WEEK 8
II. COMPLICATIONS WITH THE PASSAGE
ØThe reason why dystocia can occur is a
contraction or narrowing of the
passageway or birth canal.
ØThis can happen at the: INLET, at the
MIDPELVIS, or at the OUTLET
ØThe narrowing causes CPD, or a
disproportion between the size of the fetal
head and the pelvic diameters, that
results in failure to progress in labor.
ANATOMY OF THE PELVIS
ØThe reason why dystocia can occur is a
contraction or narrowing of the
passageway or birth canal.
ØThis can happen at the: INLET, at the
MIDPELVIS, or at the OUTLET
ØThe narrowing causes CPD, or a
disproportion between the size of the fetal
head and the pelvic diameters, that
results in failure to progress in labor.
a.Inlet Contraction
ØIs narrowing of the anteroposterior diameter of
the pelvis to less than 11 cm or of the
transverse diameter to 12 cm or less.
ØUsually caused by rickets in early life or by an
inherited small pelvis
ØRickets- caused by lack of calcium
ØPrimigravidas – fetal head engages between
weeks 36 and 38 of pregnancy
•If occurs anytime before labor begins, the pelvis is
of adequate size
•Literally means, the fetal head sunk below the
inlet
•“Whatever goes in, comes out”- a head that
engages into the pelvic brim will be able to pass
through
•Rule: engagement does not occur in multigravidas
until labor begins, vaginal birth of a full term
infant only proves that their birth canal is
adequate
•Every primigravida should have pelvic
measurements taken and recorder before week
24 of pregnancy
•If CPD occurs, fetus may not engage but remains
“floating”, consider the possibility of cord
prolapse
b. Outlet contraction
ØIs a narrowing of the transverse diameter, the
distance between ischial tuberosities at the
outlet, to less than 11cm
Øis rare, but should be readily diagnosed at
the routine assessment of the pelvis during
the prenatal period. When in doubt,
accurate measurements of the
bony outlet by X-ray pelvimetry are
mandatory.
Management:
1.Can be delivered by NSD
2.Cesarean Section
*TRIAL LABOR
ØIf with borderline (just adequate) inlet
measurement
ØMay be done if with descent of the
presenting part and dilatation of the cervix