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Contracted pelvis in Obstetrics
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Contracted Pelvis. Fetal Macrosomia
Lecture by Andriy Berbets
Measurement of the pelvis
Normal pelvis
Normal pelvis
Anatomically contracted pelvis
• The diagnosis is correct, if at least one diameter is contracted 2cm +
• Classification:- Generally contracted pelvis- Simple flat pelvis- Flat rachitic pelvis- Transversely contracted pelvis
Anatomically contracted pelvis
Classification (by degree of contraction)- 1st degree (conjugata vera 11-9 cm)- 2nd degree (conjugata vera 9-7,5 cm)- 3rd degree (conjugata vera 7,5-6,5 cm)- 4th degree (conjugata vera less than 6,5 cm)
Generally contracted pelvis
Generally contracted pelvis
Generally contracted pelvis
• All the dimensions are equally contracted (longitudinal and transverse)
• Delivery: - over-flexion of the fetal head,- passing of the fetal head through the pelvis on
oblique dimension,- fetal head can’t fixate good enough to pubic
symphysis
Generally contracted pelvis
Generally contracted pelvis
Generally contracted pelvis
Generally contracted pelvis
Simple flat pelvis
Simple flat pelvis
• All longitudinal dimensions are contracted• Internal rotation is problematic• Moderate extension of fetal head • Asynclitism
Asynclitism
Rachitic flat pelvis
Transversely contracted pelvis
Alternative classification
Alternative classification
Michaelis’ rhombus
Clinically contracted pelvis
• Anatomical dimensions are normal• But fetus is too big and can’t pass through• Conditions for diagnosis:- Good regular uterine contractions- Cervical dilation 8cm +- Absence of amniotic sac- Empty urine bladder
Clinically contracted pelvis
• Diagnosis:- No fetal head’s descending- Cervix is not closed to fetal head- High standing of contraction ring- Early pushing efforts (head is not in pelvic cavity)- Edema of cervix, vagina and vulva- Symptoms of urine bladder’s pressure- Positive signs of Vasten and Tsangemeister
Vasten’s sign
Threat of uterine rupture
Coxalgic pelvis
Ankilotic oblique-deformated pelvis
Pelvis due to osteomalatia
Scoliotic pelvis
Pelvis with no symphysis
Pelvis with no symphysis (“cleft”)
Osteoma
Shoulder dystocia
Shoulder dystocia
Thank you!