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Breech presentation
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Randall C. Floyd, Martin L. Gimovsky
Taken alone, the measurement of pelvic diameters is not capable of reliably directing management, especially for women in labor. Experience has shown that minimal pelvic inlet measurements of 11 cm in the anteroposterior diameter and 12 cm at the transverse of the inlet, coupled with 10 cm at the mid-pelvic plane of the intraspinous diameter, are consistent with a normal bony pelvis (10, 11, 12 rule) (31–33,42). These recommended measurements should be used as a starting point in considering the labor of an average-sized fetus at term. A clinical consideration of fetal size is obviously a major issue in deciding upon the appropriateness of a labor trial. It may be helpful for the attending obstetrician to review the pelvimetry directly. The use of the fetal head circumference obtained by ultrasonography in addition to the CT-derived pelvic inlet measurements has been evaluated as a more definitive guide to fetopelvic disproportion (43).
Perineal Hernia
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
Perineal hernia patients require a detailed history of symptoms and general fitness for surgery as it may have been several years since their original proctectomy, and they should be specifically questioned as to whether the perineal bulge reduces completely when prone. If the original rectal resection was for malignant disease then complete restaging is useful to exclude recurrent disease prior to repair. If there is any doubt as to the reducibility of the hernia then a prone CT with oral contrast will delineate the defect and assure the surgeon of complete reduction. MRI of the pelvis can also help define the anatomy, particularly if there has been an attempt at occlusion of the pelvic inlet by a flap (Figure 16.2).
Pregnancy in SLE
Published in E. Nigel Harris, Thomas Exner, Graham R. V. Hughes, Ronald A. Asherson, Phospholipid-Binding Antibodies, 2020
Total hip replacement—Occasionally patients who have previously undergone total joint replacement for osteonecrosis elect pregnancy. There is no large experience yet accumulated on this topic. In the author’s personal experience we have managed term pregnancies in four patients with seven total hip replacements. All noted increased aching in the replaced joints near term, presumably related to ligament loosening. The aching remitted postpartum. One patient had painful loosening of the older of her two artificial hips 6 months postpartum and underwent revision. Another suffered staphylococcus epidermidis infection of one of her two prosthetic hips 3 months postpartum. Another patient, considering pregnancy, had extrusion of methylmethacrylate through her acetabulum (from the time of surgery). This extrusion could be palpated on pelvic examination and sufficiently narrowed the diameter of the pelvic inlet that it would have precluded vaginal delivery.
The effect of an abdominopelvic exercise program alone VS in addition to postural instructions on pelvic floor muscle function in climacteric women with stress urinary incontinence. A randomized controlled trial
Published in Physiotherapy Theory and Practice, 2023
Laura Fuentes-Aparicio, Montserrat Rejano-Campo, Laura López-Bueno, Gráinne Marie Donnelly, Mercè Balasch-Bernat
Several observational studies (Çelenay and Kaya, 2017; Mattox et al., 2000; Sapsford, Richardson, Maher, and Hodges, 2008) aimed to identify potential postural alterations in women suffering from UI. It seems that sagittal thoracic curvature is increased in women with UI compared to continent women (P < .004–0.02) (Çelenay and Kaya, 2017; Mattox et al., 2000). Modifications in lumbar curvature have also been found. Mattox et al. (2000) reported a loss of lumbar lordosis in women with pelvic organ prolapse and UI (P = .02) and Sapsford, Richardson, Maher, and Hodges (2008) reported significantly lower lumbar lordosis in women with SUI compared to asymptomatic women (P = .04). On the contrary, Çelenay and Kaya (2017) found an increase of the lumbar curvature in incontinent women (P < .001). Changes in pelvic inlet orientation, such as increased anterior pelvic tilt, are also reported in women suffering from SUI compared to continent controls (P = .002) (Çelenay and Kaya, 2017).
The vertical dimension of obesity: adverse pregnancy outcomes in the short obese versus tall obese parturient
Published in Journal of Obstetrics and Gynaecology, 2022
Shadan S. Mehraban, Joanna C. Pessolano, Jane M. Ponterio, Katherine Williamson, Anastasiya Holubyeva, Michael Moretti, Nisha Lakhi
Our findings that point to a higher incidence of second stage caesarean delivery in short obese women is important, as Caesarean delivery at full cervical dilatation is associated with more than double the risk of intraoperative trauma compared to caesarean section during the first stage of labour (Hendler et al. 2005; Selo-Ojeme et al. 2008). The risk of other second stage complications, including shoulder dystocia was also greater in our short stature cohort, although it did not reach statistical significance. Thoms and Godfried found an inverse correlation between maternal height and size of the pelvic inlet in a population of 98 women, demonstrating that 41% of the variance in pelvic dimensions could be explained by maternal height. Another study among Ghanaian women also found an inverse correlation between height and distance of the anterior–posterior diameter of the pelvic inlet. (Adadevoh et al. 1989). Although studies among shorter mothers who had full-term births showed lower birth weight (LBW) (Inoue et al. 2016; Wells 2017), our study did not show a statistically significant difference between the two groups.
A retrospective study of stage IB node-negative cervical cancer treated with adjuvant radiation with standard pelvic versus central small pelvic fields
Published in Southern African Journal of Gynaecological Oncology, 2018
Tlotlo B Ralefala, Leon van Wijk, Rakiya Saidu
Yeo et al.15 described their SPF borders as extending from the inferior edge of the sacroiliac joints to the inferior of the obturator foramina, and 1–1.5 cm medial to the true pelvic inlet. The protocol was of no adjuvant RT if the GOG score < 40, SPF if the GOG score was in the range 40–120, and WPF if the score was > 120. Four field plans were used, delivering 45–50.4 Gy. All patients received additional HDR vaginal brachytherapy, 10 Gy in two fractions. PORT was administered to 61 patients (36 SPF, 25 WPF). The overall DFS was 98.2% after five years. Lymphoedema was mild (grade 1–2) and significantly fewer instances were reported in the SPF group, presumably because the lateral pelvic lymphatics were less exposed to RT than in the WPF group. Chronic GI complications were also surprisingly low (one patient in each group, both grade 1 severity).