Contracted Pelvis

Cliquez pour modifier le style des sous-titres du masque KABERA Ren MD PGY II-Resident Family and Community Medicine OBS-GYN DEPT UTH-B 4/21/12 KABERA RENE Dec 2009

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 labour.
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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. 4/21/12 KABERA RENE

DIAGNOSIS
HISTORY

Rickets: is expected if there is a history of delayed walking and dentition. Trauma or diseases: of the pelvis, spines or lower limbs. Bad obstetric history: e.g. prolonged labour ended by; difficult forceps, caesarean section or still birth.
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DIAGNOSIS
EXAMINATION

General examination Abnormal gait Stature :women < 150 cm Abdomen examination Pendolous abdomen in primigravida Non engagement in last 3-4 wks in primigravida
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Diagnosis
PELVIMETRY

Internal pelvimetry (done by per vagina exam)

The inlet: Palpation of the forepelvis (pelvic brim): V-shaped depression . Diagonal conjugate: <11.5 cm (not used if the head is engaged). The outlet:

Bituberous diameter : 8 cm Mobility of the coccyx: fixed External pelvimetry t is of little value as it measures

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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 labour. Severe degree: The true conjugate is 4/21/12 It corresponds to marked KABERA RENE 6-8 cm.

Diagnosis
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 labour C-section C-section

N.B: The fetal measurements must be considered !!! 4/21/12 KABERA RENE

References

Geneva Foundation for Medical Education and Research, Contracted Pelvis, Obstetrics Simplified Diaa M.EI-Mowafi 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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KABERA RENE