于 CPD 是胎儿头部与母体骨盆之间的不称，因此评估头围（HC）相对于母体骨盆可能是产前 CPD 评估的有用辅助手段。本研究旨在验证 HC 与骨盆周长（PC）的比值作为 CPD 预测指标的概念验证。
在 11822 例分娩中，回顾性纳入 104 例因任何医学指征行腹盆腔 CT 检查且行正常阴道分娩（NVD）（n=84）或因 CPD 行剖宫产（CD）（n=20）的病例。重建母体骨盆尺寸，并测量代表胎儿 HC 的新生儿 HC。评估 CPD 病例与头盆周长指数（CPCI）之间的相关性，CPCI 代表 HC 与 PC 之间的百分比（HC/PC×100）。
与 NVD 组相比，CD 组的中骨盆 CPCI（MP-CPCI）更大：分别为 103±11%和 97±8%（p=0.0003）。在逻辑回归分析中，MP-CPCI 被发现与 CPD 所致 CD 独立相关：MP-CPCI 每增加 1%，CD 因 CPD 的可能性增加 11%（调整后的优势比[aOR]1.11，95%CI，1.03-1.19，p=0.004）。随着 MP-CPCI 的增加，CD 因 CPD 的 aOR 逐渐增加，从 MP-CPCI 为 100 时的 3.56（95%CI，1.01-12.6）增加到 105 时的 5.6（95%CI，1.63-19.45）、110 时的 21.44（95%CI，3.05-150.84）和 115 时的 28.88（95%CI，2.3-362.27）。
代表胎儿 HC 和母体 PC 相对尺寸的 MP-CPCI 是一种简单的工具，可潜在地区分低风险和高风险 CPD 的产妇。需要前瞻性随机研究来评估产前骨盆测量和 MP-CPCI 预测产时 CPD 风险的可行性。
