Computed tomographic study of anatomical relationship between pubic symphysis and ischial spines to improve interpretation of intrapartum translabial ultrasound

Abstract

Objective: 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). Methods: 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. Results: 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°. Conclusion: 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.