The evolution of pelvic canal shape and rotational birth in humans

Background The human foetus typically needs to rotate when passing through the tight birth canal because of the complex shape of the pelvis. In most women, the upper part, or inlet, of the birth canal has a round or mediolaterally oval shape, which is considered ideal for parturition, but it is unknown why the lower part of the birth canal has a pronounced anteroposteriorly oval shape. Results Here, we show that the shape of the lower birth canal affects the ability of the pelvic floor to resist the pressure exerted by the abdominal organs and the foetus. Based on a series of finite element analyses, we found that the highest deformation, stress, and strain occur in pelvic floors with a circular or mediolaterally oval shape, whereas an anteroposterior elongation increases pelvic floor stability. Conclusions This suggests that the anteroposterior oval outlet shape is an evolutionary adaptation for pelvic floor support. For the pelvic inlet, by contrast, it has long been assumed that the mediolateral dimension is constrained by the efficiency of upright locomotion. But we argue that the mediolateral elongation has evolved because of the limits on the anteroposterior diameter imposed by upright posture. We show that an anteroposteriorly deeper inlet would require greater pelvic tilt and lumbar lordosis, which compromises spine health and the stability of upright posture. These different requirements of the pelvic inlet and outlet likely have led to the complex shape of the pelvic canal and to the evolution of rotational birth characteristic of humans.

Application of a three-dimensional virtual model to study the effect of fluoroscopic angle on infra-acetabular corridor parameters and screw insertion rates

Purpose To use three-dimensional (3D) virtual models to study how the parameters and insertion rates of the infra-acetabular corridor (IAC) change under different fluoroscopic angles. Methods The pelvis computed tomography data of 187 patients are imported into Mimics software in DICOM format to generate a 3D model. The anterior pelvis plane is used as the reference plane to measure the diameter of the optimum IAC when the pelvis model is tilted forward by 5°, 15°, 25°, 35° and 45°. The diameter of at least 3.5 mm is defined as the cutoff for placing a 3.5 mm screw, the rate of infra-acetabular screw (IAS) insertion is calculated, and the mean length of the IAC and the mean tilt of the corridor axis in relation to the sagittal midline plane (SMP) are measured. Results The similar diameters of the IAC can be found under fluoroscopy at 5°–35°, with the largest diameter of 4.08 ± 1.84 mm and the highest screw insertion rate of 60.42% at 15° and 25°, whereas the diameter and insertion rate are lowest at 45°. The corridor length increases with increasing fluoroscopic angle, and the angle of the corridor axis to the SMP decreases gradually. Conclusion The conventional fluoroscopic angle of the pelvic inlet is not suitable for the IAS insertion. The parameters of the IAC vary according to a certain rule under different fluoroscopic angles, so a surgeon can select the appropriate fluoroscopic angle in accordance with the type of fracture and the fracture line angle.

Application of a three-dimensional virtual model to study the effect of fluoroscopic angle on infra-acetabular corridor parameters and screw insertion rates

Purpose To use three-dimensional (3D) virtual models to study how the parameters and insertion rates of the infra-acetabular corridor (IAC) change under different fluoroscopic angles. Methods The pelvis computed tomography data of 187 patients are imported into Mimics software in DICOM format to generate a 3D model. The anterior pelvis plane is used as the reference plane to measure the diameter of the optimum IAC when the pelvis model is tilted forward by 5°, 15°, 25°, 35° and 45°. The diameter of at least 3.5 mm is defined as the cutoff for placing a 3.5 mm screw, the rate of infra-acetabular screw (IAS) insertion is calculated, and the mean length of the IAC and the mean tilt of the corridor axis in relation to the sagittal midline plane (SMP) are measured. Results The similar diameters of the IAC can be found under fluoroscopy at 5°–35°, with the largest diameter of 4.08 ± 1.84 mm and the highest screw insertion rate of 60.42% at 15° and 25°, whereas the diameter and insertion rate are lowest at 45°. The corridor length increases with increasing fluoroscopic angle, and the angle of the corridor axis to the SMP decreases gradually. Conclusions The traditional 45° pelvic inlet radiograph is not suitable as the fluoroscopic angle for IAS insertion. The parameters of the IAC vary according to a certain rule under different fluoroscopic angles, so a surgeon can select the appropriate fluoroscopic angle in accordance with the type of fracture and the fracture line angle.

Recent Possibilities for the Diagnosis of Early Pregnancy and Embryonic Mortality in Dairy Cows

One of the most recent techniques for the on-farm diagnosis of early pregnancy (EP) in cattle is B-mode ultrasonography. Under field conditions, acceptable results may be achieved with ultrasonography from Days 25 to 30 post-AI. The reliability of the test greatly depends on the frequency of the transducer used, the skill of the examiner, the criterion used for a positive pregnancy diagnosis (PD), and the position of the uterus in the pelvic inlet. Non-pregnant animals can be selected accurately by evaluating blood flow in the corpus luteum around Day 20 after AI, meaning we can substantially improve the reproductive efficiency of our herd. Pregnancy protein assays (PSPB, PAG-1, and PSP60 RIA, commercial ELISA or rapid visual ELISA tests) may provide an alternative method to ultrasonography for determining early pregnancy or late embryonic/early fetal mortality (LEM/EFM) in dairy cows. Although the early pregnancy factor is the earliest specific indicator of fertilization, at present, its detection is entirely dependent on the use of the rosette inhibition test; therefore, its use in the field needs further developments. Recently found biomarkers like interferon-tau stimulated genes or microRNAs may help us diagnose early pregnancy in dairy cows; however, these tests need further developments before their general use in the farms becomes possible.

The evolution of pelvic canal shape and rotational birth in humans

The human foetus needs to rotate when passing through the tight birth canal because of the complex shape of the pelvis. In most women the upper part, or inlet, of the birth canal has a round or mediolaterally oval shape, which is considered ideal for parturition, but it is unknown why the lower part, or outlet, of the birth canal has a pronounced anteroposteriorly oval shape. Here we show that the shape of the lower birth canal affects the ability of the pelvic floor to resist pressure exerted by the abdominal organs and the foetus. Based on a series of finite element analyses, we found that the highest deformation, stress and strain occur in pelvic floors with a circular or mediolaterally oval shape, whereas an anteroposterior elongation increases pelvic floor stability. This suggests that the anteroposterior oval outlet shape is an evolutionary adaptation for pelvic floor support. For the pelvic inlet, by contrast, it has long been assumed that the mediolateral dimension is constrained by the efficiency of upright locomotion. But we argue that upright stance limits the anteroposterior dimension of the inlet. A deeper inlet requires greater pelvic tilt and lumbar lordosis, which compromises spine health and the stability of upright posture. These different requirements on the pelvic inlet and outlet have led to the complex shape of the human pelvic canal and to the evolution of rotational birth.

Descent of Fetal Head into The Pelvic Inlet in Primigravida: Systematic Review

Background: Skilled care before, during and after delivery can save the lives of women and newborns. Antenatal care is useful for detecting problems in pregnancy and childbirth, as well as preparing for labor. It is estimated that labor will begin 2-3 weeks after the entry of the fetal head on pelvic inlet. Objective: This study was conducted to determine the prevalence of descending of the fetal head at the pelvic inlet in the primigravida of 34-36 weeks of gestation. Methods: This study uses a systematic review study method with the data used are the results of research that have been circulating in the world. Results: In Weekes and Flynn's (1975) study, the entry of the fetal head into the pelvic cavity and having passed the pelvic inlet with a sample of 422 primigravidas, the prevalence was 34 weeks (2%), 35 weeks (1%). Of the three studies analyzed at 36 weeks' gestation, a prevalence was 4.22%.

3D pelvimetry and biometric measurements: a surgical perspective for colorectal resections

Purpose Male sex, high BMI, narrow pelvis, and bulky mesorectum were acknowledged as clinical variables correlated with a difficult pelvic dissection in colorectal surgery. This paper aimed at comparing pelvic biometric measurements in female and male patients and at providing a perspective on how pelvimetry segmentation may help in visualizing mesorectal distribution. Methods A 3D software was used for segmentation of DICOM data of consecutive patients aged 60 years, who underwent elective abdominal CT scan. The following measurements were estimated: pelvic inlet, outlet, and depth; pubic tubercle height; distances from the promontory to the coccyx and to S3/S4; distance from S3/S4 to coccyx’s tip; ischial spines distance; pelvic tilt; offset angle; pelvic inlet angle; angle between the inlet/sacral promontory/coccyx; angle between the promontory/coccyx/pelvic outlet; S3 angle; and pelvic inlet to pelvic depth ratio. The measurements were compared in males and females using statistical analyses. Results Two-hundred patients (M/F 1:1) were analyzed. Out of 21 pelvimetry measurements, 19 of them documented a significant mean difference between groups. Specifically, female patients had a significantly wider pelvic inlet and outlet but a shorter pelvic depth, and promontory/sacral/coccyx distances, resulting in an augmented inlet/depth ratio when comparing with males (p < 0.0001). The sole exceptions were the straight conjugate (p = 0.06) and S3 angle (p = 0.17). 3D segmentation provided a perspective of the mesorectum distribution according to the pelvic shape. Conclusion Significant differences in the structure of pelvis exist in males and females. Surgeons must be aware of the pelvic shape when approaching the rectum.

Determining the protective characteristics and risk factors for the development of anastomotic leakage after low anterior resection for rectal cancer

Purpose Anastomotic leakage is one of the most serious postoperative complications associated with surgery for rectal cancer. The present study aimed to identify the protective characteristics and risk factors associated with anastomotic leakage after low anterior resection for rectal cancer. Methods This was a retrospective, single-center study conducted between January 2009 and December 2017 at our institution. In total, 136 rectal cancer patients who underwent low anterior resection were included in the study. We analyzed preoperative and intraoperative factors. In addition, the pelvic dimensions were measured using computed tomography in all cases. Results Among the 136 patients, anastomotic leakage occurred in 21 (15.4%), including 18 males and 3 females. The median body mass index was 21.1 kg/m2. The construction of a covering stoma was found to be a protective factor. In addition, the operation time (≥ 373 min), intraoperative blood loss (≥ 105 ml), and size of the pelvic inlet (≥ 113 mm) were identified as risk factors for anastomotic leakage. Conclusion The construction of a covering stoma was a possible protective factor. However, a longer operation time, higher intraoperative blood loss, and larger pelvic inlet dimensions were possible risk factors for developing anastomotic leakage after low anterior resection in patients with rectal cancer.