Krauss T, Osmers R, Westerfeld S, Metzger I, Puchta J, Kuhn W
Univ.-Frauenklinik Göttingen.
Z Geburtshilfe Neonatol. 1997 Nov-Dec;201(6):247-52.
To what extent is the cesarean section indication "arrest of labour" due to pathological forms of the pelvis and what is the meaning of the assimilation pelvis in modern obstetrics.
NMR-pelvimetries were performed in 166 post partum women from June 1993 to August 1995. The patients were divided into 4 groups. Group 1: patients who had had cesarean section owing to arrest of labour (n = 56), group 2: patients who had had cesarean section due to breech presentation (n = 20), group 3: patients who had had cesarean section owing to another indication (threatening fetal asphyxia, multiple pregnancy, premature delivery, placental abruption, gestosis, n = 40), group 4: patients who had a spontaneous delivery (control group, n = 50). After analysing the NMR pictures all the pelves were alloted to one of the case studies according to their pelvic form. The diagnosis "assimilation pelvis" was made according to the criteria of Kirchhoff (1949). The four groups were compared and analysed.
In group 1 an assimilation pelvis was found in 61%. The obstetrically most unfavourable canal pelvis occurred most frequently, amounting to 29%. In only 9% we found a contracted pelvis. In group 2 the proportion of the assimilation pelvis was even higher, rising to 65%. Only 35% of all pelves had a normal shape. In group 3 we found an assimilation pelvis in 50% of all cases. 66% of all patients with spontaneous delivery had a normal pelvis. An assimilation pelvis was found in 34%. In these cases duration of labour was prolonged by 4 hours on average (mean value: 9.5 hours).
Due to its frequency in our days the assimilation pelvis plays a major obstetrical role. This is true in particular when there is a pathological course of labour. From this results that pelvic parameters other than the conjugata vera will be of diagnostic importance, especially those parameters which are able to characterise the assimilation pelvis with its high promontory, the steepness of the pelvic inlet, the lengthening of the birth canal and the decrease of the hollow of the sacrum. We take the view that the angle of the pelvic inlet, the pelvic inclination and the direct length of the pelvis are of outstanding importance.
因骨盆病理形态导致的剖宫产指征“产程停滞”占多大比例，以及同化骨盆在现代产科学中的意义是什么。
1993年6月至1995年8月，对166名产后女性进行了核磁共振骨盆测量。患者分为4组。第1组：因产程停滞行剖宫产的患者（n = 56），第2组：因臀位行剖宫产的患者（n = 20），第3组：因其他指征（胎儿窘迫、多胎妊娠、早产、胎盘早剥、妊娠中毒症，n = 40）行剖宫产的患者，第4组：自然分娩的患者（对照组，n = 50）。分析核磁共振图像后，根据骨盆形态将所有骨盆归入其中一个病例研究。根据基尔希霍夫（1949年）的标准做出“同化骨盆”的诊断。对这四组进行比较和分析。
第1组中61%发现有同化骨盆。产科最不利的管型骨盆出现频率最高，达29%。仅9%发现有狭窄骨盆。第2组中同化骨盆的比例更高，升至65%。所有骨盆中只有35%形状正常。第3组中所有病例的50%发现有同化骨盆。所有自然分娩患者的66%骨盆正常。34%发现有同化骨盆。在这些病例中，产程平均延长4小时（平均值：9.5小时）。
由于同化骨盆在当今出现的频率，它在产科中起着重要作用。尤其是在产程出现病理情况时更是如此。由此得出，除真结合径外的骨盆参数具有诊断重要性，特别是那些能够表征同化骨盆特征的参数，如其高岬、骨盆入口的倾斜度、产道的延长以及骶骨凹陷的减小。我们认为骨盆入口角度、骨盆倾斜度和骨盆的直接长度具有突出重要性。
