A Retrospective Review of Performance and Utility of Routine Clinical Pelvimetry

Clinical pelvimetry is the manual examination of the pelvis to determine if it is of adequate size for child-birth. The technique of clinical pelvimetry is described in most obstetrical textbooks1-3 and taught to medical students and residents despite no evidence of interobserver agreement and poor correlation to radio-graphic pelvimetry.4 Additionally, controlled studies have repeatedly shown that X-ray pelvimetry, presumed to be more accurate than manual pelvimetry, is not a successful predictor of vaginal delivery or need for operative delivery.4 Current clinical opinion expressed in obstetrical textbooks is that, except in very few sce-narios, all women should be given a trial of labor.5 If all women should be given a trial of labor, then the results of pelvimetry would not be expected to alter labor management. This study aimed to determine, in light of current opinion and evidence, to what extent clinical pelvimetry continues to be practiced and used. Methods We conducted a retrospective review of prenatal records in an approximately 3-month time frame at two separate military hospitals. One was an overseas hos-pital. The other was a US-based hospital at which there was a family medicine residency. The providers of pre-natal care at both locations were board-certified family physicians, obstetricians, and nurse midwives. The pro-viders had been trained at a variety of institutions (both military and civilian). No prenatal records were excluded. We reviewed the records of active duty military women and spouses of active duty men. The physicians reviewing the records had not provided any of the initial prenatal care for the subject patients. Prenatal records were reviewed to ob