[go: up one dir, main page]
Scribd
Upload
2K views19 pages

Contracted Pelviss Pres

This document defines a contracted pelvis and describes the causes, diagnosis, and management of cephalopelvic disproportion (CPD). A contracted pelvis is one where the size and shape of the pelvis is altered enough to affect normal labor mechanics. Causes include nutritional deficiencies, diseases, injuries, and developmental defects. Diagnosis involves medical history, examinations, and imaging. Management includes trial of labor, caesarean section, or other procedures depending on the severity of the disproportion and other factors. Trial of labor aims to avoid unnecessary c-sections while delivering a healthy baby but carries risks if disproportion is too severe.

Uploaded by

Auri Surury
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
2K views19 pages

Contracted Pelviss Pres

This document defines a contracted pelvis and describes the causes, diagnosis, and management of cephalopelvic disproportion (CPD). A contracted pelvis is one where the size and shape of the pelvis is altered enough to affect normal labor mechanics. Causes include nutritional deficiencies, diseases, injuries, and developmental defects. Diagnosis involves medical history, examinations, and imaging. Management includes trial of labor, caesarean section, or other procedures depending on the severity of the disproportion and other factors. Trial of labor aims to avoid unnecessary c-sections while delivering a healthy baby but carries risks if disproportion is too severe.

Uploaded by

Auri Surury
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
You are on page 1/ 19

DEFINITION

 A contracted pelvis may be defined as


one in which there is alteration in the
size and shape of the pelvis of
sufficient degree so as to alter the
normal mechanism of labour in an
average size baby.
ETIOLOGY
 NUTRITIONAL AND ENVIRONMENTAL DEFECTS
 Rachitic - a flat pelvis distorted as a result of rickets.

 Osteomalacic- Softening of the bones, typically through a


deficiency of vitamin D or calcium.
DISEASES OR INJURIES AFFECTING THE BONES
OF THE PELVIS
 Fracture, tumour, TB, poliomyelitis, hip joint disease
DEVELOPMENTAL DEFECTS
 Naegele’s pelvis-It is produced due to arrested
development of one ala

of the sacrum
 Robert’s pelvis- Ala of
both sides are absent and
sacrum is fused to the
innominate bone

 Kyphotic pelvis

a deformed pelvis
associated with a kyphotic
deformity of the spine.
DIAGNOSIS
 Medical history- Fracture, tumour, TB, poliomyelitis, hip
joint disease
 Obstetric history
o Previous prolonged labour
o Previous still birth
o Baby born with asphyxia
o History of neonatal convulsion and mental retardation
o Instrumental delivery
o Maternal injury
o Appearance of the patient
Contd….

 Contracted pelvis should suspected in following cases


o Small stature
o Pendulous abdomen
o Exaggerated spinal curvature
o Deformities of the limb
Contd….
 ABDOMINAL EXAMINATION

 Posterior position – common

 Pendulous abdomen

 Badly flexed head

 VAGINAL EXAMINATION

 CLINICAL PELVIMETRY
HAZZARDS
radiation exposure to the mother and the fetus
CEPHALOPELVIC DISPROPORTION

The disparity in the relation between the head and the


pelvis is called CPD
DIAGNOSIS
 Clinical- Abdominal and Abdomino-vaginal method
 Imaging pelvimetry
 Cephalometry –USG, MRI, X-ray
MANAGEMENT
PRETERM INDUCTION OF LABOUR
TRIAL OF LABOUR
 CAESAREAN SECTION
 Severely contracted pelvis
 Elderly primi gravida
 Breech
 Previous LSCS
 Failed trial of labour
If disproportion due to fetal cause,
 Craniotomy
 Symphysiotomy
 Manipulative correction
TRIAL OF LABOUR

It is the conduction of spontaneous labour in a


moderate degree of CPD, in an institution under
supervision with watchfull expectancy, hoping for a
vaginal delivery
Aims – avoiding unnecessary CS and at delivering a
healthy baby
Contraindications
 midpelvic and outlet contraction

 Complicating factors like elderly


primigravida, malpresentation, postmaturity,
post CS, pre-eclampsia, medical disorders
 Facilities of CS is not available
Conduction of trial labour
Labour should ideally spontaneous
Hydration maintained by IV drip
Progress of labour is observed-descent of fetus,
dilatation of cervix
No procedure should be employed before the cervix is
at least 3cm dialated
Watch maternal and fetal condition
After the membranes are ruptured, pv is to be done
 Cord prolapse

 Colour of liquor

 Assess the pelvis and cervix


Successful outcome depends on-
 Degree of pelvic contraction

 Shape of the pelvis

 Favourable vertex presentation

 Intact membranes till the full dilatation of


cervix
 Effective uterine contractions

 Tolerance of the patient


Trial labour to be continued till evidence of descent of
the head and progressive cervical dilatation and
maternal and fetal condition remain good
Termination of trial labour
Spontaneous delivery with or without episiotomy
Forceps or ventouse
Caesarean section
Successful trial labour- a healthy baby is born vaginally,
spontaneous or by forceps or ventouse with the
mother in good condition
Advantages –
 eliminates unnecessary CS

 Eliminates injudicious use of premature


induction of labour
 Ensures the woman a good future obstetrics
Disadvantages
 Test of disproportion remains unproven

 Increased perinatal morbidity or mortality

You might also like