Olivier Ami MD, PhD, Presenter: Nothing to Disclose

Vincent D. Delmas, Abstract Co-Author: Nothing to Disclose

Dominique Musset MD, Abstract Co-Author: Nothing to Disclose

Online childbirth simulation is a new and promising tool to detect labor dystocia and seem to be a significant improvement over pelvimetry. This tool works with standard CT or MRI scan.

The aim of this study was to evaluate the diagnostic interest of a distant vaginal delivery simulation service working with standard ct-scan or mri scan pelvimetry. 200 pregnant women who underwent a pelvimetry with MRI (100) or CT-Scan (100) for clinical and/or sonographical suspicion of cephalopelvic disproportion were enrolled in this prospective study. The predibirth™ (Predinat, France) software was available through a simple website, and the following parameters were entered manually by the radiologists : anteroposterior inlet, transverse inlet, interspinous distance, biparietal diameter, cephalic circumference. Favorability of childbirth was estimated using the percentage of necessary fetal head molding during fetal engagement, descent and rotation during the most frequent and favourable trajectory of the fetus inside the birthcanal. Childbirth was defined at high risk of dystocia when the score of favourability was less than 25 %, mildly favourable between 25 and 50 %, and highly favourable when the score was greater than 50 %.  

The results indicates that the planned cesarean sections rate could have potentially been reduced by 30 %, and the instrumental extractions reduced by 91 %.

Of the 200 pregnant women tested, 106 delivered normally, of which 103 had an estimated highly favourable score by the Predibirth. 22 were delivered by elective cesarean section, of which 7 had an estimated highly favourable score, 11 were at high risk of dystocia, and 4 showed mild risk. 48 were delivered by emergency cesarean section, of which 12 had an estimated highly favourable score, 30 were at high risk of dystocia, and 6 showed mild risk. 24 were delivered with instrumental extraction, of which 2 had an estimated highly favourable score, 6 were at high risk of dystocia, and 16 showed mild risk. Considering the cases where biomechanical predictions of favourability could be verified, the simulation predictions were significantly coherent with the reality of childbirth (p < 0,0001).

Ami, O, Delmas, V, Musset, D, Online Childbirth Simulation for Prevention of Cephalopelvic Dystocia.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12037124.html