Professional Documents
Culture Documents
DEFINITION
Anatomical definition: It is a pelvis in which one or more of its main diameters are reduced below average normal by one or more centimetres Obstetric definition: It is a pelvis in which one or more of its main diameters are reduced to the extent that interferes with the normal mechanism of labour
ETIOLOGY
1. Developmental causes
Small gynaecoid -- generally contracted pelvis Small android Small anthropoid Small flat platypelloid pelvis Naegeles pelvis Roberts pelvis High assimilation pelvis Low assimilation pelvis Split pelvis
NAEGELES PELVIS
ROBERTS
PELVIS
FAULTY DEVELOPMENT
Bone tuberculosis
Severe malnutrition Poliomyelitis Hip joint disease Fractures of the pelvic bones, tumours of the pelvic bones
Rachitic pelvis
Osteomalacic pelvis
3.
Scoliosis Kyphosis
Spondylolisthesis
Coccygeal deformity
Kyphotic pelvis
Scoliotic pelvis
GENERAL: Rickets, Osteomalacia, Poliomyelitis, TB, fracture OBSTETRIC: Previous prolonged labour, difficult vaginal delivery, perineal tear, vesico-vaginal or recto-vaginal fistula
2. PHYSICAL EXAMINATION
Height: high risk <150 cm
Congenital or acquired deformities of pelvic bones, hip joint, spine Gait: abnormal gait - waddling Rickets : square head, rosary beads in costal ridges, pigeon chest, bow legs, harrisons sulcus
3. ABDOMINAL EXAMINATION
4. PELVIMETRY * Clinical
Data
Findings
Symphysis Sacrum
Side walls Ischial spines Interspinous diameter Sacrosciatic notch Subpubic angle Bituberous diameter Coccyx
Severe degree:
Extreme degree: 6 cm.
MECHANISM OF LABOUR
1. Flat rachitic pelvis
Engagement : with the sagittal suture in the transverse diameter Asynclitism with anterior parietal bone presentation Lateral displacement of the head Deflexion of the head and descent Rotation of the occiput 2/8 circle anteriorly
CEPHALOPELVIC DISPROPORTION
DIAGNOSING CPD
1. Abdominal method ( Pinards method )
TRIAL LABOUR
The conduction of spontaneous labour in a moderate degree of cephalo-pelvic disproportion, in an institution under supervision with watchful expectancy, hoping for a vaginal delivery
CONTRAINDICATIONS
Associated mid-pelvic and outlet contraction Elderly primigravida Mal-presentation Post-maturity Post caesarean pregnancy Pre - eclampsia Medical disorders like heart disease, DM, TB Unavailability of facilities for caesarean section
MANAGEMENT
Elective Caesarean section --In case of contraction of both the transverse and A-P diameters of the mid-pelvic plane
Vaginal delivery --- In uncomplicated cases with minor contraction * by forceps or ventouse with deep episiotomy to prevent perineal injuries