Individual conditions grouped according to the international nosology and classification of genetic skeletal disorders*
Christine M Hall, Amaka C Offiah, Francesca Forzano, Mario Lituania, Michelle Fink, Deborah Krakow in Fetal and Perinatal Skeletal Dysplasias, 2012
Radiographic features: in the skull there is craniosynostosis resulting in brachycephaly and turricephaly and pronounced convolutional markings. The occiput is small and there is a steep skull base. The thorax is long and narrow and there may be an additional pair of ribs. The ribs have an irregular contour (‘ribbon’ ribs). Pectus carinatum or excavatum develops. In the spine the interpedicular distances are wide and the pedicles long and slender. The vertebral bodies have concave anterior and posterior borders. Kyphoscoliosis develops during childhood. There is a narrow pelvic inlet. The iliac bones are hypoplastic inferiorly and there is a vertical groove of the lateral borders. The long bones are mildly bowed with wide metaphyses. There may be dislocation of the radial heads. In the hands there is arachnodactyly and contractures result in camptodactyly. There is talipes equinovarus.
Shoulder dystocia
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
The McRoberts maneuver should be employed immediately. Assistants should be coached to use and continue the McRoberts maneuver. This accomplishes delivery in most cases and aids in delivery in others (41). It also provides assistants with a constructive alternative to fundal and downward suprapubic pressure, which only impacts the shoulders further. The McRoberts maneuver or supine squat flexes the lumbar spine and retracts the perineum (Fig. 2). The maneuver releases the traction that is locking and depressing the posterior shoulder against the sacral promontory. This spontaneous traction by itself can cause an Erb’s palsy, especially if the parturient spontaneously extends rather than flexes the pelvis (42,43). The McRoberts maneuver also straightens out the lumbosacral lordosis and the sacral promontory and removes the compressive force of the delivery table on the sacrum. Radiologic studies evaluating the changes in the pelvis that occur have documented a significant increase in the size of the pelvic inlet with flattening of the sacral prominence (44). In addition, it pushes the anterior shoulder superiorly and places the pelvic inlet perpendicular to the axis of the fetus. These actions together usually place the posterior shoulder of the fetus in the maternal pelvis as the maneuver is being applied; it reduces the force necessary for delivery by 30% and produces less risk for injury of a simulated fetus (45).
Labour: normal and abnormal
Louise C Kenny, Jenny E Myers in Obstetrics, 2017
The pelvic inlet or brim is bounded anteriorly by the upper border of the symphysis pubis (the joint separating the two pubic bones), laterally by the upper margin of the pubic bone, the ileopectineal line and the ala of the sacrum, and posteriorly by the promontory of the sacrum (Figure 12.1). The normal transverse diameter in this plane is 13.5 cm and is wider than the anterior–posterior (A–P) diameter, which is normally 11.0 cm (Figure 12.2). The fetal head typically enters the pelvis orientated in a transverse position in keeping with the wider transverse diameter. The angle of the inlet is normally 60° to the horizontal in the erect position, but in Afro-Caribbean women this angle may be as much as 90°. This increased angle may delay the head entering and descending through the pelvis during labour compared to labour in Caucasian women.
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).
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.
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).
Related Knowledge Centers
- Pelvic Brim
- Pelvimetry
- Pubic Symphysis
- Abdominal Cavity
- Pelvic Cavity
- Pelvis
- Sacrum
- Arcuate Line of Ilium
- Pectineal Line
- CT Scan