Contracted pelvis shorter pelvic diameters difficulty for delivery of an average sized baby effects complications management

1. CONTRACTED PELVIS
Sharon Treesa Antony
Second year M.Sc Nursing
Govt. College of Nursing Kottayam

2. DEFINITION
 Anatomically contracted pelvis is defined as one
where the essential diameters of one or more
planes are shortened by 0.5cm.
 Obstetrically, it is a state in which there is alteration
in size or shape of the pelvis of sufficient degree a
to alter the normal mechanism of labour in an
average size baby.

3. ETIOLOGY
 Short women
 Nutritional and environmental defects
 Diseases or injuries affecting bones of the pelvis:
fracture, tumors, TB arthritis
 Spine: kyphosis, scoliosis, spondylolisthesis,
coccygeal deformity
 Lower limbs: poliomyelitis, hip joint disease

4.  Developmental defects: Naegel’s pelvis, Robert’s
pelvis, high or low assimilation pelvis

5. RACHITIC FLAT PELVIS
 Inlet
 Sacral promontary is pushed downwards or
forwards producing a reniform shape
 Short APD
 Cavity
 Sacrum is flat and tilted backwards
 Sharp angulation at sacrococcygeal joint
 Outlet
 Widened transverse diameter and pubic church

6. OSTEOMALACIC PELVIS
 Due to softening of the pubic bones
 The promontary is pushed downwards and
forwards and the lateral pelvic walls are pushed
inwards causing the anterior wall to form a beak
 Triradiate shape of inlet
 Approximation of 2 ischial tuberosities
 Markedly shortened sacrum
 Coccyx is pushed forward

7. ASYMMETRICAL/ OBLIQUELY CONTRACTED
PELVIS
 Naegel’s pelvis
 Scoliotic pelvis
 Disease affecting one hip or sacroiliac joint
 Tumors or fracture affecting one side of the pelvic
bones during growing age

8. NAEGELE’S PELVIS
 Due to arrested development of one ala of the
sacrum
 Congenital
 Acquired( osteitis of sacroiliac joint)
 Pelvis is obliquely contracted at all levels but more
marked in the outlet
 Straight iliopectineal line on the affected side

9. SCOLIOSIS
 Acetabulam is pushed inwards on the weight
bearing side
 Contraction of one of the oblique diameters

10. ROBERT’S PELVIS
 Ala of both the sides are absent
 Sacrum is fused with innominate bones

11. KYPHOTIC PELVIS
 Sacrum is tilted backward in the upper part and
towards the lower part, it is narrow and straight
 APD is increased at the inlet but is decreased at the
outlet
 Narrow suprapubic angle
 Pendulous abdomen

12. PELVIC DIAMETERS
 Inlet contraction
 APD: <10cm
 TD<12cm
 Diagonal conjugate<11.5cm
 Midpelvic contraction
 Transverse + posterior sagittal diameter </= 13.5cm
 TD< 8cm
 Outlet contraction
 Interischial tuberous diameter </= 8cm

13. DIAGNOSIS
 Past history
 Physical examination
 Deformities of pelvic bones, hip joint, spine
 Dystocia dystrophia sundrome
 Abdominal examination

14. ASSESSMENT OF PELVIS
 Clinical pelvimetry
 Sacrum: smooth, short and well curved and the
promontary cannot bereached or the sacrum may
be long or straight
 SacroSciatic notch:
The notch is sufficiently wide so that 2 fingngers can
be easily placed over the sacrspinous ligament
covering the notch

15.  Ischial spines: spines are usually smootha nd
difficult to palpate. They may be prominent or
encroach to the cavty
 Iliopectineallines: beaking suggestive of narroe
forepelvis

16.  Side walls: convergent
 Posterior surface of symphysis pubis angulation/
beaking
 Sacrococcygeal joint: mobility and hooked coccyx
 Pubic arch: shoulld accomodate palmar aspect of 2
fingers
 Diagonal conjugate : may be less
 Subpubic angle: roughly corresponds to fully
abducted middle and index fingers

17.  TD of outlet: by placing the knuckles between the
ischial tuberosities
 APD of outlet

18.  X ray pelvimetry
 CT
 MRI
 USG

19. CEPAHLO PELVIC DISPROPORTION
 It is a state where the normal proportion between
the size of the fetus to the pelvis is isturbed.

20. DIAGNOSIS
 Clinical
 Abdominal
 Abdomino vaginal method
 Imaging pelvimetry
 Cephalometry
 USG
 MRI
 X ray

21. EFFECTS OF CONTRACTED PELVIS
 Pregnancy
 Chance of incarceration of retroverted gravid uterus
in flat pelvis
 Abdomen becomes pendulous
 Malpresentations

22.  Labor
 Increased incidence of early rupture of membranes
 Cord prolapse
 Slow cervical dilatation
 Prolonged or obstructed labour
 Operative interference, PPH, Shock

23.  Maternal injuries
 Fetal hazards from asphyxia

24. MANAGEMENT OF INLET CONTRACTION
 Ascertain the degree of disproportion
 Minor inlet contraction:
spontaneous delivery
 Moderate and severe degrees:
Induction of labor
CS
Trial labor

25. INDUCTION OF LABOR
 2-3 week prior to EDC in multi gravida with history
previous difficult labor

26. ELECTIVE CS
 Major degree of inlet contraction
 Moderate degree of inlet contraction with outlet
contraction or other complicating factors like
malpresentation

27. TRIAL LABOUR
 It is the conduction of spontaneous labour i
moderate degree of cephalopelvic disproportion, in
an institution under supervision with watchful
expectancy, hoping for a vaginal delivery

28. CONTRAINDICATIONS
 Associated mid pelvic and outlet contraction
 Presence of complicating factors like primigarvida,
malpresentation, postmaturity, post caesarean
pregnancy, pre eclampsia, medical disorders like
heart disease, diabetes, TB etc
 Lack of facilities for caesarean section round the
clock

29. CONDUCTION OF TRIAL LABOUR
 Prefers spontaneous labor, induce only if labor
doesnot start even after due date
 NPO, maintain hydration by IVF, adequate
analgesics
 Maintain partograph
 Maternal and fetal monitoring
 In failure to progrs: amniotomy+ oxytocin after
cervix is 3cm
 Pelvic examination after membranes are ruptured

30. FAVOURABLE FACTORS
 Flat pelvis better than android
 Vertex
 Degree of contraction: minor
 Intact membranes till full dialatation
 Good uterine contraction
 Emotional stability of woman

31. UNFAVOURABLE FEATURES
 Appearance of abnormal uterine contraction
 Cervical <1cm/hour in the active phase
 Descent of fetal head < 1cm/hour
 Arrest of cervical dilation and nondescent of fetal
head inspite of oxytocin therapy
 Early rupture of membranes
 Formation of caput and evidence of excessive
mouldng
 Fetal distress

32. HOW LONG TRIAL TO BE CONTINUED
 Termination of trial
 Spontaneous delivery with or without episiotomy
 Forceps/ ventouse: difficult forceps delivery is to be
avoided
 Caesarean section

33. MIDPELVIC AND OUTLET CONTRACTION
 CPD at the outlet is defined as one where the
biparietal – suboccipitobregmatic plane fails to pass
through the bispinous and anteroposterior plane of
the outlet.

34. MANAGEMENT
 Elective caesarean section
 Vaginal delivery:
 In minor degrees of contraction
 with watchful expectancy
 Forceps/ventouse+ deep episiotomy
 Patograph
 Oxytocin SOS

35. CASES SEEN LATE IN LABOUR
 Caesarean section to avoid difficu;t forceps
 Forceps with deep episiotomy
 Syphysiotomy foolowed by ventouse
 Craniotomy if fetus is dead

36. THANK YOU