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Passage
Lecturer: Doc M. Nualla

Practice Case

AOG = 39 weeks and 5 days

EDC = October 12, 2022

Estimated Fetal Weight (EFW)

(Fundic height) 34 cm - 12 (engaged) x 155 = 3410g

Presentation = Breech

LM3 = Engaged

LM4: Fetal Attitude = Flexed

Passage 1
 Stage of labor at time of admission = Stage 1 since IE: 5cm < 10 cm; if 10 cm =
Stage 2

To determine if patient will deliver vaginally:

Compute for EFW

Assess pelvic cavity if adequate

Let patient go on trial of labor

Anatomy

Female Pelvis

Linea terminalis

separates true pelvis from false pelvis

True Pelvis boundaries

3 planes

Inlet

superior plane of true pelvis

boundaries

posterior - sacral promontory and alae of sacrum

lateral - linea terminalis

anterior - horizontal pubic rami and symphysis pubis

Midpelvis

Outlet

False Pelvis boundaries

Pelvic Assessment

X-ray pelvimetry

obsolete in practice

quantitative approach

used only for deformity of the pelvis

Passage 2
 Clinical pelvimetry

used in practice

qualitative manual assessment of pelvic diameters

cannot accurately predict vaginal delivery

contraction of pelvic diameters → diminishes pelvic capacity to create

dystocia during labor

Assessment of Pelvic Inlet

Diagonal Conjugate - clinically measurable

Passage 3
Passage 4
 Station 0 = mid pelvis

BPD at Station -3 with most depended part of fetal head at Station 0 →

Engagement

Passage 5
 Assessment of Midpelvis

Passage 6
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 Flexion → to present smallest diameter of fetal head as it reaches the midpelvis
Internal rotation → to pass through the midpelvis

Assessment of Pelvic Outlet

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Passage 12
 External rotation → to allow acromial diameter (shoulders) to pass through; happens
spontaneously

Anatomical Classification of Pelvis

Passage 13
 Gynecoid - Best

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 SUMMARY

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