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Frémondière P, Haeusler M, Thollon L, Webb NM, Marchal F. Obstetrical Constraints and the Origin of Extended Postnatal Brain Maturation in Hominin Evolution. BIOLOGY 2024; 13:398. [PMID: 38927278 PMCID: PMC11201025 DOI: 10.3390/biology13060398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/18/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024]
Abstract
The origin of difficult birth is still a matter of debate in obstetrics. Recent studies hypothesized that early hominins already experienced obstructed labor even with reduced neonatal head sizes. The aim of this work is to test this hypothesis using an extant obstetrical sample with known delivery outcomes. Three delivery outcomes (i.e., instrument-assisted, Caesarean section, and vaginal birth) were evaluated using a discriminant analysis based on 131 mother-baby dyads and 36 feto-pelvic variables. This obstetrical sample was compared with 20 australopithecine "dyads" generated from the combination of six pelvic reconstructions (three for Australopithecus afarensis, two for A. africanus, and one for A. sediba) and three fetal head size estimations. The obstetrical analysis revealed that dystocic births can be predicted by pelvic features such as an anteroposteriorly flattened pelvic inlet. Australopithecines shared these pelvic morphologies with humans and had eutocic birth only for infants of 110 g brain size or smaller, equaling a human-like neonatal/adult brain size ratio of 25-28%. Although birth mechanism cannot be deduced, the newborn/adult brain size ratio was likely more human-like than previously thought, suggesting that australopithecines were secondarily altricial to circumvent instances of obstructed labor and subsequently require a prolonged postnatal brain growth period, implying some aspects of life history pattern similar to modern humans.
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Affiliation(s)
- Pierre Frémondière
- Faculty of Medical and Paramedical Sciences, School of Midwifery, Aix Marseille University, 51 Boulevard Pierre Dramard, 13344 Marseille CEDEX 15, France
- UMR 7268 ADES, Aix Marseille University, EFS, CNRS, 51 Boulevard Pierre Dramard, 13344 Marseille CEDEX 15, France;
| | - Martin Haeusler
- Institute of Evolutionary Medicine, University of Zürich, Winterthurerstrasse 190, 8057 Zürich, Switzerland;
| | - Lionel Thollon
- LBA, Aix Marseille University, Gustave Eiffel University, 51 Boulevard Pierre Dramard, 13344 Marseille CEDEX 15, France;
| | - Nicole M. Webb
- Institute of Evolutionary Medicine, University of Zürich, Winterthurerstrasse 190, 8057 Zürich, Switzerland;
- Department of Palaeoanthropology, Senckenberg Gesellschaft für Naturforschung, Senckenberganlage 25, 60325 Frankfurt am Main, Germany
| | - François Marchal
- UMR 7268 ADES, Aix Marseille University, EFS, CNRS, 51 Boulevard Pierre Dramard, 13344 Marseille CEDEX 15, France;
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Hêches J, Marcadent S, Fernandez A, Adjahou S, Meuwly JY, Thiran JP, Desseauve D, Favre J. Accuracy and Reliability of Pelvimetry Measures Obtained by Manual or Automatic Labeling of Three-Dimensional Pelvic Models. J Clin Med 2024; 13:689. [PMID: 38337383 PMCID: PMC10856490 DOI: 10.3390/jcm13030689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: The morphology of the pelvic cavity is important for decision-making in obstetrics. This study aimed to estimate the accuracy and reliability of pelvimetry measures obtained when radiologists manually label anatomical landmarks on three-dimensional (3D) pelvic models. A second objective was to design an automatic labeling method. (2) Methods: Three operators segmented 10 computed tomography scans each. Three radiologists then labeled 12 anatomical landmarks on the pelvic models, which allowed for the calculation of 15 pelvimetry measures. Additionally, an automatic labeling method was developed based on a reference pelvic model, including reference anatomical landmarks, matching the individual pelvic models. (3) Results: Heterogeneity among landmarks in radiologists' labeling accuracy was observed, with some landmarks being rarely mislabeled by more than 4 mm and others being frequently mislabeled by 10 mm or more. The propagation to the pelvimetry measures was limited; only one out of the 15 measures reported a median error above 5 mm or 5°, and all measures showed moderate to excellent inter-radiologist reliability. The automatic method outperformed manual labeling. (4) Conclusions: This study confirmed the suitability of pelvimetry measures based on manual labeling of 3D pelvic models. Automatic labeling offers promising perspectives to decrease the demand on radiologists, standardize the labeling, and describe the pelvic cavity in more detail.
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Affiliation(s)
- Johann Hêches
- Swiss BioMotion Lab, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1011 Lausanne, Switzerland;
| | - Sandra Marcadent
- Signal Processing Laboratory 5, École Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland; (S.M.); (J.-P.T.)
| | - Anna Fernandez
- Women-Mother-Child Department, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1011 Lausanne, Switzerland; (A.F.); (S.A.); (D.D.)
| | - Stephen Adjahou
- Women-Mother-Child Department, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1011 Lausanne, Switzerland; (A.F.); (S.A.); (D.D.)
| | - Jean-Yves Meuwly
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1011 Lausanne, Switzerland;
| | - Jean-Philippe Thiran
- Signal Processing Laboratory 5, École Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland; (S.M.); (J.-P.T.)
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1011 Lausanne, Switzerland;
| | - David Desseauve
- Women-Mother-Child Department, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1011 Lausanne, Switzerland; (A.F.); (S.A.); (D.D.)
| | - Julien Favre
- Swiss BioMotion Lab, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1011 Lausanne, Switzerland;
- The Sense Innovation and Research Center, CH-1007 Lausanne, Switzerland
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Wells JCK, Desoye G, Leon DA. Reconsidering the developmental origins of adult disease paradigm: The 'metabolic coordination of childbirth' hypothesis. Evol Med Public Health 2024; 12:50-66. [PMID: 38380130 PMCID: PMC10878253 DOI: 10.1093/emph/eoae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/18/2023] [Indexed: 02/22/2024] Open
Abstract
In uncomplicated pregnancies, birthweight is inversely associated with adult non-communicable disease (NCD) risk. One proposed mechanism is maternal malnutrition during pregnancy. Another explanation is that shared genes link birthweight with NCDs. Both hypotheses are supported, but evolutionary perspectives address only the environmental pathway. We propose that genetic and environmental associations of birthweight with NCD risk reflect coordinated regulatory systems between mother and foetus, that evolved to reduce risks of obstructed labour. First, the foetus must tailor its growth to maternal metabolic signals, as it cannot predict the size of the birth canal from its own genome. Second, we predict that maternal alleles that promote placental nutrient supply have been selected to constrain foetal growth and gestation length when fetally expressed. Conversely, maternal alleles that increase birth canal size have been selected to promote foetal growth and gestation when fetally expressed. Evidence supports these hypotheses. These regulatory mechanisms may have undergone powerful selection as hominin neonates evolved larger size and encephalisation, since every mother is at risk of gestating a baby excessively for her pelvis. Our perspective can explain the inverse association of birthweight with NCD risk across most of the birthweight range: any constraint of birthweight, through plastic or genetic mechanisms, may reduce the capacity for homeostasis and increase NCD susceptibility. However, maternal obesity and diabetes can overwhelm this coordination system, challenging vaginal delivery while increasing offspring NCD risk. We argue that selection on viable vaginal delivery played an over-arching role in shaping the association of birthweight with NCD risk.
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Affiliation(s)
- Jonathan C K Wells
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Gernot Desoye
- Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - David A Leon
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Frémondière P, Thollon L, Marchal F, Desseauve D. The impact of femoral rotation on sacroiliac articulation during pregnancy. Is there evidence to support Farabeuf's hypothesis by finite element modelization? Eur J Obstet Gynecol Reprod Biol 2023; 290:78-84. [PMID: 37738891 DOI: 10.1016/j.ejogrb.2023.08.381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Counter-nutation movement is deemed crucial during the management of the birth process. It is a combination of lateral ilia expansion and backward displacement of the promontory resulting from the external rotations of the femurs producing an enlargement of the pelvic inlet. However, since its description by Farabeuf, this mechanism has never been challenged and analyzed in a dynamic finite element study. METHODS Based on a female pelvic mesh and sacroiliac ligaments, we simulated external rotations of both femurs with imposed rotation of the two acetabulum centers. We hypothesize that lateral ilia expansion generates a sacrum movement resulting in a backward displacement of the promontory and a pelvic inlet enlargement. RESULTS Finite element simulation confirms our hypothesis and reveals that ilio-sacro-transverse and axile ligaments play an essential role in this mechanism. Indeed, the increase in stiffness (ranging from 500 MPa to 750 MPa) of these ligaments accentuates the counter-nutation movement and the opening of the inlet. Instead of the anatomic congruence between the ilium and the sacrum, the sacroiliac ligaments may explain the counter-nutation. After a 6° of femur rotation, the inlet area increases to 11 cm2 (141 cm2 vs. 130 cm2). This enlargement could be noteworthy in case of obstructed labor or shoulder dystocia. Moreover, the association between external rotation and flexion of the femurs could be more efficient for opening the pelvic inlet. CONCLUSIONS Our result did not support the original assumption of Farabeuf. By revealing how postural adjustment increases the bony birth canal, this study provides essential information for the clinical management of the delivery.
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Affiliation(s)
- Pierre Frémondière
- Aix Marseille Univ, CNRS, EFS, ADES, 51 boulevard Pierre Dramard, 13344 Marseille cedex 15, France; Aix Marseille Univ, School of Midwifery, Faculty of Medical and Paramedical Sciences, 51 boulevard Pierre Dramard, 13344 Marseille cedex 15, France.
| | - Lionel Thollon
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, 51 boulevard Pierre Dramard, 13344 Marseille cedex 15, France
| | - François Marchal
- Aix Marseille Univ, CNRS, EFS, ADES, 51 boulevard Pierre Dramard, 13344 Marseille cedex 15, France
| | - David Desseauve
- Department of Women-Mother-Child, Gynecology and Obstetrics Unit, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Gynecology and Obstetrics Unit, Hôpital de la Croix-Rousse 103 Grande rue de la Croix-Rousse, 69004 Lyon, France.
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Shimaoka R, Takahashi Y, Ono H, Matsui M, Asai K, Iwagaki S. Magnetic resonance imaging pelvimetric measurements as predictors for emergent cesarean delivery in obstructed labor. Eur J Obstet Gynecol Reprod Biol X 2023; 19:100216. [PMID: 37501741 PMCID: PMC10368825 DOI: 10.1016/j.eurox.2023.100216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Objective This study aimed to investigate the usefulness of various magnetic resonance imaging (MRI) pelvimetric parameters for predicting emergent cesarean delivery due to obstructed labor. Study design This was a prospective observational study. MRI pelvimetry was performed in cases of a clinically suspected maternal narrow pelvis, maternal short stature, fetal overgrowth, and abnormal placental position. MRI pelvimetry was performed at 34.7 ± 4.2 gestational weeks using a 1.5 T MRI system. The pelvic inlet angle, pelvic inclination, obstetric conjugate, sacral outlet diameter (SOD), and coccygeal pelvic outlet were measured in the sagittal section. The interspinous diameter and intertuberous diameter were measured in coronal sections. Fetal anomalies, cesarean deliveries before the onset of labor, and non-reassuring fetal status were excluded from the analysis. Results MRI pelvimetry was performed in 154 patients. After excluding 76 cases, including 19 cases of absolute cephalopelvic disproportion, 78 cases of trial of labor were included. Of these, 63 were vaginal deliveries and 15 were emergent cesarean deliveries due to obstructed labor. The cut-off value for body mass index (BMI) was 22.2, with an area under the curve (AUC) of 0.69, for predicting obstructed labor. The cut-off value for the SOD was 10.7 cm with an AUC of 0.69. BMI alone had a sensitivity of 80%, specificity of 66%, positive predictive value (PPV) of 36%, and negative predictive value (NPV) of 93%. When BMI and SOD were combined, sensitivity was 53%, specificity was 90%, PPV was 57%, and NPV was 89%. The odds ratio for emergent cesarean delivery was 5.42 (95% confidence interval 1.06-27.6, p = 0.041) if the SOD was less than the cut-off value in the binomial logistic regression analysis in cases with an BMI > 22. Conclusion We confirmed that MRI pelvimetry was a reliable tool for better patient selection for obstructed labor. The SOD was the best predictor of obstructed labor, with a cut-off value of 10.7 cm for women with a low BMI.
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Starrach T, Schmidhuber L, Elger L, Franz M, Buechel J, Hübener C, Kolben T, Koliogiannis V, Mahner S, Hasbargen U, Fischer B. Pelvic inlet area is associated with birth mode. Acta Obstet Gynecol Scand 2022; 102:59-66. [PMID: 36320156 PMCID: PMC9780724 DOI: 10.1111/aogs.14478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION To determine whether a pelvis is wide enough for spontaneous delivery has long been the subject of obstetric research. A number of variables have been proposed as predictors, all with limited accuracy. In this study, we use a novel three-dimensional (3D) method to measure the female pelvis and assess which pelvic features influence birth mode. We compare the 3D pelvic morphology of women who delivered vaginally, women who had cesarean sections, and nulliparous women. The aim of this study is to identify differences in pelvic morphology between these groups. MATERIAL AND METHODS This observational study included women aged 50 years and older who underwent a CT scan of the pelvis for any medical indication. We recorded biometric data including height, weight, and age, and obtained the obstetric history. The bony pelvis was extracted from the CT scans and reconstructed in three dimensions. By placing 274 landmarks on each surface model, the pelvises were measured in detail. The pelvic inlet was measured using 32 landmarks. The trial was registered at the German Clinical Trials Register DRKS (DRKS00017690). RESULTS For this study, 206 women were screened. Exclusion criteria were foreign material in the bony pelvis, unknown birth mode, and exclusively preterm births. Women who had both a vaginal birth and a cesarean section were excluded from the group comparison. We compared the pelvises of 177 women between three groups divided by obstetric history: vaginal births only (n = 118), cesarean sections only (n = 21), and nulliparous women (n = 38). The inlet area was significantly smaller in the cesarean section group (mean = 126.3 cm2 ) compared with the vaginal birth group (mean = 134.9 cm2 , p = 0.002). The nulliparous women were used as a control group: there was no statistically significant difference in pelvic inlet area between the nulliparous and vaginal birth groups. CONCLUSIONS By placing 274 landmarks on a pelvis reconstructed in 3D, a very precise measurement of the morphology of the pelvis is possible. We identified a significant difference in pelvic inlet area between women with vaginal delivery and those with cesarean section. A unique feature of this study is the method of measurement of the bony pelvis that goes beyond linear distance measurements as used in previous pelvimetric studies.
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Affiliation(s)
- Teresa Starrach
- Department of Obstetrics and GynecologyUniversity Hospital, Ludwig Maximilian UniversityMunichGermany
| | - Lisa Schmidhuber
- Department of Obstetrics and GynecologyUniversity Hospital, Ludwig Maximilian UniversityMunichGermany
| | - Luisa Elger
- Department of Obstetrics and GynecologyUniversity Hospital, Ludwig Maximilian UniversityMunichGermany
| | - Marie Franz
- Department of Obstetrics and GynecologyUniversity Hospital, Ludwig Maximilian UniversityMunichGermany
| | - Johanna Buechel
- Department of Obstetrics and GynecologyUniversity Hospital, Ludwig Maximilian UniversityMunichGermany
| | - Christoph Hübener
- Department of Obstetrics and GynecologyUniversity Hospital, Ludwig Maximilian UniversityMunichGermany
| | - Thomas Kolben
- Department of Obstetrics and GynecologyUniversity Hospital, Ludwig Maximilian UniversityMunichGermany
| | - Vanessa Koliogiannis
- Department of RadiologyUniversity Hospital, Ludwig Maximilian UniversityMunichGermany
| | - Sven Mahner
- Department of Obstetrics and GynecologyUniversity Hospital, Ludwig Maximilian UniversityMunichGermany
| | - Uwe Hasbargen
- Department of Obstetrics and GynecologyUniversity Hospital, Ludwig Maximilian UniversityMunichGermany
| | - Barbara Fischer
- Department of Evolutionary Biology, Unit for Theoretical BiologyUniversity of ViennaViennaAustria
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Ricklan SJ, Decrausaz SL, Wells JCK, Stock JT. Obstetric dimensions of the female pelvis are less integrated than locomotor dimensions and show protective scaling patterns: Implications for the obstetrical dilemma. Am J Hum Biol 2020; 33:e23451. [PMID: 32567787 DOI: 10.1002/ajhb.23451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The "obstetrical dilemma" hypothesis assumes that the modern human female pelvis serves two discrete functions: obstetrics and locomotion. We investigate whether these differing functions create observable patterns of morphological covariation and whether those patterns differ by height, weight, and age. This allows evaluation of evidence for canalization and phenotypic plasticity relevant to obstetric and locomotor function among a living female population. METHODS Landmarks (N = 86) were collected and inter-landmark distances were calculated (N = 36) on the pelvis and proximal femur of CT scans of living women aged 20 to 90 years (M = 93) receiving a routine CT scan. Partial least squares and relative SD of eigenvalues analyses were used to evaluate integration overall and within locomotor and obstetric modules, respectively. Ordinary Least Squared regression was used to evaluate scaling relationships between inter-landmark distances and height, weight, and age. RESULTS The obstetric pelvis was significantly less internally integrated than the locomotor pelvis. Many obstetric measurements were constrained in absolute terms relative to height; shorter women had relatively larger birth canal dimensions, and several key obstetric dimensions showed relative freedom from height. Lower weight women had some relatively larger obstetric and locomotor dimensions. Regarding age, younger women showed a few relatively larger outlet dimensions. CONCLUSIONS This study suggests that the obstetric pelvis and the locomotor pelvis function are morphologically distinct, with the obstetric pelvis showing relatively greater flexibility. These relationships between relative constraints support the hypothesis that the modern female pelvis shows evidence of both canalization and phenotypic plasticity in obstetric and locomotor structures.
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Affiliation(s)
- Sarah J Ricklan
- Department of Archaeology, University of Cambridge, Cambridge, UK.,New York University Grossman School of Medicine, New York, New York, USA
| | - Sarah-Louise Decrausaz
- Department of Archaeology, University of Cambridge, Cambridge, UK.,Department of Anthropology, University of Victoria, Victoria, British Columbia, Canada
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, Population, Policy, and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jay T Stock
- Department of Archaeology, University of Cambridge, Cambridge, UK.,Department of Anthropology, Western University, London, Ontario, Canada.,Department of Archaeology, Max Planck Centre for the Science of Human History, Jena, Germany
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