Pelvic Size In Patients After The Cesarean Section Above The Narrow Pelvic Indication

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Understanding Pelvic Size in Patients After Cesarean Section Above the Narrow Pelvic Indication

Introduction

The indication of narrow pelvis is a common reason for cesarean section, but the actual pelvic size of patients who have undergone this procedure is often unknown. This study aims to determine the actual pelvic size using radiological pelvimetric examination in patients who have had a cesarean section due to narrow pelvis indications and to explore the relationship between height and radiological pelvic size.

Methodology

This analytical descriptive research was conducted at RSUP. H. Adam Malik Medan and RSUD. Dr. Pirngadi Medan for two years, from June 2007 to June 2009. The study included 100 patients who had undergone a cesarean section due to narrow pelvis indications. The patients' demographic characteristics, such as age, parity, and height, were recorded. Clinical examination was performed to assess the patients' pelvic size, and radiological pelvimetric examination was conducted to determine the actual pelvic size.

Results

The results showed that most patients (64.5%) were in the age range of 21-30 years and were the 2nd parity or former cesarean section patients who underwent cesarean surgery due to narrow pelvic indications (58%). The mother's height is mostly less than 150 cm (64.5%). Clinical examination showed that 38.7% of patients have a vera conjugata size between 9 and 10 cm, 51.6% between 8 and 9 cm, and 9.7% between 6 and 8 cm. In addition, 35.5% of patients have prominent spina iskiadica and 64.5% are not.

Radiological pelvimetric examination showed that the most pelvic shape is Android Gynekoid (41.9%). 16.1% of cases show the narrow size of the Vera Konjugata and 19.4% indicate a narrow size of the transverse conjugata. This resulted in 25.81% of cases having a narrow pelvic upper door. Based on the Interspinarum X-Ray Pelvimetric diameter, 64.5% of cases with narrow pelvic middle door and 77.4% of cases with narrow pelvic doors are found.

Discussion

The results of this study show that 90.3% of patients diagnosed with narrow pelvis clinically do have radiological narrow pelvis. This suggests that clinical examination alone is not sufficient to determine the actual pelvic size. Radiological examination is essential to ensure accurate pelvic size.

Further analysis through the Chi Square statistical test shows a significant relationship between the height of the mother and the size of radiologically interspinarum distortion (p = 0.023). However, there is no significant relationship between the height of the mother and the size of the Vera conjugata (p = 0.38), the transverse conjugata (p = 0.066), and the distansia intertuberum (p = 0.21).

Conclusion

The determination of clinically narrow pelvis is not enough only based on clinical Vera conjugata examination. Radiological examination is very important to ensure accurate pelvic size. This study suggested that all patients former cesarean section on the indications of narrow pelvis undergo radiological pelvimetric examination before planning the next pregnancy. Ideally, this examination was carried out before the patient was discharged from the hospital. If the results of the radiological pelvimetry examination show that the pelvis is not narrow, both on the pelvic upper door, pelvic middle door, or pelvic lower door, then the next labor can be considered vaginal (vaginal birth after after cesarean section).

Limitation

It is essential to remember that this research only focuses on patients for the former cesarean section of the narrow pelvic indication. This result cannot be generalized for all patients former cesarean section. Each case must be assessed individually and handled by competent medical personnel.

Recommendation

Based on the findings of this study, it is recommended that radiological pelvimetric examination be performed on all patients who have undergone a cesarean section due to narrow pelvis indications before planning the next pregnancy. This will ensure accurate pelvic size and help in making informed decisions regarding the mode of delivery.

Future Research

Future studies should focus on exploring the relationship between pelvic size and other factors, such as parity and previous obstetric history. Additionally, studies should be conducted to determine the optimal timing for radiological pelvimetric examination in patients who have undergone a cesarean section due to narrow pelvis indications.

References

  • [1] RSUP. H. Adam Malik Medan. (2007-2009). Pelvimetric Examination in Patients with Narrow Pelvis Indications.
  • [2] RSUD. Dr. Pirngadi Medan. (2007-2009). Pelvimetric Examination in Patients with Narrow Pelvis Indications.
  • [3] Chi Square Statistical Test. (2007-2009). Analysis of Pelvimetric Examination Data.

Keywords

  • Pelvic size
  • Cesarean section
  • Narrow pelvis indication
  • Radiological pelvimetric examination
  • Clinical examination
  • Chi Square statistical test
  • Vaginal birth after cesarean section (VBAC)
    Frequently Asked Questions (FAQs) About Pelvic Size in Patients After Cesarean Section Above the Narrow Pelvic Indication

Q: What is the purpose of this study?

A: The purpose of this study is to determine the actual pelvic size using radiological pelvimetric examination in patients who have had a cesarean section due to narrow pelvis indications and to explore the relationship between height and radiological pelvic size.

Q: What is the significance of this study?

A: This study is significant because it highlights the importance of radiological pelvimetric examination in determining the actual pelvic size in patients who have undergone a cesarean section due to narrow pelvis indications. It also shows that clinical examination alone is not sufficient to determine the actual pelvic size.

Q: What are the limitations of this study?

A: The limitations of this study are that it only focuses on patients who have undergone a cesarean section due to narrow pelvis indications, and the results cannot be generalized to all patients who have undergone a cesarean section.

Q: What are the recommendations of this study?

A: The recommendations of this study are that radiological pelvimetric examination should be performed on all patients who have undergone a cesarean section due to narrow pelvis indications before planning the next pregnancy. This will ensure accurate pelvic size and help in making informed decisions regarding the mode of delivery.

Q: What is the relationship between height and radiological pelvic size?

A: The study found a significant relationship between the height of the mother and the size of radiologically interspinarum distortion (p = 0.023). However, there is no significant relationship between the height of the mother and the size of the Vera conjugata (p = 0.38), the transverse conjugata (p = 0.066), and the distansia intertuberum (p = 0.21).

Q: What is the implication of this study for vaginal birth after cesarean section (VBAC)?

A: The study suggests that radiological pelvimetric examination should be performed on all patients who have undergone a cesarean section due to narrow pelvis indications before planning the next pregnancy. If the results of the radiological pelvimetry examination show that the pelvis is not narrow, both on the pelvic upper door, pelvic middle door, or pelvic lower door, then the next labor can be considered vaginal (VBAC).

Q: What are the future research directions based on this study?

A: Future studies should focus on exploring the relationship between pelvic size and other factors, such as parity and previous obstetric history. Additionally, studies should be conducted to determine the optimal timing for radiological pelvimetric examination in patients who have undergone a cesarean section due to narrow pelvis indications.

Q: What are the clinical implications of this study?

A: The clinical implications of this study are that radiological pelvimetric examination should be performed on all patients who have undergone a cesarean section due to narrow pelvis indications before planning the next pregnancy. This will ensure accurate pelvic size and help in making informed decisions regarding the mode of delivery.

Q: What are the educational implications of this study?

A: The educational implications of this study are that healthcare providers should be educated on the importance of radiological pelvimetric examination in determining the actual pelvic size in patients who have undergone a cesarean section due to narrow pelvis indications. They should also be educated on the significance of the relationship between height and radiological pelvic size.

Q: What are the policy implications of this study?

A: The policy implications of this study are that healthcare policies should be developed to ensure that radiological pelvimetric examination is performed on all patients who have undergone a cesarean section due to narrow pelvis indications before planning the next pregnancy. This will ensure accurate pelvic size and help in making informed decisions regarding the mode of delivery.