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- Title
Computed tomographic study of anatomical relationship between pubic symphysis and ischial spines to improve interpretation of intrapartum translabial ultrasound.
- Authors
Arthuis, C. J.; Perrotin, F.; Patat, F.; Brunereau, L.; Simon, E. G.
- Abstract
<bold>Objective: </bold>To analyze the anatomical relationship between the pubic symphysis and the ischial spines to determine reliable landmarks for the assessment of fetal head descent by intrapartum translabial ultrasound (ITU).<bold>Methods: </bold>All computed tomography (CT) scans performed for breech presentation and for twin delivery between 2006 and 2014 in a tertiary university hospital were obtained for measurement and analysis by two operators. The symphysis-left ischial spine angle (SIA) and the symphysis-left ischial spine distance (SID) were measured on three-dimensional reconstructions from the CT volume dataset. We calculated intra- and interobserver agreements for SIA and SID with 95% prediction intervals, created Bland-Altman plots with 95% limits of agreement and estimated the intraclass correlation coefficient (ICC). A sagittal plane projection from the SIA enabled calculation of a sagittal angle, corresponding to the angle of progression (AoP) on ITU.<bold>Results: </bold>SIA and SID were obtained from CT images from 458 women. Reproducibility was good for both SIA (intraobserver ICC, 0.94 (95% CI, 0.88-0.97) and interobserver ICC, 0.81 (95% CI, 0.66-0.92)) and SID (intraobserver ICC, 0.92 (95% CI, 0.82-0.97) and interobserver ICC, 0.83 (95% CI, 0.73-0.92)). The median SIA was 106° (interquartile range (IQR), 105-109°) and median SID was 26.1 (IQR, 23.4-29.5) mm. SIA and SID were not correlated with pelvic diameter or height. The 50th percentile of AoP was 110°.<bold>Conclusion: </bold>Knowledge of the anatomical relationship between the pubic symphysis and ischial spines makes it possible to establish a sonographic method for assesssing fetal head descent by taking into account the level of the ischial spines. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
- Subjects
COMPUTED tomography; PUBIC symphysis; INTRAPARTUM care; ULTRASONIC imaging; STATISTICAL correlation; DIAGNOSTIC imaging; FETAL ultrasonic imaging; HEAD; MATERNAL age; THIRD trimester of pregnancy; RESEARCH evaluation; ANATOMY; ISCHIUM
- Publication
Ultrasound in Obstetrics & Gynecology, 2016, Vol 48, Issue 6, p779
- ISSN
0960-7692
- Publication type
journal article
- DOI
10.1002/uog.15842