Contracted pelvis gynecological condition for bsc nursing and msc nursing students

1. CONTRACTED PELVIS
Rassiya.K.K

2. PELVIS

3. Contracted pelvis is an alteration in the size & /
shape of the pelvis of sufficient degree so as to
alter the normal mechanism of labour in an average
size baby.

5.  Inlet
Shortest AP diameter <10 cm
Largest transverse diameter <12 cm
 Midpelvis
Interspinous diameter <10 cm
 Outlet
Intertuberous ,, -<8 cm
Sub pubic arch narrowing
Inter tuberous diameter doesnot admit 4 knuckles.

6. Causes
1. Nutritional & environmental
Minor variation common
Major –Rachitic & osteomalacic
2. Diseases or injuries affecting the pelvis, spine &
bones of the lower limbs.
Pelvic tumours, Fracture , Tubercular
artritis

7. Spinal – Kyphosis, Scoliosis, coccygeal
deformity.
Lower limbs- congenital dislocation of the
hip,poliomyelitis in childhood, hip joint disease
3. Developmental defects.
Naegle’ pelvis & Robert’s pelvis

8. Rachitic pelvis
Due to rickets change occure in the soft
pelvis due to weight bearing.
Sacral promontory is pushed downwards and
forwards- shortening AP diameter, sacrum is flat,
widening of transverse diameter.

9. RACHITIC FLAT PELVIS

10. Osteomalacic pelvis
Softening of the pubic bone due to calcium &
vit-D deficiency & lack of exposure to sunlight.
The promontory is pushed downwards and forwards
and the lateral pelvic walls are pushed inwards,
anterior wall to form a beak. Approximation of
ischeal tuberosities, sacrum shortened and coccyx
pushed forward.
CS is required.

11. OSTEOMALACIC PELVIS

13. Naegle’s pelvis – Arrested development of one ala of
the sacrum- may be congenital or aquired as a
result of osteitis.
Robert’s pelvis. – Ala of both sides are absent & the
sacrum is fused with the innominate bones.
Transversely contracted pelvis

14. NAEGELE’S PELVIS

15. ROBERT’S PELVIS

16.  Scoliotic pelvis.- The body weight fall more on one
side of the pelvis than on the other. So the
acetabulum is pushed inwards on the weigt bearing
side.

17. Kyphotic Pelvis. Tilting of upper part of the sacrum
backwards&the lower part forwards – increasing AP
diameter of inlet & decreasing the same at the
outlet.

18. DIAGNOSIS OF CONTRACTED PELVIS.
Past history – Rickets, osteomalacia, TB of pelvic
joints / spine, polio
Obstetrical- H/O prolonged & tedious labour followed
by Either spontaneous or difficult instrumental
delivery. Difficult vaginal delivery ending in still birth/
early neonatal death.
Physical examination-
Stature- short < 5 ft, any evidence of congenital
anomalies- deformity of chest ,spine waddling
gait,tilting of the pelvis

19. Abdominal examination
Inspection- pendulous abdomen specially in primi
Non engagement of the head beyond 37 wks in
primi
malpresentation.

20. ASSESSMENT OF PELVIS (PELVIMETRY)
Clinical pelvimetry
is the assessment of pelvic structures and diameters
of pelvis by PV examination.
Time- after 37 weeks of gestation , best result when
performed after cervical dilatation.
Radiopelvimetry
Is the use of X-ray in measuring important diameters
of pelvis

21. CEPHALO PELVIC DISPROPORTION
(CPD)

23. Definition
The normal proportion between the size of the fetus to the
size of the pelvis is disturbed
or
The disparity in the relation between the head & the
pelvis is called CPD.
Disproportion may be either due to an average size baby
with a small pelvis or due to a big baby with normal size
pelvis or due to combination of both.

24. Diagnosis.
Clinical- Abdominal method,
Abdomino vaginal method –
Non engagement of fetal head at 38th week in
primi.
Munro Kerr – Muller method
X-ray pelvimetry
Cephalometry ( Ultrasonographic measurement of
biparietal diameter.
MRI

25. ABDOMINAL METHOD

26.  Place pt in dorsal position with thigs slightly flexed
and seperated.
 The head is grasped by the left hand. two fingers (
index and middle) of the right hand are placed
above the symphysis pubis with palmar surface of
the fingers in line with the anterior surface of the
symphysis pubis to note the degree of overlapping
if any , when the head is pushed downward
downward and back wards.

27.  Inference
- when the head can be pushed down in the pelvis
without overlapping of the parietal bone on the SP-no
disproportion.
-Head can be pushed down a little but there is slight
overlapping of the parietal bone evidenced by touch
on undersurface of the fingers - moderate
disproportion
- Head cannot be pushed down and instead the
parietal bone overhangs the SP displacing the
fingers- severe disproportion.

30.  Inference
 - The head can be pushed down upto the level of
ischeal spines and there is no overlapping of the
parietal bone over the SP - No disproportion
 The Head can be pushed down a little but not upto
the level of ischeal spines and slight overlapping of
the parietal bone- slight or moderate disproportion
 The head can not be pushed down,and the parietal
bone overhangs the SP displacing the thumb-
Severe dispropotion.

33. EFFECTS OF CONTRACTED PELVIS ON
PREGNANCY & LABOUR
Pregnancy-
Incarceration of retroverted gravid uterus in flat
pelvis.
Pendulous abdomen, malpresentation.
Labour-
Early rupture ofmembrane , Cordprolapse,
slow cervical dilatation, prolonged labour,&
in neglected cases obstructed labour with
exhaution , dehydration,ketoacidosis & sepsis

34. Increased incidence of operative interference,
shock, PPH,& sepsis

35. MATERNAL INJURIES
 Cervical tear, vaginal & perineal lacerations
 In Multigravida increased chance of rupture of the
uterus
 Chance for VVF& RVF
Featal Hazards
Trauma & Asphyxia

36. MANAGEMENT OF CONTRACTED PELVIS (
INLET CONTRACTION)
 Premature induction of labour
 Elective CS at term
 Trial labour.

37. PREMATURE INDUCTION
Induction 2-3 weeks prior to due date , the size of
the baby is smaller, so that spontaneous vaginal
delivery is possible
Elective CS at term
Indication
Major degree of inlet contraction
Moderate degree of inlet contraction with outlet
contraction or with complicating factors.

38. TRIAL LABOUR
Is the conduction of spontaneous labour in a
moderate degree of cephalo pelvic disproportion,in
an institution under supervision with watchful
expectancy, hoping for a vaginal delivery.
Aims
Avoiding unnecessary CS & delivering a living
undamaged child

39. Contra indication
* Associated midpelvic & outlet contraction
* Presence of complicating factors – elderly primi,
GDM, PIH, malpresentation Post CS
* Unfavourable surroundings

40. CONDUCTION OF TRIAL LABOUR
 Labour should ideally spontaneous onset
 Prevent early rupture of membrane- enema should
not be given & the pt should be in bed.
 Keep NPO status ,IV glucose drip, I/O chart
 Analgesics
 Partogram
 If there is no progress ,Induction of labour by LROM
followed by oxytocin drip

41.  PV examination to exclude cord prolapse, colour of
liqour,

42. Duration of trial labour
As long as the membranes are intact ,Progress is
satisfactory,& maternal &fetal condition remain
good trial may be continued.
Not to wait for more than half an hr after the ROM
with Cx fully dilated.

43. Unfavourable Features.
Abnormal uterine contraction
Early ROM
Postr Presentation
Cervical dilatation <1 cm /hr with good uterine
contractions.
Thick & edematous Cx
Formation of caput & evidence s of moulding
Fetal distress.

44. TERMINATION OF TRIAL LABOUR
 Spontaneous labour ( 30%)
 Forceps or ventous ( 30%)
 CS ( 40%)

45. Successful Trial:- if an damaged baby is born
vaginally, spontaneously or by forceps or ventous
with the mother in good condition.
Delivery by CS or delivery of a dead baby
spontaneously or by craniotomy – Failure of trial
labour

46. Advantages
* Eliminate unnecessary CS
* A successful trial gives guarantee to her future
obstetrics.
Disadvantages
* Increased perinatal mortality
* Increased Maternal morbidity