slides for medical student on CPD and contracted pelvis

1. CPD & CONTRACTED
PELVIS
Submitted by
Mamta
3rd year student
Aiims Bhopal
AIIMS BHOPAL

2. ANATOMY OF NORMAL PELVIS

3. 12

4. Type of female pelvis based on the shape of the inlet:-
CALDWELL MOLLOY CLASSIFICATION

5. CONTRACTED PELVIS

6. Anatomical definition:-
It is a pelvis in which , its diameters is reduced below the
normal by one or more centimeters.
Obstetric definition:-
Contracted pelvis is the alteration in the size and shapes of
the pelvis of a sufficient degree to alter the normal
mechanism of labor in an average sized baby

7. Etiology of contracted pelvis:-
1) Nutritional and environmental defects:-
minor variation : common (which is often overlooked until complication arises.)
major variation : Rachitic & osteomalacic-rare
2)Diseases or injuries affecting the bones of the pelvis:-
spines :- kyphosis , scoliosis , coccygeal deformity
lower limbs :- poliomyelitis , hip joint disease
3) Developmental defects – Naegele’s pelvis and Robert’s pelvis
4) Short women :- prone to develop contracted pelvis

8. Rachitic Flat Pelvis
• Rickets is predominantly a disease of early childhood when the
bones remains soft and unossified. In childhood, changes occur in
the bony pelvis due to weight bearing. The classic change in the
pelvic bone are shown :-
• INLET
a) sacral promontory is pushed downward or forward producing
reniform shape
b) Short anterior posterior diameter

9. Cavity
• Sacrum is tilted backwards
• Sharp angulation at sacrococcygeal joint
Outlet – Widened transverse diameter and pubic arch

10. OSTEOMALACIC PELVIS
• Due to softening of the pubic bones,
• the promontory is pushed downwards and forwards and the lateral
pelvic walls are pushed inwards causing the anterior wall to form a beak.
• Sacrum Markedly shortened
• Coccyx is pushed forward
• Cs is ideal.

11. ASYMMETRICAL / OBLIOUESLY
CONTRACTED PELVIS
•Naegels pelvis.
•Scoliotic pelvis.
•Robert’s pelvis
•Kyphotic pelvis

12. NAEGLE’S PELVIS ROBERT’S PELVIS
b) It is a congenital disorder a) almost entire absence of
or acquired ala of sacrum.
• absence of one b)sacrum is fused with innominate
ala of the sacrum. bone

13. SCOLIOSIS
• Acetabulum is pushed inwards on the weightbearing
• Sideway curvature of spine

14. KYPHOTIC
• a) sacrum is tilted backward
in the upper part and
forward in the lower part ,
• it is narrow and straight
• Thus, the feature is an
extreme funneling of the
pelvis.
• Pendulous abdomen

15. DIAGNOSIS OF CONTRACTED PELVIS
1) History
•Rickets : is expected if there is a history of delayed
walking and dentition.
•Trauma or disease: of the pelvis, spines or lower limbs.
•Bad obstetric history : e.g. prolonged labor ended by;
difficult forceps , caesarean section or still birth
.

16. Examination-GENERAL EXAMINATION:-
•Gait: abnormal gait suggesting abnormalities in
the pelvis spines or lower limbs.
•Stature: women with less than 150 cm height
usually have contracted pelvis.
•Spines and lower limbs: may have a disease or
lesion.
Manifestations of rickets.

17. •Dystocia dystrophia syndrome: The women is Short,
Stocky, Sub fertile, having android pelvis and masculine hair
distribution, with history of delayed menarche.
• This woman is more exposed to occipito-posterior position
and bony dystocia.
Abdominal examination :
• Non engagement of the head , in primigravida
• Pendulous abdomen in a primigravida.
• Malpresentations: are more common.

18. Pelvimetry-
• It is assessment of the diameters and capacity done
at 38-39 weeks.it includes:
•CLINICAL PELVIMETRY:-
•Internal pelvimetry for:- inlet, cavity and outlet.
•External pelvimetry for: inlet and outlet.
IMAGING PELVIMETRY-:
• Radio pelvimetry , Computerized tomography(CT), (MRI), X-
ray pelvimetry ,

19. CLINICAL ASSESSMENT OF PELVIS

20. CEPHALOPELVIC DISPROPORTION

21. • Cephalopelvic disproportion is the disparity in relation
between the head of baby and mother’s pelvis
• CPD either due to:-
(a) The baby’s head is proportionally too large
(b) The mother’s pelvis is too small
DEFINITION

22. CAUSES:-
1) Large baby due to -: hereditary factor , Diabetes , Multiparity
2) Abnormal fetal positions
3) Contracted pelvis
4) Abnormally shaped pelvis
5) Nutritional deficiency
6) Developmental factor
7) Injury to pelvic bone

23. Diagnosis of CPD at the brim
• The presence and degree of CPD at the brim can be
ascertained by the following:-
1) CLINICAL-: a) Abdominal method
b) Abdominovaginal (muller-munro & kerr)
2) IMAGING PELVIMETRY
3) CEPHALOMETRY:-
3.1) Ultrasound
3.2) MRI
3.3) X-ray

24. (1) ABDOMINAL METHOD
• The patient is placed in dorsal
position with the thighs slightly
flexed and separated. The head is
grasped by the left hand.
• Two fingers (index and middle) of the
right hand are placed above the
symphysis pubis keeping the fingers
in line with the anterior surface of
the symphysis pubis to note the
degree of overlapping, when the
head is pushed downwards and
backwards.

25. INFERENCE:
• The head can be pushed down in the pelvis without overlapping of
the parietal bone on the symphysis pubis – no disproportion.
• Head can be pushed down a little but there is slight overlapping of
the parietal bone – moderate disproportion.
• Head cannot be pushed down and instead the parietal bone
overhangs the symphysis pubis displacing the fingers – severe
disproportion.

26. • The patient is asked to empty the bladder.
and placed in lithotomy position.
• Two fingers of the right hand are
introduced into the vagina with the finger
tips placed at the level of ischial spines and
thumb is placed over the symphysis pubis.
• The head is grasped by the left hand and is
pushed in downward and backward
direction into the pelvis.
ABDOMINOVAGINAL METHOD (MULLER-MUNRO KERR):

27. INFERENCE
• The can be pushed down up to the level of ischial spines and there is
no overlapping of the parietal bone over the symphysis pubis – no
disproportion.
• The head can be pushed down a little but not up to the level of ischial
spines and there is slight overlapping of the parietal bone – slight or
moderate disproportion.
• The head cannot be pushed down and instead the parietal bone
overhangs the symphysis pubis displacing the thumb – severe
disproportion.

28. MANAGEMENT OF CONTRACTED PELVIS
It depends mainly the degree of disproportion:-
• Minor disproportion (minor degree of contracted pelvis):- vaginal
delivery.
• Moderate disproportion (moderate degree of contracted pelvis):
trial labor, if failed then caesarean section.
• Marked disproportion (severe or extreme degree of contracted
pelvis): caesarean section.

29. TRIAL LABOR
• Definition: It is the conduction of spontaneous labor in a moderate degree
of cephalopelvic disproportion, in an institution under supervision with watchful
expectancy, hoping for a vaginal delivery.
• Aims: A trial labor aims at avoiding an unnecessary cesarean
section and at delivering a healthy baby.

30. COMPLICATIONS OF CONTRACTED PELVIS
MATERNAL
a) During pregnancy :-
• Malpresentations.
• Pendulous abdomen .
• Nonengagement.
b) During Labor
• slow cervical dilation and prolonged labor.
• Premature rupture of membranes and cord prolapse.
• Obstructed labor and rupture uterus’
• Injury to pelvic joints or nerves from difficult forceps delivery.
• Postpartum hemorrhage.

31. FETAL:-
• Intracranial hemorrhage
• Asphyxia
• Fracture skull
• Nerve injuries
• Intra-amniotic infection

32. REFERANCE
• DC DUTTA’S textbook of obstetrics (chapter 24)