Dissertations / Theses on the topic 'Pelvimetry'

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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
As medidas dos diametros da pelve, obtidas diretamente sobre o filme radiografico, sao conhecidas como pelvimetria radiografica. Essa tecnica, que possibilita determinar o padrao pelvimetrico para cada raca, serve como subsidio para metodos profilaticos contra complicacoes que possam ocorrer durante o parto, alem de permitir a classificacao anatomica e obstetrica da pelve. Por meio da pelvimetria foram analisadas radiografias da pelve, na projecao ventrodorsal, de 250 femeas caninas adultas de diferentes racas, a fim de estabelecer as dimensoes pelvicas. Medias e desvios-padrao foram, respectivamente...
The measurements of the diameters of the pelvis, the study radiographic is acquaintance as a pelvimetry radiographic. That know-how makes the assignation by possible standard pelvimetric for each breed , serving as a dole about to prevention against complications than is to may be become of during the break, besides from provide categorization anatomic and obstetric from the pelvis. By pelvimetry have been evaluated radiography the pelvis at the ventrodorsal radiographs of 250 female canine adult of different breeds, for the purpose of establish the dimensions pelvics. The averages and deflections norm have been respectively: Breed Brasilian Mastif... (Complete abstract, click electronic access below)

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The objective of this work was to evaluate the measurement development and the sexual maturity stage in Zebu Gir heifers in interval of 46 to 57 days, along 8 months. There were carried out 31 Zebu heifers (Bos indicus) with age between 11 to 29 months, in extensive livestock, management in grass Brachiaria decumbens paddocks and had free access to shade, water and mineral ad libitum. The follicular development was characteristic by presence or not of follicle by ultrasound. The measurement was done by characteristics as, girth height, bodily length, pillion length; distance between isquiun-isquiun; distance between iliun-iliun; rib depth, thoracic perimeter and bodily weight. The data were subjects to regression analysis by SAEG (2007). Only 4 female (4 / 31, 7,7%) showed by ultrasound the presence of luteum body, which means female puberty, but, there were linear growth to bodily development and for weight gain with mean 0,177kg. The heifers showed late when compeer to puberty and sexual maturity, where only 4 animals showed puberty until 29 months of age. The bodily weight of Zebu Gir seems more important than female ages to puberty arise and probably the bodily weight at last to be raised is ± 270 kg.
Objetivou-se verificar o desenvolvimento biométrico, e o estádio de maturidade sexual em novilhas da raça Gir em intervalos de 46 a 57 dias, durante 8 meses. Foram utilizadas 31 novilhas zebuínas (Bos taurus indicus) da raça Gir leiteiro, com idades variando entre 11 e 21 meses, criadas em regime extensivo, manejadas em piquetes com pastagem predominantemente de Brachiaria decumbens, água, sombra e sal mineral ad libitum. O desenvolvimento folicular foi caracterizado pela presença ou não de folículos por ultrassonografia. A biometria foi feita mensurando as características de altura de cernelha; comprimento corporal; comprimento de garupa; distância entre ísqueos; distância entre íleos; profundidade de costela, perímetro torácico, peso corporal. Os dados obtidos foram submetidos a analise descritiva e analise de regressão utilizando-se o SAEG (2007). Somente 4 fêmeas (4/31, 7,7%) apresentaram corpo lúteo pela avaliação ultrassonografica, indicando à puberdade dessas fêmeas, porém houve crescimento linear para desenvolvimento corporal e para ganho de peso diário com média de 0,177kg. As novilhas mostraram-se tardias com relação a puberdade e maturidade sexual, onde apenas 4 animais apresentaram a puberdade até os 29 meses de idade. O peso corporal na raça Gir leiteira parece ser mais importante que a idade da fêmea para o surgimento da puberdade e provavelmente o peso corporal mínimo a ser alcançado é de ± 270kg.

The relationship between the preauricular sulcus and pitting on the dorsal aspect of the pubic corpus in association with pregnancy and parturition has aroused considerable interest since the early 1970's. The major limitation of much of the discussion is that it has been based on data derived from skeletal samples with either unknown or uncertain obstetric histories. The excavation of the crypts beneath Christ Church, Spitalfields between 1984 and 1986 produced 968 skeletons, 387 of which were recovered in association with securely associated, legible coffin plates. Of the 138 adult females in this sample the parity status of 94 has been reconstructed from historical documentation. Such obstetric factors as parity status, number of births, age at first and last births and birth spacing have been examined in relation to the presence or absence of the preauricular sulcus, its type and size, pubic pitting, sacral scarring and the extension of the pubic tubercle. The results suggest that the preauricular sulcus and sacral scarring are independent of obstetric events and that although the small numbers of females with more than one pubic pit or an extended pubic tubercle had born children, the absence of these features is associated with both parous and nulliparous females. Unlike previous studies, both localised cortical resorption and tubercle extension were evaluated as a component part of the obstetric pelvis. The more capacious pelvis proved to be associated with wider and longer preauricular sulci and with the presence of pubic pitting. In order to facilitate comparative studies the Christ Church females are described as part of the sample from which they are derived. Their environmental and cultural backgrounds are discussed.

The shape of the lumbar and thoracic spinal curves in healthy subjects, when standing and when adopting a variety of working positions, was investigated using angular measures. The hypothesis that spinal and pelvic posture is determined by body position was supported. The mechanism by which body position influences spinal and pelvic posture was investigated using angular indices of the lengths of the hip flexors and extensors. The hypothesis that hamstring stretch determines postural adaptation to sitting positions was not supported. A multivariate analysis revealed that an index of iliopsoas length was the best predictor of posterior pelvic tilt in a variety of sitting positions. A supplementary investigation was carried out using data on the range of motion of the pelvis in the different body positions and its relationship to the muscle length indices. The role of the hamstring muscles in sitting posture was clarified. Some electromyographic data is presented to further illustrate the effect of body position on the role of the hip and trunk muscles in posture. A replication of the main findings and an investigation of some of the practical implications of the work were carried out drawing attention to some mechanisms of postural stress, potential problems of increased lumbar lordosis and their cost-effective alleviation through workspace design. The provision of a footrest, for example, was found to have significant effects on lumbar and pelvic angles in standing as well as in sitting. Further research into standing posture in the workplace is indicated by these findings. Some hypotheses for future investigation are presented.

A series of 4 observational studies was performed on a Bovelder herd at Johannesburg Water’s Northern Farm. The heifer and cow breeding seasons started on 15 October and 1 November every year, and consisted of 50 d and 60 d of oestrus observation respectively, with once daily artificial insemination (AI). Five to 7 days after the AI period bulls were added in multi-sire groups for a period of 42 d. Pregnancy diagnoses were performed between 23 March and 26 April every year. The farming system had been in place for >25 years, with few deviations. In the first study, reproductive tract scoring (RTS) by transrectal palpation on a 5- point scale was performed 1 day before the start of breeding on a group of heifers (n = 272) born in 2002. Heifers with RTS 1 or 2 were estimated to be pre-pubertal, those with RTS 3 pubertal and those with RTS 4 or 5 post-pubertal. Pre-breeding body weight (BW) and body condition score (BCS) were recorded, and Kleiber ratio (KR) was calculated (average daily gain/end weight0.75). Heifers were followed until they weaned their first calves. The objectives of this study were to determine if RTS is a valid tool to predict reproduction and production performance in limited bred beef heifers, and to compare its predictive value with that of BW, BCS, age and KR. After adjustment for BW and age, RTS was positively associated with pregnancy rate to the 50 day AI season (P < 0.01), calf weaning weight (P < 0.01) and pregnancy rate to the subsequent breeding season (P < 0.01), and negatively associated with days to calving (P < 0.01). RTS was a better predictor of fertility than was vi KR, and similar in its prediction of calf weaning weight. It was concluded that RTS is a predictor of heifer fertility and compares well with other traits used as a predictor of production outcomes. It was further hypothesised that RTS may predict long-term reproductive performance due to its association with pregnancy outcome and days to calving after first breeding, combined with reports that heifers calving early tend to calve early in subsequent seasons and have increased lifetime production. In study 2, a 7-year longitudinal study, 292 beef cows in two age cohorts were observed from 1-2 d before their first breeding season (day of RTS), until they had weaned up to 5 calves. Years to reproductive failure was defined as the number of years until a cow failed to become pregnant during the AI season. Animals with RTS 1 or 2 were at increased risk of early reproductive failure compared to those with RTS 4 or 5 (HR = 1.4, 95% CI 1.0, 1.9) despite the fact that RTS was not associated with calving rate or days to calving after the second calving season. The predictive value of RTS was lower in the age cohort with a higher prevalence of anoestrus. Most animals with RTS 1 or 2 that were subsequently detected in oestrus were in early to mid di-oestrus at the time of scoring. It was concluded that RTS is a valid culling tool to improve long-term reproductive success in a seasonal breeding system, by excluding poor performing animals. It was further concluded that the predictive value of RTS decreases with increasing prevalence of anoestrus and at certain stages of the oestrous cycle. Apart from failure to calve, dystocia as a result of foeto-maternal disproportion is the cause of significant production loss in beef heifers. Internal pelvis area (PA) can be calculated as the product of vertical and horizontal diameter of the pelvis measured transrectally using a calliper device. In study 3, the effects of five culling strategies using prebreeding PA data on calving and dystocia rates and on pre-breeding and calf birth weight (BWT) were compared in 484 heifers. Multiple regression analyses were used to determine independent predictors of PA, calf BWT and dystocia. Hypothetical culling of 10 or 20% of heifers was applied within age cohort after ranking by each of the following: unadjusted PA (PA); PA adjusted to 365 d of age (APA); PA:BW ratio (PA:BW); PA adjusted to the median BW of the group by the regression coefficient of PA on BW(BWPA) and PA similarly adjusted to the median lean BW (LBWPA). Dam parity, calf BWT and either BWPA or LBWPA were the only independent predictors of dystocia (P < 0.05), whereas the effect of PA tended to be significant only after adjusting for calf BWT (P = 0.08). After culling by PA or APA, retained heifers were heavier, had a higher calving rate and calves tended to be heavier at birth compared to culled heifers, but dystocia rates were not different. Although culling by PA:BW resulted in lower dystocia rate, it resulted in lower pre-breeding BW in retained than in culled heifers. Culling by BWPA and LBWPA had better sensitivity and specificity for dystocia than PA, and resulted in higher calving- and lower dystocia rates in the retained heifers, without affecting the pre-breeding BW or calf BWT. It was concluded that pelvimetry is a useful culling tool to aid in the management of dystocia in yearling heifers, and that adjustment of PA to median BW within age group improves its accuracy and avoids the undesirable side-effects of using unadjusted PA. The strong association of PA with calving rate resulted in the hypothesis for study 4, namely that PA can add prognostic value to RTS as a predictor of reproductive failure in beef heifers. Transrectal ultrasound (US) examination of the reproductive tract was also investigated in this study (n = 488) with the objective of identifying which ultrasonographic measures taken at a single point in time before the onset of breeding were independently associated with reproductive outcomes. In this study pregnancy failure was defined as the failure to become pregnant after the AI and bull breeding periods while anoestrus was defined as the failure to be detected in oestrus during the entire 50 d AI period. BCS, uterus horn diameter, absence of a CL, largest follicle of less than 13mm and PA were the pre-breeding examination variables that remained in prognostic models (P < 0.1). Combining either the model based on the three remaining US measures or RTS with PA provided more accurate prognostic models for pregnancy failure and anoestrus than using RTS alone (P < 0.05). It was concluded that US measures have prognostic value for pregnancy failure in restricted bred yearling heifers as a result of their association with anoestrus, and that smaller PA has additional value to identify poor performing heifers. In conclusion, pre-breeding examination is useful to identify beef cows with lower potential to reproduce successfully over the long term in a restricted breeding system. It is recommended that PA should always be included in such examination, either unadjusted or adjusted by BW, in herds with a low and high incidence of dystocia respectively, in combination with ultrasonography of the reproductive tract. When ultrasonography is not available, the accuracy of RTS by transrectal palpation can likely be improved by repeating it in low scoring animals after 7 days.
Thesis (PhD)--University of Pretoria, 2013.
gm2014
Production Animal Studies
unrestricted

Orientador: Júlio Carlos Canola
Banca: Fabrício Singaretti de Oliveira
Banca: Gilson Helio Toniollo
Resumo: As medidas dos diametros da pelve, obtidas diretamente sobre o filme radiografico, sao conhecidas como pelvimetria radiografica. Essa tecnica, que possibilita determinar o padrao pelvimetrico para cada raca, serve como subsidio para metodos profilaticos contra complicacoes que possam ocorrer durante o parto, alem de permitir a classificacao anatomica e obstetrica da pelve. Por meio da pelvimetria foram analisadas radiografias da pelve, na projecao ventrodorsal, de 250 femeas caninas adultas de diferentes racas, a fim de estabelecer as dimensoes pelvicas. Medias e desvios-padrao foram, respectivamente... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: The measurements of the diameters of the pelvis, the study radiographic is acquaintance as a pelvimetry radiographic. That know-how makes the assignation by possible standard pelvimetric for each breed , serving as a dole about to prevention against complications than is to may be become of during the break, besides from provide categorization anatomic and obstetric from the pelvis. By pelvimetry have been evaluated radiography the pelvis at the ventrodorsal radiographs of 250 female canine adult of different breeds, for the purpose of establish the dimensions pelvics. The averages and deflections norm have been respectively: Breed Brasilian Mastif... (Complete abstract, click electronic access below)
Mestre

Thesis (M. Tech. Agriculture) -- Central University of Technology, Free state, 2012
Low lifetime rearing success and high perinatal mortality have been associated with small pelvic areas of ewes. Ewes with small pelvic areas are more prone to experience dystocia during parturition and high perinatal mortality. It would thus make sense to include pelvic area as criterion in selecting breeding animals (rams) in an attempt to assure bigger pelvic areas in the female progeny as the heritability of pelvic area ranges between 50-60%. The aims of this study were to develop two instruments to accurately measure the pelvic area and rump slope in small stock, to investigate the hindquarter dimensions and to quantify the relationship between a number of easy to measure external body measurements and pelvic dimensions of Dorper sheep. The pelvic meter developed was pre-tested on 90 sheep prior to slaughtering at an abattoir and shortly after slaughter. The correlation between the pre- and post- slaughter measurements was highly significant (P <0.05; r = 0.85). In this study 272 Dorper and White Dorper rams (5-7 months of age) participating in the Northern Cape Veldram project and 332 young Dorper and White Dorper ewes (±12 months of age) from three different breeders were measured. The inside pelvic area was measured trans-rectally. The rams’ pelvic areas were measured five times transrectally, at 40 days intervals between the ages of 223 ± 41 and 385 ± 41 days of age. The height of the pelvis was obtained by measuring the distance between the dorsal pubic tubercle on the floor of the pelvis and the sacrum (spinal column) on the top. The width of the pelvis was measured as the widest distance, between the right and the left shafts of the ilium bones. The pelvic area was calculated using the π (PH/2)*(PW/2) formula. Other linear body measurements (body height, shoulder height, chest depth, forequarter width, hindquarter width, rump length) as well as body weight were taken. The rams’ rump slope was measured in degrees with an instrument that was developed for this purpose, and the ewes’ rump slope was visually scored on a scale from 1-5 with one being very flat and five being very droopy. The overall mean pelvic area of ewes 35.44 ± 4.89 cm2 and those of the rams 28.22 ± 3.21 cm2 differed with 7.22 cm2. Stud ewes recorded significantly larger (P <0.05) pelvic areas (37.38 ± 4.3 cm2) than commercial ewes (33.92 ± 3.77cm2). Results indicated that there are no significant correlations between pelvic dimensions and other body measurements considered in this study, indicating the need to measure pelvic area directly. Both the pelvic meter and rump slope meter, specially developed for this study, proved to be accurate and relatively practical to use in Dorper sheep.

Analisou-se pelves de 72 primatas neotropicais, adultos, 42 machos e 30 fêmeas não prenhes, da espécie Aotus azarai infulatus, para obtenção dos diâmetros pélvicos, in vivo, e compará-los com o dimorfismo sexual, correlacionando-os com a biometria corpórea e a origem dos animais. Mensurou-se nas radiografias em projeção ventro-dorsal, digitalizadas, os diâmetros biilíaco superior, biilíaco inferior, biilíaco médio, diagonal direito, diagonal esquerdo, sacro púbico e área da entrada da pelve. As médias verificadas foram: para o comprimento do corpo 30,94 cm; comprimento da cauda 35,63 cm; perímetro do tórax 18,97 cm; perímetro da pelve 17,11 cm e o peso 0,96 g. As médias verificadas para o DDD da pelve foram 2,61 cm; DDE 2,66 cm; DBIM 1,97 cm; DBIS 1,41 cm; DBII 1,58 cm; DSP 2,48 cm e a AEP 3,85 cm. Concluiu-se com o estudo que tendo sido verificados os diâmetros biilíaco médio menores do que os diâmetros sacro-púbico tanto nos machos quanto nas fêmeas, pode-se dizer a pelve de Aotus azarai infulatus é classificada como dolicopélvica e existe dimorfismo sexual em relação às pelves Aotus azarai infulatus adultos.
Related data to the diameters of the pelvis from 72 Neotropical primates, owl monkeys (Aotus azarai infulatus), 42 adult males and 30 adult non-pregnant females, were obtained in vivo by ventrodorsal projection radiographic exams, compared between sex and correlated with the measures of the body and their origin. The mean values of the body length (30.94 cm), tail length (35.63 cm), thoracic perimeter (18.97 cm), hip perimeter (17.11) and the weight (0.96 g) were verified. The radiographic images were digitalized and the superior biiliac (DBIS), inferior biiliac (DBII), medium biiliac (DBIM), right diagonal (DDD), left diagonal (DDE), sacrum-pubic diameters (DSP) and the inlet pelvic area (AEP) were measured. The mean values were DBIS 1.41 cm; DBII 1.58 cm; DBIM 1.97 cm; DDD 2.61 cm; DDE 2.66 cm; DSP 2.48 cm; AEP 3.85 cm. In conclusion, once medium biiliac diameters were minor than sacrum-pubic diameters in males and females, the pelvis from Aotus azarai infulatus can be classified as dolicopelvic and we also conclude there is pelvic sexual dimorphism in adult owl monkeys (Aotus azarai infulatus).

Dystocias can cause numerous losses inside the herd, such as: losses related to the parturient, the calf and with economic consequences like reduction in the milk yield, reduction of fertility, premature cull of cows and additional expenses with veterinary services. The fetus-pelvis incompatibility is the cause of calving difficulties in literature. The objective of this experiment was the measurement of the external and internal pelvic region of Holstein cows, besides the evaluation of its possible influence upon difficulty of birth presented by them, through the comparison between real observations and the usage of the Predicted Calving Difficulty Score. 236 Holstein cows were evaluated, between second and sixth birth order; their parturitions and respective calves. General corporeal, external and internal region measurements were done, using the pattern ruler and the Rice Pelvimeter®. The averages of the most important corporeal measures were: weight 696.88 kg; body length 1.56 m; body score 3.72. The average of the pelvis measures were: hook width 49.27 cm; pelvic width 18.62 cm; pelvic height 19.92 cm. The correlation estimated between corporeal extern measures and intern pelvic from the pelvis were of low intensity. The Predicted Calving Difficulty Score showed effective in the retratation of the difficulty degrees between natural births, degrees 1, 2 and 3, indicating that this can be a useful tool in order to avoid problems arising from dystocias inside the herd
A ocorrência de partos distócicos em uma propriedade pode acarretar inúmeros prejuízos por perdas relacionadas à parturiente, ao produto, com conseqüências econômicas como: redução na produção de leite, diminuição de fertilidade, descarte prematuro do animal, e gastos adicionais com manejo e serviços veterinários. A incompatibilidade feto-pélvica é a causa de distocias mais citada na literatura. Esse estudo foi realizado com o objetivo de mensurar a região pélvica externa e interna de vacas da raça Holandesa, avaliando uma possível influência destas sobre o grau de dificuldade de parto por elas apresentado, através da comparação entre as observações reais e o uso do escore de predição de dificuldade de parto. Foram avaliadas 236 vacas Holandesas, entre segunda e sexta ordem de parição, seus partos e respectivos bezerros. Mensurações corpóreas gerais e das regiões externa e interna da pelve das vacas foram realizadas utilizando régua padrão e Pelvímetro de Rice. As médias e desvios-padrão para as medidas corpóreas de maior importância foram: peso 696,88(±)75,95 kg; comprimento corporal 1,5(±)0,18 m; e escore corporal 3,72(±)0,28. As médias e desvios padrão para as medidas da pelve foram: biilíaca externa 49,27(±)3,00 cm; biilíaca interna média 18,62(±)1,21 cm; sacropubiana 19,91(±)1,61 cm. As estimativas de correlação entre medidas externas corpóreas e pélvicas e as medidas internas da pelve foram de baixa intensidade. O escore de predição de dificuldade de parto se mostrou efetivo na retratação dos graus de dificuldade entre os partos normal, grau 1, 2 e 3, indicando o mesmo como uma ferramenta útil para evitar problemas oriundos de distocias dentro do rebanho

Syftet med detta arbete var att utreda felkällor som förekommer vid användning av olika tekniker/modaliteter vid bäckenmätning. Då det finns risker med röntgenstrålning önskar man reducera stråldosen vid undersökningarna samtidigt som man vill använda sig av en enkel metod. De olika modaliteterna som jämförs är i) direktdigital detektor och bildplatta, ii) bildförstärkarteknikteknik, iii) CT. Den modalitet man använder sig av idag är direktdigital detektor och bildplatta. För att korrigera för förstoring som uppkommer vid röntgenundersökningen placeras en mätsticka i bildfältet. Om mätstickan vinklas mot sagittalplanet blir korrigeringen fel och detta visas i teori och praktiska försök. Bildförstärkare kan användas för att ta sidobilden. Bildförstärkarens geometriska egenskaper ger dessvärre en måttdistorsion så att objekt i det perifera bildfältet blir förstorade mer än objekt centralt belägna. Det har inte framkommit något bra sätt att korrigera för distorsionen. CT har inte använts vid bäckenmätningar på Helsingborgs lasarett tidigare. Att använda topogrammet vid CT- undersökning kan även det vara behäftat med längddistorsion och förslag ges hur man kan korrigera för felet. I CT-snittbilder fås ingen längddistorsion.

Einleitung Aufgrund verschiedener Studien zum fetalen Outcome – darunter die große prospektive, multizentrische Studie von Hannah et al. aus dem Jahre 2000 – galt die primäre Sectio caesarea (Sectio) jahrzehntelang als sicherster Geburtsmodus bei Beckenendlage (BEL). Bis 2006 boten 92,5 % der Geburtszentren den Gebärenden keine vaginale Entbindung aus BEL an [1–6]. Die kritische Aufarbeitung der Studiendaten von Hannah et al. ergab schwere Mängel im Design und in der Durchführung, was zur späteren Relativierung der Studienergebnisse führte [7, 8]. Anschließende Veröffentlichungen derselben und anderer Autoren zeigten, dass sich das 2-Jahres-Outcome von vaginal und operativ aus BEL entbundenen Kindern und von Kindern nach vaginaler Entbindung aus einer Schädellage nicht unterscheidet. Eine wichtige Voraussetzung für ein adäquates Outcome bei einer vaginalen Entbindung aus BEL ist eine optimale und sofortige postpartale neonatologische Betreuung. [7, 9–13] Durch den Trendwandel, Frauen bei BEL wieder eine vaginale Entbindung anzubieten, gewinnt die Betreuung, die Risikoselektion und die Aufklärung der Patientinnen durch spezialisierte Fachkräfte zunehmend an Bedeutung [9, 19–21]. Insbesondere die Risiken für das Kind erfordern es, dass die Planung und die Leitung einer vaginalen Geburt aus BEL in einem Zentrum mit einem erfahrenen geburtsmedizinischen und neonatologischen Team erfolgt. Neben der praktischen Erfahrung bei der Kindsentwicklung und der Verwendung geburtsmedizinischer Handgriffe ist auch eine adäquate, routinierte neonatologische Betreuung unabdingbar, um ein gutes Langzeit-Outcome zu gewährleisten [11, 12, 21, 22]. Nach den derzeitigen Leitlinien werden für die pränatale Risikoselektion anamnestische und klinische Parameter sowie die sonografische Gewichtsschätzung verwendet. Beispielsweise wurden höhere Erfolgsraten und eine geringere neonatale Morbidität bei Mehrgebärenden beschrieben und ein höheres Risiko für Feten mit intrauteriner Wachstumsrestriktion (Geburtsgewicht ≤10. Perzentile) [5, 10, 12]. Der Wert einer zusätzlichen Beckendiagnostik ist umstritten und in den aktuellen Leitlinien nicht explizit gefordert. Trotzdem nutzen einige Zentren – darunter das Perinatalzentrum der Universität Leipzig – insbesondere bei der Risikogruppe der Erstgebärenden – eine zusätzliche Pelvimetrie. Diese wird heute mittels Magnet-resonanz¬tomografie (MRT) durchgeführt. Das Hauptanliegen der Untersuchung ist der Ausschluss eines feto-maternalen Missverhältnisses und der damit verbundenen Risiken. Zusätzlich generiert diese Selektionsmaßnahme ein stärkeres Vertrauen sowohl bei den Schwangeren als auch bei den betreuenden Ärzten in den Erfolg der geplanten vaginalen Entbindung aus BEL. Welche pelvimetrischen Parameter für die Selektion geeignet sind, wurde für die MRT bisher nicht untersucht. Die Identifikation geeigneter Prognoseparameter ist aber unabdingbar, um Schwangere mit dem generellen Wunsch einer vaginalen Entbindung auf sichere Weise zu unterstützen. Material und Methoden In der vorliegenden monozentrischen Analyse des Perinatalzentrums Level 1 der Universitätsklinik Leipzig wurden 62 erstgebärende Patientinnen mit geplantem Spontanpartus bei BEL untersucht. Die retrospektive Analyse umfasst einen Zeitraum von 2 Jahren (01.01.2011–31.12.2012). Im Rahmen der Geburtsplanung war neben der Selektion gemäß den deutschen Leitlinien nach hausinternem Standard auch eine zusätzliche MRT-Untersuchung erfolgt [21]. Hierbei wurde eine CV ≥ 12 cm als Grenzwert festgelegt. Patientinnen mit Kontraindikationen für eine vaginale Entbindung gemäß den deutschen Leitlinien oder einer CV < 12 cm oder einer nicht vollständigen Geburtsplanung erhielten eine primäre Sectio und wurden in dieser Studie nicht berücksichtigt. Auch Patientinnen mit Mehrlingsschwangerschaften wurden aus der Analyse ausgeschlossen. Vor Durchführung der Studie lag ein positives Votum der Ethikkommission vor. Neben den anamnestischen Daten der Schwangeren, wie Alter, Gewicht, BMI, Körpergröße, Beckenanomalien und Vorerkrankungen wurden Distanzen (CV, SOD, CPO, PW, ISD und ITD) und Winkel (PI, PAA, PIA) des knöchernen Beckens mittels einer MRT-Untersuchung um die 36. SSW von 2 Untersucherinnen gemessen und die Genauigkeit der Messungen anhand der Interraterreliabilität und der Intraraterreliabilität geprüft. Die fetalen Proportionen, wie der Kopfumfang, BIP, FOD, Abdomenumfang und Femurlänge, sowie das Schätzgewicht wurden per Sonografie in der 35. - 37. SSW (1. Sonografie) und bei Geburt in der 38. - 40. SSW (2. Sonografie) über die Formel nach Merz et al. und Hadlock et al. bestimmt [56, 58]. Die Daten des neonatalen Outcomes, wie Gewicht, Körperlänge, Kopfumfang, APGAR, pH-Wert und Base Excess des Nabelschnurblutes wurden kurz nach der Geburt erhoben. Das Outcome des Geburtsmodus, sowie die Art des Geburtsbeginns wurden erhoben. Die Patientinnen wurden nach dem Outcome ihrer Entbindung – vaginal vs. sekundäre Sectio – in 2 Gruppen eingeteilt. Die Neonaten wurden nach gutem (APGAR-1 > 5 und APGAR-2 >7) und schlechtem (APGAR-1 ≤ 5 und APGAR-2 ≤ 7) frühen neonatalen Outcome in 2 Gruppen eingeteilt. Die Gruppen vaginale Entbindung und die Gruppe sekundäre Sectio wurden auf Ihre Unterschiede in den anamnestischen Daten der Mütter, den MRT-Messungen, sowie den beiden Sonografien (1. und 2. Sonografie) und dem neonatalen Outcome verglichen. Alle signifikanten Parameter wurden in eine univariate und eine multivariate logistische Regressionsanalyse eingeschlossen. Die Gruppen des frühen neonatalen Outcomes wurden ebenfalls auf alle vorangegangenen Parameter der Mütter, sowie der Neugeborenen verglichen. Ergebnisse Die Rate der vaginalen Entbindungen lag bei 56,5 % (35/62) und die der sekundären Sectiones bei 43,5% (27/62). Von den anamnestischen Daten der Mütter war der BMI bei Schwangerschaftsbeginn in der Gruppe der sekundären Sectios (22,7  2,8) höher als in der Gruppe der vaginalen Entbindungen (21,3  2,3; p = 0,044; T = -2,06). Die 1. Sonografie fand im Mittel in der 36,5 SSW statt. Bei dieser Untersuchung waren der fetale Abdomenumfang (AU) und das fetale Schätzgewicht (SG) in der Gruppe der sekundären Sectio Patientinnen signifikant höher (AU = 307 ± 14 mm vs. 296 ± 19 mm; p = 0,014; T = -2,54; SG = 2781 ± 278 g vs. 2573 ± 353 g; p = 0,015; T= -2,5). Im Vergleich der Schätzung der Körpergewichte stellte sich die Formel von Merz et al. als genauer am Geburtsgewicht dar als vergleichbare Formeln von Hadlock et al. [56, 58]. Die Intraobserver-Variabilität für die MRT-Messungen, sowie die Interobserver-Variabilität für die Messung waren für alle Strecken und Winkel genau bis sehr genau. Die PW (pelvic width=Beckenweite), der ISD (Interspinaler Diameter) und der ITD (Intertubärer Diameter) waren signifikant größer in der Gruppe der Sectio entbundenen Patientinnen (PW = 13,9 ± 1 cm vs. 13,3 ± 0,9 cm; p = 0,041; T = 2,1; ISD = 11,35 ± 0,7 cm vs. 10,5 ± 0,9; p = <,000; T = 3,8; ITD = 14,1 ± 1 cm vs. 13,5 ± 1,1 cm; p = 0,033; T = 2,2). Alle signifikanten Parameter wurden in einer univariaten und einer multivariaten logistischen Regressionsanalyse auf ihr Vorhersagepotential des Geburtsmodus analysiert. In der univariaten Regression waren PW, ISD und ITD signifikant als Vorhersageparameter für den Geburtsmodus. In der multivariaten Regressionsanalyse zeigte sich einzig der ISD noch als signifikanter Vorhersageparameter für den Geburtsmodus (p = 0,013; ExpB = 0,195 [0,053 – 0,711]. Die ROC-Kurve für den ISD zeigt mit einer AUC = 74,3 % und mit der Regressionsgleichung y = 14,483 - 1,349 * ISD, dass der Einfluss des ISD auf den Geburtsmodus vaginal signifikant ist. Ab einem ISD von ≥ 11,35 cm sinkt die Wahrscheinlichkeit für die Notwendigkeit einer sekundären Sectio auf < 30 %. Die Art des Geburtsbeginns (medikamentös vs. spontan hatte keinen Einfluss auf den Geburtsverlauf. Bei der Auswertung der neonatalen Parameter zeigte sich nur der Base Excess niedriger bei den vaginal entbundenen Neugeborenen (BE = -6,93 ± 3,8 vs. -4,9 ± 4,8; p = 0,014; T = -2,54). Im Vergleich der frühen neonatalen Outcomegruppen (gutes vs. schlechtes Outcome) unterschieden sich weder die MRT-Parameter noch die Charakteristika der Neugeborenen. Diskussion In der klinischen Praxis ist die MRT-Pelvimetrie zur Präselektion von Erstgebärenden, die bei BEL eine vaginale Geburt planen, fest etabliert. Es werden allerdings Grenzwerte genutzt, die noch mit konventioneller Röntgen-Bildgebung generiert wurden [35–41] und zum Teil erheblich variieren (siehe Kap. 1.6.1.) [35–41]. Darüber hinaus ist das prognostische Potenzial der mit MRT-Pelvimetrie erhobenen Beckenparameter auf den Geburtsverlauf bis heute nicht ausreichend validiert. Hier setzt die vorliegende Studie an. Im Rahmen einer retrospektiven Analyse wurden bei 62 erstgebärenden Patientinnen mit geplantem Spontanpartus bei BEL untersucht, inwiefern die Beckenparameter CV, PW, SOD, CPO, ISD, ITD, PIA, PAA, PI geeignet sind, um den Geburtsverlauf – vaginale Geburt vs. sekundäre Sectio – vorherzusagen. Dabei erwies sich lediglich der ISD als signifikanter prognostischer Faktor für eine erfolgreiche vaginale Geburt. Aufgrund seiner Lage im mittleren Beckenniveau bildet dieser den Beckenraum genauer ab als ein Parameter des Beckeneingangs, wie die CV.:Inhaltsverzeichnis Inhaltsverzeichnis II Abkürzungsverzeichnis VI 1 Einführung 7 1.1 Definition und Inzidenz 8 1.2 Äußere Wendung 9 1.3 Geburtsmodi bei BEL 10 1.3.1 Vaginale Entbindung 10 1.3.2 Primäre (elektive) Sectio 11 1.3.3 Sekundäre Sectio 11 1.4 Geburtsplanung bei BEL 11 1.5 Rolle der Pelvimetrie 12 1.5.1 Konventionelle (Röntgen-) Pelvimetrie 12 1.5.2 MRT-Pelvimetrie 12 2 Aufgabenstellung 14 3 Material und Methoden 15 3.1 Patientinnenkollektiv 15 3.2 Sonografie 15 3.2.1 Kopfumfang 16 3.2.2 Abdomenumfang 17 3.2.3 Femurlänge 18 3.2.4 Fetales Schätzgewicht 19 3.3 Magnetresonanztomografie (MRT) 20 3.3.1 T1- und T2-Wichtung 21 3.3.2 Spin-Echo (SE) und Turbo-Spin-Echo (TSE) Sequenz 22 3.3.3 Pelvimetrische Parameter 23 3.3.4 Abstände im Sagittalschnitt 24 3.3.5 Winkel im Sagittalschnitt 25 3.3.6 Abstände im Transversalschnitt 27 3.4 Outcome 28 3.4.1 Maternales Outcome 28 3.4.2 Neonatales Outcome 29 3.5 Statistik 30 4 Ergebnisse 31 4.1 Anamnestische Daten 31 4.2 Bildgebung für die pränatale Selektion 32 4.2.1 Sonografie bei der Geburtsplanung (1. Sonografie) 32 4.2.2 Sonografie vor der Entbindung (2. Sonografie) 33 4.3 Vergleich der Methoden zur Schätzung des Kindsgewichtes 34 4.4 MRT-Parameter 36 4.4.1 MRT-Abstände 38 4.4.2 MRT-Winkel 39 4.4.3 Korrelationen der MRT-Parameter 40 4.4.4 Logistische Regressionsanalyse 41 4.4.5 Interspinaler Abstand (engl. interspineous diameter, ISD) 42 4.5 Outcome der Geburt 44 4.6 Neonatales Outcome 46 4.6.1 Vaginale Geburt und Sekundäre Sectio 46 4.6.2 Gutes und schlechtes neonatales Outcome 47 4.6.3 Einfluss der maternalen Parameter 48 4.6.4 Neonatale Parameter 49 5 Diskussion 50 5.1 Prognostischer Stellenwert der MRT-Pelvimetrie bei BEL 50 5.1.1 Prognostische Rolle der CV 50 5.1.2 Prognostische Rolle des ISD 51 5.1.3 Weitere MRT-Parameter mit potenzieller prognostischer Relevanz 52 5.1.4 Eignung der MRT-Pelvimetrie zur Prognose des Geburtsverlaufs bei BEL 54 5.2 Einfluss der anamnestischen Daten der Mütter auf den Geburtsmodus 56 5.3 Fetale Einflussfaktoren auf den Geburtsmodus 58 5.3.1 Einfluss des Geburtsmodus auf das Outcome des Neugeborenen 61 5.4 Einflussfaktoren der Geburtseinleitung auf den Geburtsmodus 62 5.5 Neonatales Outcome 62 5.5.1 Geburtsmodus und neonatales Outcome 62 5.5.2 Einfluss der Pelvimetrie-Parameter der Mütter auf das frühe neonatale Outcome 63 5.6 Limitationen 64 5.7 Fazit 65 6 Zusammenfassung 66 7 Literatur 71 8 Erklärung über die eigenständige Abfassung der Arbeit 82 9 Eigene wissenschaftliche Beiträge 83