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CONTRACTED PELVIS

KABERA Ren, MD Family Physician KABUTARE HOSPITAL RWANDA

PLAN
Introduction Definition Types of Pelvis Risk factors Diagnosis Management References

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INTRODUCTION

Knowledge of the shape and dimensions of the normal female pelvis is essential for a proper understanding of the second stage of labor and its abnormalities since the body pelvis is an important component which determines the birth canal structure.

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DEFINITION

Anatomical definition: It is a pelvis in which one or more of its diameters is reduced below the normal by one or more centimeters. Obstetric definition: It is a pelvis in which one or more of its diameters is reduced so that it interferes with the normal mechanism of labor.

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TYPES :CALDWELL-MOLOY CLASSIFICATION

Gynecoid (50%)

Anthrapoid (25-30%)

Android (17%)

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Platypelloid 3%

CLASSIFICATION OF MERGER (FRENCH)


Robert Merger 1903-1986 Bassin aplati Bassin transversalement retreci Bassin generalement retreci et aplati Bassin generalement retreci

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CLASSIFICATION OF THOMS
American obstetrician Herbert Thoms 1885-1972 Dolichopellic Pelvis :True conjugate > Transverse Mesatipellic Pelvis :True conjugate = Transverse or < of 1 cm Brachypellic Pelvis :True conjugate < Transverse of 1 to 3 cm Platypellic Pelvis :True conjugate < Transverse of 3 cm and above

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2 INNOMINATE BONES : ILIUM ISCHIUM

PUBIS SACRUM COCCYX

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RISK FACTORS
Factors influencing the size and shape of the pelvis Developmental factor: hereditary or congenital. Racial factor. Nutritional factor: malnutrition results in small pelvis. Sexual factor: as excessive androgen may produce android pelvis. Metabolic factor: as rickets and osteomalacia. Trauma, diseases or tumors of the bony pelvis, legs or spines.
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DIAGNOSIS History Trauma or diseases: of the pelvis, spines or lower limbs. Bad obstetric history: e.g. prolonged labor ended by difficulty; forceps, caesarean section or still birth.

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DIAGNOSIS
Examination General examination Abnormal gait. Stature: women < 150 cm. Abdominal examination Pendulous abdomen in primigravida. Non engagement in last 3-4 wks of pregnancy in primigravida.
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ABDOMINAL PALPATION NOT ENGAGED (PONDULOUS)

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DIAGNOSIS

Pelvimetry External pelvimetry is of little value as it measures diameters of the false pelvis. Measures :Michaelis,Trillat

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DIAGNOSIS Internal pelvimetry (done by per vagina exam) The inlet:-Pelvic brim, Pelvic cavity Palpation of the forepelvis (pelvic brim): Vshaped depression. Diagonal conjugate: <11.5 cm (not used if the head is engaged). Ischeal spine :pelvic cavity

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Diagnosis :Internal pelvimetry-Inlet


DIAGONAL CONJUGATE AND SUBPUBIC ANGLE ASSESSMENT

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DIAGNOSIS: INTERNAL PELVIMETRY-OUTLET


Bituberous diameter : 8 cm Mobility of the coccyx: fixed

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WIDE SUBPUBIC ANGLE IN GYNECOID TYPE NARROW IN ANDROID TYPE

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MANAGEMENT
The true conjugate >9 8-9 cm 8-9 cm < 8 cm Bituberous diameter > 8 cm > 8 cm 8 cm > or < 8cm Decision Vaginal delivery Trial of labor C-section C-section

N.B: The fetal measurements must be considered !!!


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MANAGEMENT
Degrees of Contracted inlet pelvis Minor degree: The true conjugate is 9-10 cm. It corresponds to minor disproportion. Vaginal delivery. Moderate degree: The true conjugate is 8-9 cm. It corresponds to moderate disproportion. Trial of labor. Severe degree: The true conjugate is 6-8 cm. It corresponds to marked disproportion. C-section. Extreme degree: The true conjugate is less than 6 cm, vaginal delivery is impossible even after craniotomy as the bimastoid diameter (7.5 cm) is not crushed. C-section.
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REFERENCES
Geneva Foundation for Medical Education and Research, Contracted Pelvis, Obstetrics simplified diaa M.Ei-mowafi.2009 Williams Obstetrics .Section IV. Labor and Delivery. Chapter 20. Dystocia: Abnormal Labor, 22nd ed. 2005. Current Obstetrics and Gynecologic diagnosis and treatment. Section III Pregnancy at risk. Abnormalities of the passage, 9th ed. 2003.

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Thank you
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