Prospective randomized study of x-ray pelvimetry in the primigravida. A randomized trial of medical quality assurance. Improving physicians' use of pelvimetry.
A prospective randomized study was performed to determine the usefulness of x-ray pelvimetry before oxytocin induction or augmentation. Two hundred primiparous women were entered into this study. Agreement on pelvic size by the clinical and radiologic assessment occurred in 76.5% of the cases. When the total groups were compared, there were no differences in pregnancy outcome. In the induction of labor subgroups there were less forcep deliveries and lower five-minute Apgar scores in the pelvimetry group. In the augmentation subgroups there were no differences. The subgroup of patients diagnosed clinically to have a borderline pelvis, had a higher incidence of cesarean section (P less than .05) if they had x-ray pelvimetry. These results suggest that the elimination of x-ray pelvimetry in primigravida women does not lead to a compromise in infant outcome when electronic fetal monitoring is used. The capacity of educational programs to improve physician performance remains doubtful despite many evaluative efforts. This is especially true for programs sponsored by the federal government. We tested the efficacy of an educational program conducted by Professional Standards Review Organizations in reducing the inappropriate use of x-ray pelvimetry. This procedure may cause harm to the fetus, and there is little evidence that it is efficacious. We randomly assigned 120 hospitals in six Professional Standards Review Organizations to study and control groups. Physicians with delivery privileges at each study hospital participated in an educational program that discussed acceptable indications for x-ray pelvimetry. Pelvimetry use was similar in study and control hospitals before the program. However, after the program, pelvimetry was performed by physicians at study hospitals less than one third as often as by physicians at control hospitals. We conclude that educational programs can improve physician performance substantially and that such programs can be effectively conducted by federally sponsored physician organizations.
There is not enough evidence to support the use of x-ray pelvimetry in women whose fetuses have a cephalic presentation.