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Contracted pelvis

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Contracted pelvis in Obstetrics

Contracted pelvis in Obstetrics

Published in: Health & Medicine

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  • 1. Contracted Pelvis. Fetal Macrosomia Lecture by Andriy Berbets
  • 2. Measurement of the pelvis
  • 3. Normal pelvis
  • 4. Normal pelvis
  • 5. Anatomically contracted pelvis • The diagnosis is correct, if at least one diameter is contracted 2cm + • Classification: - Generally contracted pelvis - Simple flat pelvis - Flat rachitic pelvis - Transversely contracted pelvis
  • 6. Anatomically contracted pelvis Classification (by degree of contraction) - 1st degree (conjugata vera 11-9 cm) - 2nd degree (conjugata vera 9-7,5 cm) - 3rd degree (conjugata vera 7,5-6,5 cm) - 4th degree (conjugata vera less than 6,5 cm)
  • 7. Generally contracted pelvis
  • 8. Generally contracted pelvis
  • 9. Generally contracted pelvis • All the dimensions are equally contracted (longitudinal and transverse) • Delivery: - over-flexion of the fetal head, - passing of the fetal head through the pelvis on oblique dimension, - fetal head can’t fixate good enough to pubic symphysis
  • 10. Generally contracted pelvis
  • 11. Generally contracted pelvis
  • 12. Generally contracted pelvis
  • 13. Generally contracted pelvis
  • 14. Simple flat pelvis
  • 15. Simple flat pelvis • • • • All longitudinal dimensions are contracted Internal rotation is problematic Moderate extension of fetal head Asynclitism
  • 16. Asynclitism
  • 17. Rachitic flat pelvis
  • 18. Transversely contracted pelvis
  • 19. Alternative classification
  • 20. Alternative classification
  • 21. Michaelis’ rhombus
  • 22. Clinically contracted pelvis • • • - Anatomical dimensions are normal But fetus is too big and can’t pass through Conditions for diagnosis: Good regular uterine contractions Cervical dilation 8cm + Absence of amniotic sac Empty urine bladder
  • 23. Clinically contracted pelvis • - Diagnosis: No fetal head’s descending Cervix is not closed to fetal head High standing of contraction ring Early pushing efforts (head is not in pelvic cavity) Edema of cervix, vagina and vulva Symptoms of urine bladder’s pressure Positive signs of Vasten and Tsangemeister
  • 24. Vasten’s sign
  • 25. Threat of uterine rupture
  • 26. Coxalgic pelvis
  • 27. Ankilotic oblique-deformated pelvis
  • 28. Pelvis due to osteomalatia
  • 29. Scoliotic pelvis
  • 30. Pelvis with no symphysis
  • 31. Pelvis with no symphysis (“cleft”)
  • 32. Osteoma
  • 33. Shoulder dystocia
  • 34. Shoulder dystocia
  • 35. Thank you!