Description about contracted pelvis, rachitic pelvis, osteomalacic pelvis, causes and its management.

1. By
R.Vijayalakshmi
IIIrd BHMS

2. DEFINITION
IT IS A PELVIS IN
WHICH ONE OR MORE
OF ITS DIAMETER IS
REDUCED BY MORE
THAN 1cm .

3. ETIOLOGY
NUTRITIONAL DEFECTS
RACHITIC FLAT PELVIS
OSTEOMALACIC PELVIS

4. RACHITIC FLAT
PELVIS
INLET: SACRAL PROMONTORY IS PUSHED
DOWNWARDS.
ANTROPOSTERIOR DIAMETER:
SHORT
SACRUM:FLAT & TILTED BACK
SACROCOCCYGEAL JOINT:
SHARP ANGULATION

6. OSTEOMALACIC PELVIS
DUE TO SOFTENING OF PELVIC BONES.
INLET: TRIRADIATE
SACRUM: SHORT
COCCYX: PUSHED FORWARD

9. DISEASES
TUMORS
TUBERCULAR ARTHRITIS

10. TUMOR OF HIP

11. TUBERCULOSIS OF HIP

12. INJURIES
FRACTURES
KYPHOSIS
SCOLIOSIS
SPONDYLOLISTHESIS

16. FRACTURES OF PELVIS

18. SPINAL DEFORMITIES

19. KYPHOTIC PELVIS:
SACRUM
 UPPER PART:
TILTED BACKWARD
 LOWER PART:
NARROW & STRAIGHT
ANTROPOSTERIOR DIAMETER:
 INCREASED AT INLET
 DECREASED AT OUTLET

20. SCOLIOSIS
ACETABULAM:
PUSHED INWARDS ON WEIGHT
BEARING SIDE.
ONE OF THE OBLIQUE
DIAMETER CONTRACTED.

21. SPONDYLOLISTHESIS

23. DEVELOPMENTAL DEFECTS
NAEGELE’S PELVIS
ROBERT’S PELVIS
HIGH / LOW ASSIMILATION
PELVIS.

24. NAEGELE’S PELVIS

25. NAEGELE’S PELVIS
DUE TO ARRESTED DEVELOPMENT
OF ONE ALA OF SACRUM.
PELVIS IS CONTRACTED AT ALL
LEVELS & MORE MARKED IN OUTLET.
ILIO PECTINEAL LINE:
STRAIGHT ON AFFECTED
SIDE.

26. NAEGELE’S PELVIS

27. ROBERT’S PELVIS
ALA OF BOTH SIDES ARE
ABSENT.
SACRUM:
FUSED WITH INNOMINATE
BONES.

28. ROBERT’S PELVIS

31. DIAGNOSIS
IS BASED ON:
PAST HISTORY
TRAUMA
PHYSICAL EXAMINATION
PELVIC BONE DEFORMITY
ABDOMINAL EXAMINATION

32. INVESTIGATIONS:
IS USED IN
ASSESSMENT OF THE DIMENSIONS &
CAPACITY OF ADULT FEMALE
PELVIS IN RELATION TO BIRTH OF
THE BABY.

34. OTHER
INVESTIGATIONS:
 CT PELVIS
 MRI
 USG

35. EFFECTS OF
CONTRACTED PELVIS
1.PREGNANCY
 INCARCERATION OF RETROVERTED
GRAVID UTERUS.
 MALPRESENTATIONS.

36. Contd...
2.LABOUR
 EARLY RUPTURE OF
MEMBRANES.
 CORD PROLAPSE
 SLOW CERVICAL DILATATION
 PPH
 SHOCK

37. MECHANISM OF LABOUR
IN CONTRACTED PELVIS

38. THE DIFFERENCE IN MECHANISM OF
LABOUR IN CONTRACTED PELVIS FROM
NORMAL PELVIS IS THAT:
 THE HEAD REMAINS DEFLEXED &
THE ENGAGEMENT IS DELAYED.
 ONCE THE HEAD NEGOTIATES THE
BRIM THERE IS NO DIFFICULTY IN THE
CAVITY & OUTLET. THEN THE NORMAL
MECHANISM OF LABOUR FOLLOWS.

39. MANAGEMENT OF
CONTRACTED PELVIS
IN MINOR DEGREE
VAGINAL DELIVERY AT TERM.
IN MODERATE / SEVERE
 INDUCTION OF LABOUR.
 ELECTIVE CS AT TERM.