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MR Imaging Pelvimetry: A Useful Adjunct in the Treatment of Women at Risk for Dystocia?

¹ Department of Obstetrics and Gynecology, University of Bern, Inselspital, Effingerstr. 3010 Bern, Switzerland.
² Department of Obstetrics and Gynecology, Kantonsspital, 1708 Freiburg, Switzerland.
³ Institute of Diagnostic Radiology, University of Bern, Inselspital, 3010 Bern, Switzerland.

OBJECTIVE. The objective of this study was to test the clinical value of MR imaging for diagnosing cephalopelvic disproportion and for predicting labor outcome in women at risk for dystocia.

SUBJECTS AND METHODS. Antepartum fetal sonography and maternal MR imaging pelvimetry measurements were performed at term in 38 pregnant women at risk for dystocia with a single fetus in cephalic presentation. Various methods used to diagnose cephalopelvic disproportion were evaluated in a blinded manner for their accuracy to predict both the presence of cephalopelvic disproportion and the mode of delivery (vaginal vs cesarean).

RESULTS. None of the methods tested yielded both high sensitivity (15-100%) and high specificity (24-92%) for determining the presence of cephalopelvic disproportion and high levels of accuracy for predicting labor outcome (overall predictability, 50-74%).

CONCLUSION. To achieve increased reliability of MR imaging pelvimetry in the diagnosis and treatment of dystocia and in predicting labor outcome, new methods assessing fetal-pelvic compatibility, including measurements of the pelvic outlet and the shape and configuration of the pelvis, need to be established and prospectively tested before firm recommendations for clinical use can be made.

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