Seminar h bhai , jee le Zindagi

1. SEMINAR ON-
CONTRACTED PELVIS
SUBMITTED TO –
DR. STEPHI GROVE MASSEY
( PROFESSOR )

2. INTRODUCTION
THE FEMALE PELVIS IS CONSTRUCTED TO ACCOMMODATE
THE FETUS DURING PREGNENCY AND TO FACILITATE ITS
DOWNLOAD PASSAGE THROUGH THE PELVIC CAVITY IN
CHILD BIRTH.
IT IS A PELVIS IN WHICH ONE OR MORE OF ITS
DIAMETERS IS REDUCED SO THAT IT INTERFERES WITH THE
NORMAL MECHANISM OF LABOUR.

3. DEFINITION
ANATOMICAL - CONTRACTED PELVIS IS DEFIINED AS ONE
WHERE THE ESSENTIAL DIAMETERS OF ONE OR MORE
PLANES ARE SHORTENED BY 0.5CM.
OBSTETRIC DEFINITION- WHICH STATES THAT ALTERATION
IN THE SIZE AND/OR SHAPE OF THE PELVIS OF
SUFFCICIENT DEGREE SO AS TO ALTER THE NORMAL
MECHANISM OF LABOUR IN AN AVERAGE SIZE BABY.

6. VARIATION OF FEMALE PELVIS
THE SHAPE AND SIZE OF THE FEMALE PELVIS DIFFER SO WIDELY DUE
TO MORPHOLOGICAL FACTORS SUCH AS DEVELOPMENTAL, SEXUAL,
RACIAL AND EVOLUTIONARY THAT IT IS INDEED DIFFICULT TO
DEFINE WHAT THE FEATURE OF A NORMAL PELVIS ARE-

7. ETIOLOGY OF CONTRACTED PELVIS
GROSS DEGREE OF CONTRACTED PELVIS IS NOW A DAYS A RARITY.
SEVERE MALNUTRITION, RICKETS, OSTEOMALACIA AFFECTING
GROSSLY. THE PELVIC ARCHITECTURE ARE NOT FREQUENTLY MET IN
THE PRACTICE. INSTEAD, MINOR VARIATION IN SIZE OR SHAPE IN A
PARTICULAR PLANE OF THE PELVIS IS COMMONLY FOUND, WHICH IS
OFTEN OVERLOOKED UNTIL COMPLICATION ARISES.

8. ETIOLOGY OF CONTRACTED PELVIS
COMMON CAUSES OF CONTRACTED PELVIS ARE-
1. NUTRITIONAL AND ENVIRONMENTAL EFFECTS
2. DISEASES OR INJURIES AFFECTING THE PELVIS, SPINE AND BONES
OF THE LOWER LIMBS.
3. DEVELOPMENT DEFECTS AFFECTING THE PELVIS BONES.

9. CLASSIFICATION OF CONTRACTED PELVIS
THE FOLLOWING CLASSIFICATION IS BASED ON THE AETIOLOGICAL FACTORS-
• NUTRITIONAL AND ENVIRONMENT
- MINOR VARIATION – COMMON
- MAJOR VARIATION AND OSTEOMALACIC- RARE.
• DISEASE OR INJURY OF THE BONES
- PELVIC - TUMOURS, FRACTURE, TUBERCULAR ARTHRITIS
- SPINAL- KYPHOSIS, SCOLIOSIS, COCCYGEAL DEFORMITY.
• DEVELOPMENTAL DEFECTS
- NAEGELE’S PELVIS AND ROBERT PELVIS
- HIGH OR LOW ASSIMILATION PELVIS

10. RACHITIC FLAT PELVIS
RICKETTS IS PREDOMINANTLY A DISEASE OF
EARLY CHILDHOOD WHEN THE BONES REMAIN
SOFT AND UNOSSIFIED. AT THIS TIME IF THE
CHILD LIES OR SITS IN BED, CHANGES OCCURS IN
THE SOFT PAIR DUE TO WEIGHT. THE EFFECT OF
WEIGHT BEARING DUE TO STANDING POSITION IS
NOT EVIDENT.

11.  FALSE PELVIS-
THERE IS OUTWARD DISPLACEMENT OF THE ANTERIOR PORTION OF
THE ILIAC CRESTS DUE TO THE PULL OF THE STRONG POSTURE.
SACROILIAC LIGAMENTS. THIS INCREASES THE INTERSPINOUS
MEASUREMENT, WHICH CLOSELY APPROXIMATES TO THE
INTERCRISTAL DIAMETER.

12.  INLET -
SACRAL PROMONTORY IS PUSHED DOWNWARDS AND
FORWARDS, PRODUCING A REINFORCED SHAPE OF
THE INLET WITH MARKED SHORTENING OF THE
ANTERIOR POSTER DIAMETER WITHOUT AFFECTING
THE TRANSVERSE DIAMETER, WHICH IS OFTEN
INCREASED.

13.  CAVITY -
TILTING BACK OF THE SACRUM, WHICH BECOMES
FLAT OR EVEN CONVEX. THERE MAY BE SHARP
ANGULATION AT THE SCARROW COCCYGEAL JOINT.

14.  OUTLET -
BODY WEIGHT TRANSMITTED THROUGH THE
ISCHIUM IN SITTING POSITION RESULTS IN WIDENING
OF THE TRANSVERSE DIAMETER OF THE OUTLET AND
THE PUBIC ARCH.

15. OSTEOMALACIC PELVIS
THE DEFORMITY IS CAUSED BY SOFTENING OF THE PUBLIC
BONES DUE TO CALCIUM AND VITAMIN D DEFICIENCY AND
LACK OF EXPOSURE TO SUN RAYS. IT USUALLY AFFECTS
WOMEN AFTER THEY HAVE REACHED MATURITY.

16. OSTEOMALACIC PELVIS
THE CHANGES IN PELVIS BONES ARE-
- THE PROMONTORY IS PUSHED DOWNWARDS AND FORWARDS AND THE
LATERAL PELVIC WALLS ARE PUSHED. INWARDS CAUSING THE ANTERIOR WALL
TO FORM A BEAK. THE SHAPE OF THE INLETTHUS BECOMES TRIRADIATE
- SACRUM IS MARKEDLY SHORTENED, CONCAVE, ANTERIORLY, PUSHING THE
COCCYX FORWARD.
- APPROXIMATION OF THE TWO ISCHIAL TUBEROSITIES AND MARKED
NARROWING OF THE PUBIC ARCH OCCURS.

17. ASYMMETRICAL OR OBLIQUELY CONTRACTED
PELVIS
ASYMMETRICAL OR OBLIQUE CONTRACTED PELVIS OCCURS IN
1. NEAGELE’S PELVIS
2. SCOLIOTIC PELVIS.
3. DISEASE AFFECTING ONE HIP OR SACROILIAC JOINT,
4. TUMOURS OR FRACTURE AFFECTING ONE SIDE OF THE PELVIC BONES
DURING GROWING AGE

18. NAEGELE’S PELVIS
IT IS A CONGENITAL DISORDER OCCURS DUE TO ARRESTED DEVELOPMENT OF ONE
ALA OF THE SACRUM
IT MAY BE
1. CONGENITAL TRUE NAEGELE
2. ACQUIRED - AS A RESULT OF OSTEITIS WITH RESULTING ANKYLOSIS OF THE
SACROILIAC JOINTS THERE MAY BE ASSOCIATED URINARY TRACT IN
ABNORMALLY ON THE SAME SIDE IN THE CONGENITAL VARIETY.
3. SCHOLASTIC PELVIS - IN THIS CONDITION, THE BODY WEIGHT FALLS MORE ON
ONE SIDE OF THE PELVIS THAN ON THE OTHER.

19. SCOLIOSIS
• ACETABULAM IS PUHED INWARDS ON THE
WEIGHT BEARING SIDE
• SCOLIOSIS INVOLVING ONLY THE LUMBER
REGION WILL CAUSE DEFORMITY OF THE
PELVIS

21. ROBERT'S PELVIS
( TRANSVERSELY CONTRACTED PELVIS )
THIS IS AN EXTREMELY RARE ABNORMALITY. ALA OF BOTH THE SIDES ARE
ABSENT AND THE SACRUM IS FUSED WITH THE INNOMINATE BONES. THESE ARE
OF THREE TYPES :
1. THERE IS NO HISTORY OF TRAUMA OR INJECTIONS. AND THE PELVIS IS
TRANSVERSELY CONTRACTED FROM BRIM TO OUTLET.
2. COMPLETE PRESENCE OF SACROILIAC JOINTS
3. INCOMPLETE ABSENCE OF SACROILIAC JOINTS
DELIVERY IS DONE BY CAESAREAN SECTION

22. KYPHOTIC PELVIS
THIS PELVIC DEFORMITY IS SECONDARY TO THE
KYPHOTIC CHANGES OF THE VERTEBRAL COLUMN,
EITHER FOLLOWING TB OR RICKETS. THE FORMAL
BEING COMMON KYPHOSIS SITUATED HIGH UP IN THE
THORACIC REGION IS COMPENSATED BY LUMBAR
LORCLOSIS AND HAVE LITTLE OR NO EFFECT ON
PELVIC DEFORMITY.

23. PREGNANCY
ABDOMEN BECOMES PENCLULOUS DUE TO THE SHORTENED
DISTANCE BETWEEN THE SYMPHYSIS PUBIS AND
XIPHISTERNUM. MAL- PRESENTATION IS COMMEN
MISHENICIAL DISTRESS IS EVIDENT.

24. DELIVERY
CAESAREAN SECTION IS IDEAL, AND ONE MAY HAVE TO DO
THE CLASSICAL OPERATION BECAUSE OF THE POOR
FORMATION OF THE LOWER SEGMENT OR FOR TECHNICAL
REASON.

25. MECHANISM OF LABOUR
IN CONTRACTS PELVIS
WITH VERTEX
PRESENTATION

26. FLAT PELVIS
IN THE FLAT PELVIS, THE HEAD FINDS DIFFICULTY IN NEGOTIATING THE BRIM AND
ONCE IT PASSES THROUGH THE BRIM, THERE IS NO DIFFICULTY IN THE CAVITY OR
OUTLET. THE HEAD NEGOTIATES THE BRIM BY FOLLOWING MECHANISM.
• THE HEAD ENGAGES WITH THE SAGITTAL SUTURE IN THE TRANSVERSE DIAMETER.
• HEAD REMAINS DEFLEXED AND ENGAGEMENT IS DELAYED.

27. FLAT PELVIS ( CONT;D )
• ENGAGEMENT OCCURS BY EXAGGERATED PARIETAL PRESENTATION, SO
THAT THE SUPER - SUBPARTIAL DIAMETER (8.5CM) INSTEAD OF THE
BIPARIETAL DIAMETER (9.5CM) PASSES THROUGH THE PELVIC BRIM.
• MOULDING MAY BE EXTREME, AND OFTEN THERE IS AN INDENTATION
OR EVEN A FRACTURE OF ONE PARIETAL BONE. HOWEVER, THE CAPUT
THAT FORMS IS NOT BIG.

28. GENERALLY CONTRACTED PELVIS
IN THIS TYPE OF PELVIS, THE SHAPE REMAINS UNALTERED BUT
ALL THE DIAMETERS IN THE DIFFERENT PLANES-
INLET, CAVITY AND OUTLET ARE SHORTENED
HEAD ENGAGES IN OBLIQUE DIAMETER
ENGAGEMENT OCCURS THROUGH EXTREME FLEXION AND
MOULDING, HENCE THERE IS DELAY IN ENGAGEMENT.

29. DIAGNOSTIC EVALUATION
 HISTORY COLLECTION
PAST HISTORY OF RICKETS OSTEOMALACIA TB OF THE PELVIC JOINTS, OR SPINE
POLIOMYELITIS, IS TO BE ACQUIRED.
PHYSICAL EXAMINATION
ABDOMINAL EXAMINATION
ASSESSMENT OF THE PELVIS ( PELVIMETRY )

30. DIAGNOSTIC EVALUATION
 RADIO PELVIMETRY
CT PELVIMETRY

32. THE SAILENT FEATURES TO BE NOTED TO DETECT
CONTRACTION AT -
BRIM MIDPELVIS OUTLET
- Diagonal conjugate - Sacrum - Sidewalls
- Posterior surface of the
symphysis pubis
- Ischial Spines - Sacro-coccygeal joint.
- Ilio-pectineal line - Sacro-sciatic notch - Subpubic arch
- Sacro sciatic notch. - Sidewalls - Subpubic angle

33. MANAGEMENT OF CONTRACTED PELVIS
 MEDICAL MANAGEMENT
- PERINATAL CARE
- PELVIMETRY
- FEETAL MONITORING
- LABOUR MANAGEMENT

34. MANAGEMENT OF CONTRACTED PELVIS
 SURGICAL MANAGEMENT
• CAESAREAN SECTION –
THIS IS OFTEN THE SAFEST OPTION FOR DELIVERY IN CASES OF CONTRACTED
PURPOSE, ESPECIALLY IF VAGINAL BIRTH IS DEEMED RISKY. IT ENSURES THE SAFETY
OF BOTH THE MOTHER AND THE BABY .

35. MANAGEMENT OF CONTRACTED PELVIS
 SURGICAL MANAGEMENT
• EPISIOTOMY –
IN SOME CASES, AN EPISIOTOMY ( SURGICAL INCISION OF THE
PERINEUM) MAY BE PERFORMED TO ENLARGE THE BIRTH CANAL DURING
VAGINAL DELIVERY.

36. MANAGEMENT OF CONTRACTED PELVIS
 SURGICAL MANAGEMENT
• PREMATURE INDUCTION –
PREMATURE INDUCTION IS LIMITED ONLY TO MODERATE DEGREE OF PELVIC
CONTRACTION. IN SELECTED MULTI GRAVIDA WITH PREVIOUS HISTORY OF DIFFICULT
VAGINAL DELIVERY OF AN AVERAGE SIZE BABY, THE METHOD MAY BE EMPLOYED
TWO - THREE WEEKS PERIOD TO DUE DATE. THIS MAY RESULT IN SLIGHTLY SMALLER
BABY SO THAT A SPONTANEOUS DELIVERY IS POSSIBLE.

37. MANAGEMENT OF CONTRACTED PELVIS
 NURSING MANAGEMENT
• ASSESSMENT -
1. ASSIST THE OBSTETRIC AND MEDICAL HISTORY OF THE PATIENT
2. ASSESS THE PHYSICAL EXAMINATION
3. ASSESS THE PELVIC EXAMINATION
4. ASSIST THE FEETAL EXAM ASSESSMENT
5. ASSIST THE PSYCHOLOGICAL CONDITION OF THE PATIENT

38. MANAGEMENT OF CONTRACTED PELVIS
 NURSING MANAGEMENT
• PRIORITY NEEDS -
1. NEED TO ADDRESS ANY DISCOMFORT OR PAIN ASSOCIATED WITH PELVIC ABNORMALITIES
2. NEED TO REGULAR OBSTETRIC MONITORING
3. NEED TO MONITOR LABOUR PROGRESSION
4. NEED TO PROVIDE SUPPORTIVE CARE
5. NEED TO PROVIDE EDUCATION SUPPORT

39. NURSING CARE PLAN
 Risk for delayed labour progression related to contracted pelvis
• GOAL – The goal is for the mother to achieve vaginal delivery with minimum risk of
complications
• INTERVENTIONS -
1. Monitor cervical dilation and descent of the foetus during Labour
2. Encourage position changes such as walking or using a birthing ball to facilitate Fetal descent
3. Provide emotional support and encouragement to maintain maternal confidence and motivation
during labour.

40. NURSING CARE PLAN
 RISK FOR FETAL DISTRESS RELATED TO PROLONGED LABOUR ASSOCIATED WITH
CONTRACTED PELVIS
• GOAL – The goal is to maintain fetal well being throughout Labour and delivery
• INTERVENTIONS -
1. Monitor foetal heart rate patterns continuously during labour
2. Encourage maternal hydration and adequate nutrition to support fetal well-being
3. Position the mother in left lateral position to optimise uteroplacental perfusion

41. NURSING CARE PLAN
 RISK FOR MATERNAL ANXIETY RELATED TO UNCERTAINTY ABOUT LABOUR OUTCOME ASSOCIATED WITH
CONTRACTED PELVIS
• GOAL – The goal is to Reduce and maternal anxiety and promote a positive childbirth experience
• INTERVENTIONS -
1. Establish a therapeutic relationship with the mother, providing empathetic support and active
listening
2. Encourage the mother to express her concerns and fears about childbirth, validating her emotions
3. Provide education about the condition of contracted pelvis and the planned interventions for
Labour and delivery

42. NURSING CARE PLAN
 RISK FOR CAESAREAN SECTION RELATED TO CONTACTED PELVIS
• GOAL – The goal is to achieve vaginal delivery if possible, but to ensure the safety of
the mother and baby, regardless of the mode of delivery
• INTERVENTIONS -
1. Discuss the possibility of caesarean section with the mother and family, providing education about
the indications and potential risks
2. Monitor labour progress closely and assess for signs of cephalopelvic disproportion.
3. Provide emotional support and reassurance to the mother throughout the decision making process

43. EFFECTS OF CONTRACTED PELVIS
 PREGNANCY -
1. THERE IS MORE CHANCE OF INCARCERATION OF THE RETROVERTED GRAVID
UTERUS IN FLAT PELVIS
2. ABDOMEN BECOMES PENDULOUS, ESPECIALLY IN MULTI GRAVIDA WITH LAX
ABDOMINAL WALL
3. MALPRESENTATIONS ARE INCREASED THREE - FOUR TIMES.

44. EFFECTS OF CONTRACTED PELVIS
 LABOUR -
1. THERE IS INCREASED INCIDENCE OF EARLY RUPTURE OF THE MEMBRANES
2. INCIDENCE OF COURT PROLAPSE IS INCREASED
3. CERVICAL DILATION IS SLOWED
4. THERE IS INCREASED TENDENCY OF PROLONGED LABOUR
5. THERE IS INCREASED INCIDENCE OF OPERATIVE INTERFERENCE SHOCK, POSTPARTUM,
HAEMORRHAGE AND SEPSIS

45. COMPLICATIONS OF CONTRACTED PELVIS
MATERNAL AND FETUS

46. ROLE OF NURSE
 THE NURSE SHOULD BE CONDUCTED THROUGH ASSESSMENTS OF THE MOTHER’S MEDICAL HISTORY OF
TACTICAL HISTORY AND PELVIC MEASUREMENTS TO IDENTIFY THE PRESENCE OF CONTACTED PELVIS.
 THE NURSE SHOULD MONITOR PROGRESS OF LABOUR CLOSELY, INCLUDING FHR MATERNAL VITALS AND
PROGRESSION IN CERVICAL DILATION AND EFFACEMENT
 THE NURSE SHOULD PROVIDE PROPER EDUCATION TO THE PATIENT AND FAMILY ABOUT CONTRACTED PELVIS
 THE NURSE HAVE TO PROVIDE SUPPORTIVE CARE AND COLLABORATIVE CARE FOR MANAGING THE
CONDITION
 THEY SHOULD HAVE TO PROVIDE POSTPARTUM CARE AND SUPPORTIVE TO THE MOTHER AND HER NEWBORN