A critical survey of the questionable pelvis

Precision obstetrics is within the scope of practicability. A careful survey of the female pelvis allows for recognition of absolute or relative cephalo-pelvic disproportion, and should serve to stimulate more precise evaluation of the classification, essential diameters, and areas in square centimeters, of each plane of the pelvis.Midpelvic contractions, if present, should be suspected, even in the presence of normal inlet and outlet measurements; and these cases should merit the advantages offered by stereo- and isometric roentgenpelvimetry. If clinical measurements of this plane are found to be critical, significant midpelvic disproportion is highly possible.Election of the proper procedure for the termination of the full-term pregnancy, and prediction of the course of labor may be made with a reasonable degree of accuracy.With an average size baby, in the absence of unequivocal cephalopelvic disproportion, and under the “permissive” conditions outlined above in respect to the degree and nature of contraction, the patient may, under careful supervision, be allowed to go into labor spontaneously.No single diameter, except possibly the conjugate vera, should be employed alone for the prognosis of labor.In considering the sums of any two diameters, that of the widest possible transverse diameter and the anteroposterior diameter might well be combined with the area computation for the fullest measure of efficiency. The latter consideration, emphasizing the presence or limitation of compensatory space, proves the importance of stereo-perspective and classimetric knowledge of the particular pelvis; and appears more significant than a study of the sum of the interspinous and posterior sagittal diameters.The proper clinical roentgenometric approach to the suspect pelvis promises a favorable advance in lessening maternal morbidity and mortality, a greater fetal salvage, and a lesser incidence of elective cesarean section.     

Female pelvic floor. Descriptive anatomy and clinical exploration by transvaginal ultrasound

In order to assess the state and pathology of the woman's pelvis minor, a number of methods are commonly used among practitioners, encompassing clinical exploration, radiology, MRN, urodynamics, endoscopy and echography.

Echography has been poorly used in clinical pelvic exploration and its reliability is actually a matter of controversy 1. However, echographic surveys can provide us with valuable gynecological data on the state and pathologies of the soft pelvis, within the genital regions or even going beyond them, i.e. the rectal channel, bladder, urethra, anus, vascular plexuses, and all of their supporting tissues.

At our research unit, we have been employing Transvaginal Ultrasound echography (TVU) for a long time in conjunction with other pelvis-focused methods in order to study different kinds of pelvic alterations. TVU has proven to be friendly to use, fast, harmless and inexpensive, allowing serial explorations and producing high-quality dynamic images (loop-cinema, video-tape). Furthermore, this method is fairly aseptic in that the occurrence of faeces in the rectal ampolla is not a nuisance but a bonus in tracking the contours of the rectum walls and other topographical features which would be otherwise difficult to survey.

A complete pelvic floor TVU may add no longer than 5-8 minutes to a routine gynecological examination, can be implemented by the general gynecologist and generates data that can be further studied by the appropriate specialist for a more insightful evaluation 2.     

Influence of applicator moves to dose distribution during Selectron LDR brachytherapy]

Irradiation of cancer diseases with intracavitary applicator makes impossible visual control of applicator's position during the process of irradiation. In this paper example applicator moves during the treatment are presented and their influence to dose distribution especially in reference points is discussed. Verification of applicator's position has been made by the use of roentgen films.     

Extravasation of parenteral alimentation fluid into the renal pelvis--a complication of central venous catheter in a neonate.

Many complications of central venous catheters, which include perforation of the vessel walls and extravasation of the infusate into pericardial, pleural, and peritoneal cavities, have been reported. We report an infant with a central venous catheter in inferior vena cava who experienced extravasation of parenteral alimentation fluid into the right renal pelvis secondary to perforation of the renal vein. To our knowledge, this rare complication has not been reported earlier.     

Knowledge and perception of abortion and the abortion law in Trinidad and Tobago

As for most of its Caribbean neighbours, Trinidad and Tobago's leading cause of maternal morbidity is unsafe abortion. Yet activism to introduce public policy and legislation that effectively address this aspect of women's reproductive rights and health has been met with public outcry. With almost hysterical opposition coming from certain religious quarters, there is the unsubstantiated impression that Trinidadians are overwhelmingly opposed to abortion law reform. A national survey was therefore carried out of people's knowledge and views on the current abortion law in Trinidad and Tobago. The survey found that although almost half of respondents had an unfavourable perception of abortion, more than half of them were in favour of broadening the legal grounds for accessing terminations. Incest, rape and danger to a woman's life were cited as the most significant circumstances under which abortions should be permitted. The vast majority of respondents agreed that voting on abortion law reform by members of the legislature should not be based on personal beliefs. The findings demonstrate that there is not the degree of opposition to abortion law reform that is widely assumed. On the other hand, given the wide variance of views and perceptions, we argue that public health concerns and human rights should always trump public opinion.     

The pelvis as a passageway. I. Evolution and adaptations

Man has an unusual pelvis, a large fetal head, and a complicated mechanism of labour. The evolution of the pelvic girdle, like that of the hind limb, is a story with some chapters still missing. In mammals the pelvis has been modified in various interesting ways to effect compromises between its locomotor function and the requirements of parturition. Among the primates, the increasing size of the fetal brain may have necessitated a change in the attitude of the head from extension to flexion as it goes through the pelvis. The distinctive shape of the hominid pelvis is probably an adaptation to bipedal gait. The birth canal has changed from a shallow bony ring to a deep curved tube, through which the mature fetal head can only pass by rotating as it descends.     

Abdominopelvic inspection during nonemergent laparoscopic procedures: who looks?

OBJECTIVE: A study was performed to determine whether surgeons and gynecologists inspect the entire abdomen/pelvis at the time of nonemergent laparoscopic surgery. STUDY DESIGN: A retrospective chart audit was conducted of patients who underwent elective laparoscopic cholecystectomy or laparoscopic tubal ligation. Dictated and hand-written operative notes were reviewed. Any documentation of the pelvic structures from cholecystectomy operative notes or the upper abdomen from tubal ligation operative notes was determined to be positive for abdominopelvic surveillance. RESULTS: A total of 771 operative notes were reviewed, which included 358 tubal ligations and 413 laparoscopic cholecystectomies. Two hundred four of 358 (57%) tubal ligations performed by gynecologists had a survey of the upper abdomen versus 36 of 413 (8.7%) cholecystectomies performed by surgeons that had a survey of the pelvis. CONCLUSION: Gynecologists and general surgeons either do not document or do not perform total abdominopelvic inspection universally.     

避孕方法知情选择干预对咨询服务效果的影响

目的 :评价咨询技巧培训对门诊服务提供者咨询服务效果的影响。对象和方法 :以计划生育门诊为基础 ,在基线调查后 ,对干预门诊服务提供者进行咨询技巧培训 ,项目结束时 ,通过对到干预门诊就诊的合格对象进行终末调查 ,来评估咨询服务情况及干预效果。结果 :培训干预措施显著提高了咨询服务水平 ,但仍有部分对象反映在咨询中存在服务提供者限制其使用某种避孕方法的现象。咨询服务质量的高低影响对象的避孕知识水平及其对现用避孕方法的满意程度。结论 :使咨询服务规范化 ,进一步提高服务提供者的咨询技巧 ,提高育龄群众的避孕知识普及程度。     

Aggressive angiomyxoma of the pelvis. A case report

Aggressive angiomyxoma is a locally mesenchymal, benign, and rare neoplasm. The vulva, perineum, and pelvis are the most common sites of involvement. The preoperative diagnosis is postulated by CT, sonography, MR image and angiography. The immunohistochemical study reveals the definitive diagnosis. The therapy is only surgical, and because of its tendency to recur locally, the excision has to be as complete as possible.     

Hepatoid carcinoma of the ovary and management

The designation'hepatoid carcinoma' has been introduced as a unique type of carcinoma that arises outside the liver but resembles, to a considerable extent, hepatocellular carcinoma both histologically and immunohistochemically in its staining for alpha-fetoprotein (AFP). The minimum histological criteria of hepatoid carcinomas are the evidence of AFP production and abundant eosinophilic cytoplasm. These tumors have been reported in the ovary, the lung, the stomach, the renal pelvis, and the bladder. We, in this study, present a rare patient with primary hepatoid carcinoma of the ovary (OHC) and review the previous reports.     

Results of systematic screening for minor degrees of fetal renal pelvis dilatation in an unselected population

OBJECTIVE: The purpose of this study was to determine the incidence of minor degrees of renal pelvis dilatation that is detected by antenatal ultrasound scanning in an unselected population and its value in the prediction of significant uropathies. STUDY DESIGN: This prospective study was conducted over a 24-month period. Infants with an anteroposterior pelvic diameter of >or=4 mm in the second trimester and/or >or=7 mm but <15 mm in the third trimester were enrolled. RESULTS: Pyelectasis was found in 4.5% of 5643 fetuses (1.5% with significant uropathy). Among the 213 infants whose cases were followed, 132 infants (62%) had renal anomalies, but only 83 infants (39%) had significant uropathies. The ability of the third-trimester renal pelvis dilatation to predict renal abnormalities showed a positive predictive value of 69%. Pyelectasis that was detected only in the second trimester revealed a significant uropathy in 12% of the infants. CONCLUSION: Pyelectasis was found in 4.5% of fetuses. The third-trimester anteroposterior renal pelvis diameter of >or=7 mm was the best ultrasound criterion to predict postnatal uropathies.     

ADOLESCENT PREGNANCY

This article describes eight years of experience in a teenage antepartum clinic at Kings County Hospital Center. A retrospective survey of data collected from January 1968 to December 1975 regarding the pregnancy performance of 884 teenage patients is compared with the remaining obstetrical population for 1973. Results of the study showed that young patients differed significantly from the general population in that uterine dysfunction, contracted pelvis, toxemia and anemia occurred more frequently among the teenagers. The incidence of prematurity and perinatal loss was lower.     

The role of postnatal x-ray pelvimetry after caesarean section in the management of subsequent delivery

The purpose of this study was to investigate the influence of postnatal x-ray pelvimetry after caesarean section on the management of the subsequent pregnancy. The case records of 331 women delivered by casearean section in their first pregnancy were reviewed. By standard radiological criteria, the pelvis was considered to be inadequate in 248 (75%) of them and adequate in 83 (25%). Of the women with a radiologically inadequate pelvis, 172 underwent an elective caesarean section. Seventy-six were allowed vaginal delivery: 51 of these women delivered vaginally and 25 required an emergency caesarean section. Of the women with a radiologically adequate pelvis, 61 achieved a vaginal delivery and 22 were delivered by caesarean section. All of the three cases of uterine rupture occurred in women with a radiologically adequate pelvis. This study suggests that x-ray pelvimetry is not a good predictor of the outcome of a trial of vaginal delivery. We conclude that the practice of routine postnatal pelvimetry should be abandoned.     

The role of postnatal x-ray pelvimetry after caesarean section in the management of subsequent delivery

Summary. The purpose of this study was to investigate the influence of postnatal x-ray pelvimetry after caesarean section on the management of the subsequent pregnancy. The case records of 331 women delivered by casearean section in their first pregnancy were reviewed. By standard radiological criteria, the pelvis was considered to be inadequate in 248 (75%) of them and adequate in 83 (25%). Of the women with a radio-logically inadequate pelvis, 172 underwent an elective caesarean section. Seventy-six were allowed vaginal delivery: 51 of these women delivered vaginally and 25 required an emergency caesarean section. Of the women with a radiologically adequate pelvis, 61 achieved a vaginal delivery and 22 were delivered by caesarean section. All of the three cases of uterine rupture occurred in women with a radiologically adequate pelvis. This study suggests that x-ray pelvimetry is not a good predictor of the outcome of a trial of vaginal delivery. We conclude that the practice of routine postnatal pelvimetry should be abandoned.     

A Survey of 5,000 Consecutive Deliveries in Private Practice

A study has been made of 5,000 consecutive pregnancies in booked patients in the care of the writer in private hospitals in Hobart over the period 1954–1966.
A statistical survey of the complications of pregnancy and labour in this material is given.
The management routines during the antenatal period and in labour have been presented briefly and reference is made to difficulties of adequate data recording in certain conditions.     

Risk-Reducing Salpingectomy in Canada: A Survey of Obstetrician-Gynaecologists

ObjectivePerforming risk-reducing salpingectomy (RRS) at the time of hysterectomy or as a method of tubal ligation has been suggested as a way to reduce the incidence of high grade serous carcinoma (HGSC) of the ovary, since this type of cancer is hypothesized to originate in the fallopian tube We conducted a survey of Canadian obstetrician-gynaecologists to better understand the uptake and knowledge of implementing this procedure, and to identify barriers to doing soMethodsAn anonymous, web-based survey using both quantitative and qualitative methods was sent to obstetrician-gynaecologist members of the Society of Obstetricians and Gynaecologists of Canada and the Society of Gynecologic Oncology of Canada The survey contained questions about demographics, knowledge and beliefs about RRS, and possible barriers to its implementation in women at average risk for ovarian cancerResultsOne hundred ninety-two physicians responded to the survey, a response rate of 25% . Respondents varied in their duration in practice, came from all provinces, and spent a large proportion of their time practising gynaecology Ninety percent of respondents had heard of RRS; however, 37% were unaware of the evidence supporting the hypothesis that HGSC originates in the fallopian tube, and 38% were unsure whether there would be any population benefit from performing RRS at the time of other gynaecologic surgery. Multiple barriers to implementation were identified.ConclusionMost Canadian obstetrician-gynaecologists responding to our survey were aware of RRS as a possible method to prevent ovarian cancer in women at average risk; however, barriers still exist to widespread implementation. Further research is needed to quantify the population benefit of this procedure.     

高中学生青春期生殖健康现状调查和教育模式探索

目的:了解甘肃省县级中学高一学生对生殖健康的认知和需求。方法:在甘肃省永靖县和临泽县各选取一所高级中学作为调查点,对2所中学全体高一学生进行问卷调查。调查结束后,面向全体高一年级学生开展青春期生殖健康知识讲座,并于半年后回访。结果:调查的县级中学高一学生已基本具备一定的青春期生殖健康知识,但了解不全面,有些认识甚至是错误的。大多数调查对象认为必须加强青春期生殖健康教育;学校及家长在这方面提供的教育不能满足他们的需求。青春期生殖健康知识讲座收益明显,男、女同时授课模式较男、女分开授课模式更易为学生们所接受。结论:应加强对中学生青春期生殖健康教育。     

Menstrual effluent in endometriosis shows no difference in volume, VEGF-A, MMP2 and MMP9 or sFLT

Since retrograde menstruation is considered a key event in the aetiology of endometriosis, this study sought to determine whether the menstrual effluent of women with this condition is different from that of those with a normal pelvis. As the amount of blood lost during menstruation is thought to be higher in this group, measured objective menstrual blood loss (MBL) was measured. In addition, factors enhancing both ectopic implantation of endometrium and its subsequent growth (by establishing a neo-vasculature) were chosen for study. Our hypothesis was that they are increased in the menstrual effluent of women with endometriosis. The study showed that at the time of menstruation, there is no difference in MBL or in the volume of menstrual effluent between women with endometriosis and those with a normal pelvis at laparoscopy. In addition, vascular endothelial growth factor-A (VEGF-A) message and protein, soluble truncated receptor sVEGF-R1 (sFLT), matrix metalloproteinase (MMP) 2 and MMP9 activities were also shown to be similar between the two groups. It is concluded that the enhanced expression of VEGF-A and MMP in the peritoneal fluid and ectopic lesions of endometriotic patients may be a secondary event, resulting from an innate difference in peritoneal and systemic factors rather than in the endometrium, causing an abnormal peritoneal response to menstrual debris and facilitating its ectopic implantation.     

Pelvic girdle pain in pregnancy: the impact on function

BACKGROUND: The aim of this study was to determine the prevalence of self-reported pelvic girdle pain in pregnancy and study the impact on function, the use of crutches, and waking up at night, according to location of pain. METHODS: A population-based questionnaire study was performed among all women 18-40 years in two communities in Norway in 1998-99. A total of 1,817 women with a prior delivery constituted the study sample. Pelvic girdle pain was grouped into five categories: pain in anterior pelvis, in posterior pelvis, in anterior and unilateral posterior pelvis, in anterior and bilateral posterior pelvis (a complete pelvic girdle syndrome), and pelvic pain with no information on location. RESULTS: A total of 46% (843/1,817) reported pelvic girdle pain in pregnancy at one location or more. Nineteen percent reported pain in anterior pelvis only, 14% in posterior pelvis only, 4% in anterior and unilateral posterior pelvis, and 5% reported a complete pelvic girdle syndrome. A total of 7% of all pregnant women used crutches during pregnancy and 15% reported waking up at night frequently due to pelvic girdle pain. A complete pelvic girdle syndrome, as compared to pain in the anterior pelvis only, was strongly associated with the use of crutches (adjusted odds ratio (OR) 4.3; 95% confidence interval (CI) 2.5-7.4) and with waking up at night due to pain (OR 4.6; 95% CI 2.7-7.2). CONCLUSION: Pain related to the pelvic joints is common among pregnant women in Norway and may cause serious functional problems.     

社区妇女避孕知识与行为状况调查与分析

目的:了解社区妇女对避孕知识的知晓和行为状况,以便更好地为她们提供计划生育服务和教育,提高避孕节育知情选择的正确率。方法:采用自行设计的调查表,以问卷调查的形式,对385例社区妇女进行问卷调查。结果:各种避孕知识及避孕方法知晓率为86%,行为正确率64%,其中紧急避孕行为正确率偏低。影响避孕知识水平的因素是文化程度的高低和职业。结论:要加大计划生育的宣传、咨询和指导力度,为社区妇女提供多种形式的、有针对性的机会生育优质服务,提高育龄妇女对避孕节育方法,尤其是紧急避孕方法的知晓度,扩大她们对避孕节育方法的选择范围,减少非意愿妊娠的发生。