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Parturition and Pelvic Changes

MARC A. KELLEY
Department of Anthropology, Case Western Reserve Uniuerszty, Cleueland, Ohio 44106

K E Y WORDS Dorsal pubic pitting . Interosseous groove .


Parturition

. Pre-auricular groove . Pelvis

ABSTRACT
A detailed analysis of the female bony pelvis in relation to
parity status was made. A total of 198 complete pelves were inspected for five
features considered to be associated with pregnancy and parturition. During
final analysis two features were eliminated. Three remaining features - dorsal
pubic pitting, pre-auricular grooves, and grooves located a t the site of interosseous ligament insertion were found to be significantly related to parturition. Other findings of interest were: (1) pits and grooves acquired through
pregnancy and parturition appear to become obliterated in old age, ( 2 ) the
preauricular groove is the most sensitive indicator of pregnancy and parturition, (3) moderate-large pitting in the dorsal pubic region rarely occurs in
nulliparous females, and (4)it is doubtful t h a t more precise statements than
no children and (one or more children can be made on the basis of skeletal
remains alone.
The formation of pits and grooves a t sites of
ligamentous attachments in the female bony
pelvis is a subject that warrants consideration
in both physical and forensic anthropology.
These bony changes are considered by most
investigators to be related to pregnancy and
parturition (Putschar, 31, 76; Wiltse and
Frantz, 56; Stewart, 57, 70; Angel, 69; Gilbert and McKern, 73; Houghton, 74, 75;
Ullrich, 75; Ashworth et al., 76; Suchey et
al., 79; Dunlap, 79). With the exception of
Houghton, Dunlap, and Ullrich, these studies
have dealt primarily with changes arising in
the 0s pubis. Houghton and Dunlap have analyzed the pre-auricular sulcus while Ullrich
considered the pubis, ilium, and sacrum in relation to childbearing. The work by Stewart
(701, Gilbert and McKern (731, and Holt (78)
suggest that pelvic changes are of limited
usefulness in parity estimation. Sucheys (79)
work with the 0s pubis in exceptionally well
documented material showed a statistical association, but no close correlation between pitting and full term pregnancies.
The present study examines several regions
of the female pelvis where pits and grooves are
known to occur. The purpose of this investigation is to determine what degree of reliability
AM. J. PHYS. ANTHROP. (1979)51: 541-546.

in assessment of parturition is possible when


the entire pelvis is examined.
MATERIALS AND METHODS

The Hamann-Todd osteological collection in


the Cleveland Museum of Natural History
contains well over 400 skeletonized adult
females originally housed a t Western Reserve
Medical School. The examination of each
cadaver was conducted by T. W. Todd and associates. Among numerous other entries, the
medical file for each female contains information concerning parity. This information is
stated as: certainly has had (or not had)
children, probably has had (or not had)
children, or no data. In many of the cases,
especially where parity is described with certainty, supporting information such as presence of a hymen, perineal tears (or lack of),
caesarean section scars, fourchette appearance, and abdominal striations. Many of the
cases described as probable were elderly
women. In order to maximize reliability, only
women whose parity status was stated as certainly has had (or not had) children were utilized in this study - a precaution not strictly
adhered to by Holt (78).
Skeletons of a total of 198 females (75

541

542

MARC A

\
Fig. 1 Location and appearance of dorsal puhc pitting
(l), pre-auricular groove (2).and interosseous groove (3).

White, 123 Black) meeting the above standards were located and examined. Utilizing
both innominate bones and the sacrum, 5 features were recorded: (1)dorsal pubic pitting,
(2) pre-auricular groove, (3) groove associated
with t h e interosseous ligament insertion
(hereafter designated interosseous groove),
(4) bony lipping of the dorsal pubic margin,
and (5) sacral pitting, For reasons discussed
below, the last 2 features were omitted from
the final analysis. Figure 1 illustrates the
location and typical appearance of the 3 remaining features of interest here. All pelves
were inspected for bilateral involvement. In
cases where the pits or grooves were of unequal severity, the side displaying the most extensive markings was used for analysis. Pitting on the dorsal pubis was recorded as absent, trace to small, or moderate to large
(after Stewart, 70).Trace to small IS defined
here as being either very shallow, poorly
demarcated depressions or as small well-defined pits not exceeding 2 millimeters in diam-

KELLEY

eter. Moderate t o large denotes much deeper


depressions or larger pits.
In the pre-auricular region, the groove was
described as GL (groove of ligament; after
Houghton, 741, broad-shallow, or developed. Broad-shallow describes a condition somewhat intermediate between GL
and developed that was seen in about 30%of
the cases and took the form of a poorly demarcated broad and shallow depression. Developed refers to one or more deeper and well
demarcated pits in the pre-auricular region.
The interosseous groove was found to conform
t o essentially the same criteria as the preauricular groove. It is most easily observed by
noting its tendency to produce a platform
out of the auricular surface (Houghton, 74).
RESULTS

No significant differences were found between the Blacks and Whites in the frequency
of dorsal pubic pitting, pre-auricular grooves
or interosseous grooves (chi-square values
were 0.06, 1.15, and 1.21 < 3.84 respectively
with 1 degree of freedom). These results are in
agreement with Holts (78) smaller sample
where only dorsal pubic pitting was examined.
As already mentioned, bony lipping of the
dorsal pubic margin and sacral pits were
eliminated from the final analysis. Dorsal
pubic lipping occurred indiscriminantly in
multiparous and nulliparous women alike and
reflects concomitant age-progressive, degenerative arthritis (Putschar. 76). Sacral pitting, which occurs immediately adjacent to
the pre-auricular groove, was discarded because it was noted in only 12 out of 198 cases
and therefore is of extremely limited utility.
TABLE 1

Percentaee distribution for the three traits examined

U V l U I l

No parturition
N = 107

Parturitiun
N = 91

76.6
22.4
1.0

56.0
23.1
20.9

54.2
25.2
20.6

20.9
35.2
43.9

67.3
15.9
16.8

36.2
31.9
31.9

y**AE.

Absent
Slight
Mod-severe
Preauricular groove
GL
Broad-shallow
Developed
Interosseous groove
Absent
Slight
Developed

PARTURITION AND PELVIC CHANGES

543

Tables 1 and 2 list the frequencies of the


three pelvic features and their chi-square
values respectively. A fairly large proportion
of the females, regardless of parity status
showed no evidence of dorsal pubic pitting.
However, the presence of moderate to large
dorsal pitting was observed in only one out of
107 (approx. 1%nulliparous females, while 19
out of 91 (20.9%)women experiencing parturition displayed such pits. With respect to the
preauricular groove, the GL type occurred
about 2.5 times more often in nulliparous
women. The presence of a developed groove,
while more than twice as common in women
experiencing parturition (43.9%) was still
unexpectedly high in nulliparous females
(20.6%).The interosseous groove follows a pattern similar to the pre-auricular groove. In the
dorsal pubic and pre-auricular regions, the occurrence of "intermediate" markings tends to
obfuscate the assessment of parity status. As
the chi-square values in table 2 indicate, the
null hypothesis testing for no difference in the
incidence of pits and grooves in relation to
parity status was rejected for all three pelvic
features.
I t can be seen from table 1that no one pelvic
feature possesses sufficient discriminatory
qualities to consistently determine parity
status. Therefore, table 3 examines all possible combinations of pit and groove formation
when the three pelvic regions are utilized simultaneously. The dashed line represents the
cutoff point. All trait combinations falling
above this line are most likely t o be from
nulliparous females, while all combinations
falling below the line are more characteristic
of women experiencing parturition. The presence, or absence, of two or more pelvic features increases t h e reliability of correct parity
assessment; trait combinations nearest the
dashed line tend to be the most ambiguous.
Approximately 70% (139/198) of all pelves
examined fell into their correct column in
table 3.
Figure 2 compares the frequency of moderate to large pits and grooves to parity status
by decade of life. The percentages of dorsal
pubic pitting, pre-auricular, and interosseous
grooves for each age group were averaged in
order to create one line each for females experiencing parturition and no parturition.
Pits and grooves in nulliparous females remain at relatively low and constant levels
throughout life. More notably, the percent-

544

MARC A. KELLEY
5 0

40

30
URlTlON

20

1 0
PARTURITION

//NO

31 4 0

41-50

51-60

61.70

714-

0
15-20

21-30

A G E

Fig. 2 Percentage of women by decade of life displaying moderate to large pitting or grooves for t h e dorsal
pubic surface, pre-auricular region, and site of interosseous ligament attachment in relation to parity status.
TABLE 3

Frequencies of all combinations of


the three traits examined
No parturilion

3 absent
2 absent, 1trace
2 absent, 1present
2 trace, I absent

38
18
15
. . . . . . . . . . . . . . . . . . . . . - -15- _ - _
1 absent, 1 trace, 1 present
13
1
3 trace
2 trace, 1 present
3
2 present, 1 absent
3
2 present, 1 trace
1
3 present
0
107
Total

Parturition

6
13
9
10

---.

16
4
8
14

5
6
91

ages in childbearing females rise sharply from


the third decade of life and decline sharply
from the seventh decade onwards. This suggests that the visible bony changes associated
with pregnancy and parturition are slowly
obliterated once the childbearing years are
over.
DISCUSSION

There is no doubt that pits and grooves


located in the regions examined in this study
are correlated with pregnancy and parturition. The most widely accepted etiological
mechanism for pit and groove formation in

the dorsal pubic region is that hormonal secretions during pregnancy relax and cause
hypertrophy of the ligaments (Wiltse and
Frantz, '56; Putschar, '31, '76). The subsequent tearing and hemorrhaging associated
with parturition further contribute t o pubic
changes. The contention made by Holt ('78)
that moderate to large dorsal pubic pitting occurs in approximately equal frequencies in
childbearing and non-childbearing females is
not supported by the data in the present study.
I t would appear t o occur infrequently in
nulliparous women, and then usually as a result of some other form of trauma. Wiltse and
Frantz ('56) reported 13 cases of osteitis pubis,
ten of which were related t o parturition. The
three remaining cases were related to: an auto
accident, sports accident, and pelvic surgery
respectively.
Houghton ('74) suggested that pre-auricular grooves are a more sensitive indicator of
parity than dorsal pubic pitting because body
weight stresses coupled with hormonally induced changes are especially pronounced during pregnancy. The data presented here largely agree with this statement, but it is extremely important for investigators to be
aware that "developed" pits and grooves occasionally do occur in the sacroiliac region in
nulliparous women (approx. 20% in this

PARTURITION AND PELVIC CHANGES

study). Houghton (74) could not have detected this since his sample consisted of undocumented material. Dunlap (79) examined
pre-auricular sulcus morphology in relation
to body weight for both nulliparous and
multiparous women and found no positive
correlation. Future studies might profit by
examining sulcus morphology in relation to
such variables as the degree of lordosis and
the sacral angle (Cockshott, personal communication).
The fact that many women experiencing
childbirth displayed little or no bony changes
probably reflects a complex interaction of hormonal levels, maternal birth canal diameter,
fetal head circumference, amount of physical
activity during pregnancy, number of pregnancies, obstetrical care, and age a t time of
death. I t is proposed here that parity status is
best assessed by employing the three pelvic
features discussed in this paper. The presence
of moderate to large pits and grooves a t two or
more locations is strongly suggestive of a
multiparous woman. Conversely, the absence
of two or more traits is suggestive (but somewhat less so) of a nulliparous female. The occurrence of intermediate traits presents the
most difficult situation. In cases where the
three pelvic features do fall into ambiguous
trait combinations, the investigator must
assign individual weights to each feature. I t is
suggested t h a t the most weight be assigned to
the pre-auricular groove, followed by the interosseous groove, and finally dorsal pubic pitting. One exception to this rule is moderate to
large dorsal pubic pitting, especially characteristic of females experiencing parturition.
Lw-RLT ub7-UR-s

An analysis of every available pelvis from


the Hamann-Todd collection associated with a
definitive statement on parity status resulted
in the following conclusions: (1) the combined
utilization of dorsal pubic pitting, pre-auricular grooves, and interosseous grooves gave the
highest degree of reliability for determining
parity status in this study, ( 2 ) the pre-auricular groove is the most sensitive indicator of
parturition, but is occasionally well-developed
in nulliparous women, (3) elderly females tend
to lose all imprints of past childbearing history, and (4) since it was not possible to correctly label all females within the broad catego-

545

ries of no parturition and parturition, it is


doubtful that more precise statements concerning parity status (i.e., number of pregnancies and children born) can be made.
ACKNOWLEDGMENTS

The work accomplished in this study was


greatly facilitated by the kind cooperation of
the Cleveland Natural History Museum staff
- particularly the Physical Anthropology
Laboratory which is under the direction of Dr.
D. C. Johanson. Special thanks also go to
Lyman M. Jellema, April V. Kelley, and John
Laterra for their assistance, encouragement,
and advice.
LITERATURE CITED
Angel, J. L. 1969 The bases of paleodemography. Am. J.
Phys. Anthrop., 30: 427-437.
Ashworth, J. T., M. J. Allison, E. Gerszten and A. Pezzia
1976 The pubic scars of gestation and parturition in a
group of pre-Columbian and colonial Peruvian mummies.
Am. J. Phys. Anthrop., 45: 85-89.
Cockshott, W. P. 1979 Personal communication.
Dunlap, S. S. 1979 Sex, parity, and t h e preauricular
sulcus. Paper presented a t the 48th annual meeting of the
American Association of Physical Anthropologists. San
Francisco.
Gilbert, B. M., andT. McKern 1973 A method for aging the
female 0s pubis. Am. J. Phys. Anthrop., 38: 31-38.
Holt, C. 1978 A re-examination of parturition scars on
the human female pelvis. Am. J. Phys. Anthrop., 49:
91-94.
Houghton, P. 1974 The relationship of the pre-auricular
groove of the ilium to pregnancy. Am. J. Phys. Anthrop.,
41: 381-390.
1975 The bony imprint of pregnancy. Bull N. Y.
Acad. Med., 51: 655-661.
Putschar, W. G. J. 1931 Entwicklung, Wachstum und
Pathologie der Beckenverbindugen des Menschen, mit
Besonderer Berucksichtigung von Schwangershaft,
geburt und ihren folgen. Gustav Fischer, Jena.
1976 The structure of the human symphysis
with special consideration of parturition and its sequelae.
Am. J. Phys. Anthrop., 45: 589-594.
Stewart, T. D. 1957 Distortion of the pubic symphyseal
surface in females and its effect on age determination.
Am. J. Phys. Anthrop., 15: 9-18.
1970 Identification of the scars of parturition in
skeletal remains of females. In: Personal Identification
in Mass Disasters. T. D. Stewart, ed. Nation Museum of
Natural History, Washington, D. C., pp. 127.133.
Suchey. J. M., D. V. Wiseley andT. T. Noguchl 1979 Analysis of dorsal pitting in t h e 0s pubis in a n extensive sample
of modern American females. Am. J. Phys. Anthrop., 51:
517-539.
Ullrich, H. 1975 Estimation of fertility by means of
pregnancy and childbirth alterations a t the pubis, the
ilium, and the sacrum. Ossa, 2: 23-39.
Wiltse, L. L., andC. H. Frantz 1956 Non-supportive osteitis
pubis in the female. J. Bone Jt. Surg., 38A(33: 500-516.