Ar - Contracted Pelvis

CONTRACTED PELVIS
DEFINITION
Anatomical definition:
• A pelvis in which one or more of it’s
diameters is reduced below the normal
by one or more centimeters.

Obstetric definition:
• Any of the essential diameters are
reduced to affect mechanism of labor.

CEPHALOPELVIC DISPROPOTION
( CPD )
• Disparity in relationship between the
pelvis and fetal head.

TYPES OF CONTRACTED PELVIS
A) Generally contracted pelvis.
• Small gynaecoid pelvis.

• Small android pelvis.
• Small anthropoid pelvis.
• Small platypelloid pelvis
( Simple flat pelvis )
B) Contracted at inlet / cavity / outlet.
a) Contraction at Inlet.
• Shortest AP diameter <10 cms or

• Largest transverse diameter <12 cms.
• AP diameter is assessed by diagonal
conjugate. ( DC )
• So DC < 11.5 cms is inlet contraction.
• Result: Mobile head at term.
b) Contraction at Mid pelvis.
• Interspinous diameter <10 cms.
• Result: Occipito-posterior. ( mal position )

Deep transverse arrest.
( mal rotation )
Prolonged labor.
c) Contraction at Outlet.
• Intertuberous diameter < 8cms.
• Narrow subpubic arch.
• Result: Prolonged labor.

Perineal laceration.
AETIOLOGY
I) Diseases of pelvic bone.

• Rickets.
• Osteomalacia.
II) Development anomalies.

a) Naegle’s pelvis. ( PICTURE HERE )
lacks one sacral alae.
b) Robert’s lack both sacral alae.
( Pic here )
c) Split pelvis.
( Gap between two pelvic bones )
( pic here )
III) Assimilation pelvis.
• Variation in number of vertebrae fused

to form sacrum.
Low assimilation:
• Four vertebrae fused to form sacrum.
( PIC HERE )
• Result: Obliquity of brim is decreased.

High assimilation:
• Six vertebrae fused to form sacrum.
( PIC HERE )
Result: Obliquity of brim increased.

IV) Vertebral deformity.
a) Kyphosis.
b) Scoliosis.
c) Spondylolisthesis.
• The 5th lumbar vertebra with the above

vertebral column is pushed forward.
• The sacral promontory is pushed

backwards.
• Tip of the sacrum is pushed forwards

leading to outlet contraction. ( PIC HERE )
V) Lower limb deformity.
Dislocation of femur.
Fractures of limb bones.
Tumors.
DIAGNOSIS
1) History:
Medical: H/o…
• Rickets.
• TB.
• Polio.
• Difficult vaginal delivery.
• Difficult instrumentation.
• Birth asphyxia.
• Still birth.
2) General examination:
• Short stature < 140 cms.
• Abnormal gait.
• Spine and lower limbs.
3) Per abdomen:
• Pendulous abdomen.
• Mobile head at term.
4) Assessment of pelvis.
a) Internal pelvimetry.
b) External pelvimetry.
c) Radiology:
X-ray.
Ultrasound.
CT scan.
MRI.
a) Internal pelvimetry.
Pelvic inlet: Assessed by……..

• Sacral promontory.
• Diagonal conjugate.
Pelvic Cavity: Assessed by………
• Sacral curve.
• Pelvic side wall.
• Ischial spine.
• Sacro sciatic notch.
Pelvic outlet: Assessed by………..
• Sub pubic arch. ( Two fingers )

• Sub pubic angle.
• Inter tuberous diameter. ( 4 knuckles )
• Mobility of the coccyx.

• Antero-posterior diameter.
( Tip of coccyx to lower margin of
symphysis )
b) External pelvimetry.
• Measures the false pelvis. ( Not of value )

• Thom’s, Jarcho’s or crossing pelvimeter is
used.
• Interspinous diameter. ( 25 cm )
( Between anterior superior iliac spines )
• Intercrestal diameter. ( 28 cm )
• External conjugate. ( 20 cm )
c) Radiological pelvimetry.
X-Ray Lateral view:
• The AP diameters of the pelvis.
• Width of sacrosciatic notch.
• Curvature of the sacrum.

Ultrasonography :
• Safe.
• Accurate .
• Easy method.
• Measures:
– Biparietal diameter. ( BPD )

– Head circumference. ( HC )
ASSESING CPD
Munrocker muller.
• Fetal head is the best pelvimeter.

• Active labour detects brim dispropotion.
• Patient in dorsal position.
• Left hand over abdomen.
• Right hand PV at the spine.
• If head reaches spine, there is no CPD.
• Place thumb over pubic symphysis.
• If head cannot be pushed upto spine.
Minor disproportion:
• If anterior surface of the head is in line

with the posterior surface of the
symphysis.
Moderate disproportion. ( 1st degree ):
• The anterior surface of the head is in
line with the anterior surface of the
symphysis. Vaginal delivery may or may
not occur.
Marked disproportion. ( 2nd degree ):

• The head overrides the anterior surface
of the symphysis. Vaginal delivery
cannot occur.
CPD POINTERS IN LABOR
• Prolong labor.
• High head at full dilatation.
• Cervix loosley applied to the head.
• Excess caput.
• Irreducible moulding.
COMPLICATIONS OF CPD
a) Maternal:
PROM.
Mal presentation.
Deep Transverse Arrest. ( DTA )
Obstructed labour......rupture of uterus.
Increased instrumental delivery.
Post partum hemorrhage.
Vesico vaginal fistula.
b) Fetal:
• Birth asphyxia.
• Cord prolapse.
• Sepsis.
• Birth injuries.
• Fetal death.
MANAGEMENT
Minor CPD: Vaginal delivery.
Moderate CPD: Trial of labor / LSCS.
Severe CPD: LSCS.

a) Elective cesarean if...…
• Malpresenation.
• High risk.
• Previous LSCS.
• Marked CPD.
2) Trial of labor.
( Clinical test for factors that cannot be

determined before start of labor as… )
• Efficiency of uterine contractions.
• Moulding of the head.
• Yielding of the pelvis and soft tissues.

Successful trial:
• Birth of a healthy baby vaginally and

maternal condition is good.
Failed Trial:
• LSCS / Delivery of dead or compromised

baby.
Conduction of Trial:
• Done where facilities for emergency

LSCS are available.
a) Select patient.
b) Monitor progress.
• Partogram.
• Per abdomen- descent of head.
• Per vaginal examination.
• CTG.
c) Augment labor.
• ARM.
• Oxytocin.
d) Terminate trial if............

• No progress on cervix dialation.
• Faliure of descent of head.
• Excess caput / Moulding.
• Maternal / Fetal distress.
MANAGEMENT OF LABOR IN
CONTRACTED PELVIS
THE ROLE OF FORCEPS:
• No role; Don’t use if head not engaged.
SYMPHYSIOTOMY – PUBIOTOMY:
• Prior to the era of antibiotics.
DESTUCTIVE OPERATION:
• Craniotomy.

Ar - Contracted Pelvis

Uploaded by

Copyright:

Available Formats

Ar - Contracted Pelvis

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Ar - Contracted Pelvis

Uploaded by

Copyright:

Available Formats

CONTRACTED PELVIS

• A pelvis in which one or more of it’s

diameters is reduced below the normal

by one or more centimeters.

• Any of the essential diameters are

reduced to affect mechanism of labor.

• Disparity in relationship between the

pelvis and fetal head.

A) Generally contracted pelvis.

• Small gynaecoid pelvis.

• Shortest AP diameter <10 cms or

• Interspinous diameter <10 cms.

• Result: Occipito-posterior. ( mal position )

• Intertuberous diameter < 8cms.

• Narrow subpubic arch.

• Result: Prolonged labor.

I) Diseases of pelvic bone.

II) Development anomalies.

( Gap between two pelvic bones )

• Variation in number of vertebrae fused

• Result: Obliquity of brim is decreased.

• Six vertebrae fused to form sacrum.

Result: Obliquity of brim increased.

• The 5th lumbar vertebra with the above

• The sacral promontory is pushed

• Tip of the sacrum is pushed forwards

Fractures of limb bones.

Pelvic inlet: Assessed by……..

• Sub pubic arch. ( Two fingers )

• Mobility of the coccyx.

• Measures the false pelvis. ( Not of value )

X-Ray Lateral view:

• The AP diameters of the pelvis.

• Width of sacrosciatic notch.

• Curvature of the sacrum.

– Biparietal diameter. ( BPD )

• Fetal head is the best pelvimeter.

• If anterior surface of the head is in line

Marked disproportion. ( 2nd degree ):

• Cervix loosley applied to the head.

Minor CPD: Vaginal delivery.

Moderate CPD: Trial of labor / LSCS.

Severe CPD: LSCS.

( Clinical test for factors that cannot be

• Efficiency of uterine contractions.

• Moulding of the head.

• Yielding of the pelvis and soft tissues.

• Birth of a healthy baby vaginally and

• LSCS / Delivery of dead or compromised

• Done where facilities for emergency

d) Terminate trial if............

You might also like