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Cephalopelvic disproportion
- 3. GYNECOID PELVIS CLASSIC FEMALE TYPE SEEN IN 50% FEMALE
- 4. Contd… CHARACTERISTICS INLET: ROUND TRANSVERSE DIAMETER: WIDE SIDE WALLS: STRAIGHT
- 5. Contd… ISHIAL SPINE: AVERAGE PROMINENCE SACRO-SCIATIC NOTCH: WELL ROUNDED SACRUM: WELL CURVED SUPRA PUBIC ARCH: SPACIOUS WITH 90°.
- 6. ANDROID PELVIS TYPICAL MALE TYPE. SEEN IN 30% FEMALE.
- 7. Contd... CHARACTERISTICS INLET: TRIANGLE TRANSVERSE DIAMETER: NARROW THAN GYNECOID SIDE WALLS: CONVERGENT
- 8. Contd... SACRUM: SHALLOW CURVE SACRO-SCIATIC NOTCH: LONG & NARROW SUB PUBIC ARCH: NARROW
- 9. ANTHROPOID PELVIS RESEMBLES APE PELVIS. SEEN IN 20% FEMALES.
- 11. Contd... CHARACTERISTICS INLET: OVAL SIDE WALLS: NOT CONVERGENT ISHIAL SPINE: CLOSER
- 12. Contd... SACRO-SCIATIC NOTCH: LARGE SUB PUBIC ARCH: NARROW
- 13. PLATYPELLOID PELVIS FLATTEND GYNECOID PELVIS. SEEN IN 3% FEMALE.
- 14. Contd... CHARACTERISTICS INLET: OVAL SIDE WALLS: STRAIGHT
- 20. DEFINITION: CEPHALO PELVIC DISPROPORTION IS THE DISPARITY IN RELATION BETWEEN FETAL HEAD & MATERNAL PELVIS. INCIDENCE: 2 IN 250 PREGNANCY.
- 22. CAUSES: NUTRITIONAL DEFICIENCY. PELVIC DISEASE / INJURY. DEVELOPMENTAL DEFECTS. BIG BABY MALPRESENTATION
- 23. DEGREE OF DISPROPORTION SEVERE DISPROPORTION IN THIS THE OBSTETRIC CONJUGATE IS <7.5 cm . BORDERLINE DISPROPORTION IN THIS OBSTETRIC CONJUGATE IS BETWEEN 9.5 & 10cm .
- 24. OBSTETRICCONJUGATE THE SHORTEST PELVIC DIAMETER THROUGH WHICH THE FETAL HEAD MUST PASS DURING BIRTH, MEASURED FROM SACRAL PROMONTORY TO A POINT A FEW MILLIMETERS FROM THE TOP OF PUBIC SYMPHYSIS.
- 26. INVESTIGATIONS: PELVIMETRY CEPHALOMETRY CT PELVIS MRI USG
- 27. MANAGEMENT OF CPD IN BORDER LINE CPD VAGINAL DELIVERY AT TERM. IN SEVERE CPD ELECTIVE CS AT TERM TRIAL LABOUR
- 28. TRIAL LABOR IT IS THE CONDUCTION OF SPONTANEOUS LABOR IN A MODERATE DEGREE OF DISPROPORTION IN AN INSTITUTION UNDER SUPERVISION WITH WATCHFUL EXPECTENCY HOPING FOR VAGINAL DELIVERY OR IT IS A TEST LABOR ALLOWING THE PATIENT TO ENTER INTO ACTIVE LABOR PUTTING ALL VARIABLE [POWER,PASSAGE & PASSENGER] INTO TEST & DETERMINE WHETHER VAGINAL DELIVERY IS POSSIBLE.
- 29. THE PROGRESS OF LABOUR IS MAPPED WITH PARTOGRAPH TO ACCESS THE PROGRESSIVE DESCENT OF HEAD. PROGESSIVE DILATATION OF CERVIX.
- 30. AFTER RUPTURE OF MEMBRANE , PELVIS EXAMINATION IS TO BE DONE TO EXCLUDE CORD PROLAPSE NOTE THE COLOR OF LIQUOR NOTE THE CONDITION OF CERVIX INCLUDING PRESSURE OF PRESENTING PART ON CERVIX.
- 31. SUCCESSFUL TRIAL A TRIAL LABOR IS SAID TO BE SUCCESSFUL IF A HEALTHY BABY IS BORN VAGINALLY, OR BY FORCEPS OR VENTOSE WITH THE MOTHER IN GOOD CONDITION.
- 32. FAILURE OF TRIAL A TRIAL LABOR IS SAID TO BE A FAILURE IF THE DELIVERY IS BY CESAREAN SECTION OR DELIVERY OF DEAD BABY BY CRANIOTOMY.
- 33. FAVOURABLE FACTORS FLAT PELVIS IS BETTER THAN ANDROID. VERTEX PRESENTATION. MINOR DEGREE OF CONTRACTION. INTACT MEMBRANES TILL FULL DILATATION. GOOD UTERINE CONTRACTION. EMOTIONAL STABILITY OF WOMAN.
- 34. CONTRAINDICATIONS: PRIMIGRAVIDA MAL PRESENTATION POST MATURITY POST CAESEREAN PREGNANCY PRE-ECLAMPSIA DIABETES LACK OF FACILITIES FOR C-SECTION
- 35. UNFAVOURABLE FACTORS APPEARANCE OF ABNORMAL UTERINE CONTRACTION. CERVICAL DILATATION <1cm/hr. DESCENT OF FETAL HEAD <1cm/hr. ARREST OF CERVICAL DILATATION AND NON DESCENT OF FETAL HEAD INSPITE OF OXYTOCIN THERAPY. FETAL DISTRESS.
- 36. ADVANTAGES: LOWER INCIDENCE OF CESAREAN SECTION. A SUCCESSFUL TRIAL ENSURES WOMEN A GOOD FUTURE OBSTETRICS.
- 37. DISADVANTAGES: MAY END IN FULL DILATATION OF CERVIX. INCREASED FETAL MORTALITY & MORBIDITY. IN FAILED TRIAL INCREASED OPERATIVE RISKS.
- 38. HOW LONG TO CONTINUE TRIAL LABOUR ? THE METHODS OF TERMINATION OF TRIAL IS BY SPONTANEOUS DELIVERY[30%]. SYMPHYSIOTOMY FOLLOWED BY FORCEPS OR VACCUM[30%]. C-SECTION[30%] CRANIOTOMY [IF FETUS IS DEAD]