OSCE

CLINICAL PELVIMETRY

Materials: Tape measure

1. Identify the parts of the bony pelvis
a. Ilium, pubis, ischium, pubic symphysis
b. Sacrum, Sacral promontory (upper border of the sacrum) and coccyx
c. Linea terminalis
d. The area above the linea terminalis is what we call “false pelvis” and the area
below is called the “true pelvis”

2. Identify the shape of the pelvic inlet
a. Gynecoid: this pelvis model
shows a gynecoid shape pelvis
which is thought to be the
most favorable pelvis type for
a vaginal birth
b. Android
c. Anthropoid
d. Platypelloid

3. Examining hand measurement
a. Next, measure the examining hand from the tip of the middle finger up to the
base of the thumb, using a tape measure (cms)
If measure it we will get around 11.5cm

4. Evaluation of Pelvic Inlet
a. Define the ffg:
i. Diagonal conjugate- measured from the lower border of the pubic
symphysis to the sacral promontory
ii. Obstetric conjugate-measured from the middle part of the pubic
symphysis to the sacral promontory
iii. True conjugate- measured from the upper border of the pubic symphysis
to the sacral promontory

b. The only way where we can clinically assess the pelvic inlet is by measuring the
diagonal conjugate.
i. We measure the diagonal conjugate by introducing the index and middle
fingers under the pubic symphysis, reaching for the sacral promontory.
ii. Note where the inferior border of the symphysis touches your examining
hand
 iii. Keep in mind that the measurement of the obstetric and true conjugate
will depend on the measured diagonal conjugate
iv. Report findings for the pelvic inlet: Note that in this procedure the
examining hands can hardly reach the sacral promontory
ADEQUATE: diagonal conjugate >11.5cm (sacral promontory cannot be
reached)
INADEQUATE: diagonal conjugate <11.5cm (sacral promontory can be
reached)

5. Evaluation of the Midpelvis
a. Check for the sacral curvature (note if curved or shallow/straight)
b. Measure the sacrosciatic notch- usually this should accommodate 2
fingerbreadths (note if wide or narrow)
c. Palpate the ischial spine (note if blunt or prominent)
d. Measure the bispinous diameter (>8.5cm)
e. Assess the splay of the sidewalls- In assessing the splay of the sidewalls we place
our examining index finger to the ischial spine and our thumb to the ischial
tuberosity
i. If the biischial tuberosity is lateral to the ischial spine= DIVERGENT
SIDEWALLS
ii. If the biischial tuberosity is medial to the ischial spine= CONVERGENT
SIDEWALLS
ADEQUATE: sacrum curved, sacrosciatic notch wide, ischial spines blunt,
biischial spine >8.5cm, divergent sidewalls
INADEQUATE: sacrum shallow, sacrosciatic notch narrow, ischial spines
prominent, biischial spine <8.5cm, convergent sidewalls

6. Evaluation of the Pelvic Outlet
a. Measure the interischial diameter by putting a closed fist in between the
ischial tuberosities (usually it accommodates 4 knuckle bones)
b. Next, is we estimate the subpubic angle (usually this should be greater
than 90deg angle)
c. Lastly, we assess the mobility of the coccyx
ADEQUATE: intertuberous diameter >8.5cm, subpubic angle >90deg,
coccyx movable
INADEQUATE: intertuberous diameter <8.5cm, subpubic angle <90deg,
coccyx not movable
7. END