Pelvic capacity in pregnant women, identified using magnetic resonance imaging

Acta Obstet Gynecol Scand. 2021 Aug;100(8):1454-1462. doi: 10.1111/aogs.14168. Epub 2021 Jun 15.

Abstract

Introduction: Maternal pelvic capacity plays a major role during childbirth because the passage of the fetus through the bony birth canal enables vaginal birth. Maternal birthing position may influence pelvic capacity because upright positions optimize capacity, possibly due to free movement of the pelvic joints. Herein, pelvic capacity was assessed by comparing changes in pelvic dimensions across pregnancy and in three birthing positions.

Material and methods: This diagnostic imaging study of 50 pregnant women was conducted at Aarhus University Hospital, Denmark. Pelvic measurements were obtained with 1.5 T magnetic resonance pelvimetry during gestational weeks 20 and 32, in three birthing positions: kneeling squat, semi-lithotomy and supine. Pelvic capacity was compared between gestational weeks and positions.

Results: In all three positions there is an overall increase in pelvic capacity from gestational week 20-32 at both the pelvic inlet and outlet. Comparing pelvic capacity at gestational week 32 between the semi-lithotomy and supine positions revealed that the pelvic inlet was larger in the supine position, whereas the mean pelvic outlet was 0.2 cm (p < 0.001) larger in the semi-lithotomy position. Likewise, the pelvic inlet was larger in the supine than in the kneeling squat position. Shifting from supine to kneeling squat position increased the midplane and pelvic outlet dimensions by up to 1 cm (p < 0.001).

Conclusions: The finding herein of an increased pelvic capacity as the pregnancy progresses is novel. Further, the results indicate that the supine position is optimal for increasing pelvic inlet size, whereas the semi-lithotomy and kneeling squat positions are optimal for increasing mid- and outlet-pelvic capacities.

Keywords: birthing positions; magnetic resonance imaging; pelvic capacity; pelvimetry; physiological childbirth; pregnancy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Delivery, Obstetric*
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Patient Positioning*
  • Pelvis / diagnostic imaging
  • Pelvis / physiology*
  • Pregnancy
  • Pregnant Women
  • Reference Values
  • Young Adult