Management of birth under ultrasound guidance in patients with the transversely contracted pelvis
Kurtser М.А., Ivanova N.Yu., Breslav I.Yu., Maryasheva Yu.A.
Relevance: Currently, different types of the contracted pelvis are mainly determined with the help of radiological diagnostic methods before pregnancy or in the antenatal period. Intranatally, biomechanism of childbirth characterizes the form of the pelvic contraction. In order to obtain objective manual data, a combined transabdominal and transperineal ultrasound assessment is proposed, as it an effective, safe and accurate method for monitoring the ratio of the fetal head and the birth canal.
Case report: The article presents a clinical case of a patient whose transperineal ultrasound scanning revealed that labor started with asynclitic insertion of the fetal head with a sagittal suture in the conjugate of the pelvic inlet. The occipital posterior presentation was diagnosed and the type of the transversely contracted pelvis was suspected. The progress of the fetal head in labor was evident due to an increase in the angle of progression from 106° to 125°, while the sagittal suture remained in the conjugate of the true pelvis. When the cervix was fully dilated and the angle of progression was 154°, the rotation of the head by 180° began in the plane of the pelvic outlet. The birth occurred with the anterior occipital cephalic presentation.
Conclusion: The patients with the transversely contracted pelvis may give birth spontaneously only if fetus takes the anterior occipital cephalic presentation. In case of initial posterior presentation, giving birth will occur naturally through the birth canal, only when the fetal head is rotated 180° and the fetus takes the anterior presentation. The high direct position of the fetal head is accompanied by signs of clinical inconsistency. The use of ultrasound criteria made it possible to establish a type of the contracted pelvis, which was confirmed by MRI, and it was also possible to provide evidence of the likelihood of the spontaneous birth.
Authors’ contributions: Kurtzer M.A. – text editing and final approval of the manuscript; Ivanova N.Yu. – concept, design of the study, analysis of publications, writing the text of the manuscript, provision of digital images; Breslav I.Yu. – editing the text of the manuscript, design of illustrations; Maryasheva Yu.A. – carrying out research, providing digital images, design of illustrations.
Conflicts of interest: Authors declare lack of the possible conflicts of interest.
Funding: The study was conducted without sponsorship.
Ethical Approval: The study was approved by the Ethical Review Board of the Pirogov Russian National Research Medical University, Ministry of Health of Russia.
Patient Consent for Publication: The patient provided an informed consent for the publication of her data and associated images.
For citation: Kurtser М.А., Ivanova N.Yu., Breslav I.Yu., Maryasheva Yu.A. Management of birth under ultrasound guidance in patients with the transversely contracted pelvis.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (2): 152-156 (in Russian)
https://dx.doi.org/10.18565/aig.2023.273
Keywords
birth under ultrasound guidance
transversely contracted pelvis
transperineal scanning
angle of progression
angle of rotation
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Received 24.11.2023
Accepted 22.01.2024
About the Authors
Mark A. Kurtser, Dr. Med. Sci., Professor, Academician of the Russian Academy of Sciences, Head of Savelyeva Department of Obstetrics and Gynecology, Pediatric Faculty, Pirogov Russian National Research Medical University, Ministry of Health of Russia, 111997, Russia, Moscow, Ostrovitianov str., 1, +7(495)719-78-96, m.kurtser@mcclinics.ru, https://orcid.org/0000-0003-0175-1968Irina Yu. Breslav, Dr. Med. Sci., Professor of Savelyeva Department of Obstetrics and Gynecology, Pediatric Faculty, Pirogov Russian National Research Medical University, Ministry of Health of Russia 111997, Russia, Moscow, Ostrovitianov str., 1, +7(495)719-78-96, irina_breslav@mail.ru, https://orcid.org/0000-0002-0245-4968
Natalia Yu. Ivanova, Ultrasound Diagnostics Doctor, Ultrasound Diagnostics Department, MD GROUP Clinical Hospital, 117209, Russia, Moscow, Sevastopolsky Ave., 24/1, +7(968)500-99-88, ny.ivanova@mcclinics.ru, https://orcid.org/0009-0009-9826-1287
Yulia A. Maryasheva, PhD, Radiologist, Radiology Department, MD GROUP Clinical Hospital, 117209, Russia, Moscow, Sevastopolsky Ave., 24/1, +7(926)524-95-87, maryasheva@mail.ru, https://orcid.org/0009-0007-5062-5390
Corresponding author: Irina Yu. Breslav, irina_breslav@mail.ru
