abnormal Labour Midwifery

1. CONTRACTED PELVIS
Sarju Maharjan
Sujeeta shrestha
BSN 3rd Year

2. CONTENTS
1. DEFINITION
2. CLASSIFICATION
3. ETIOLOGY
4. DIAGNOSIS
5. MECHANISM OF LABOUR
6. EFFECTS
7. MANAGEMENT

3. DEFINITION
• ANATOMICAL=It is a pelvis in which one or
more of its essential diameters are reduced
below the normal by one or more cm.
• OBSTETRIC=It is a pelvis in which its one or
more diameters are reduced so that it i

4. CONTD....
• Interfers with normal mechanism of labour also can
be defined asvthe pelvis having alteration in size
and shape of sufficient degree so as to alter the
normal mechanism of labor in an average size
baby.

5. TYPES OF FEMALE PELVIS
• GYNAECOID PELVIS (classic female type)
• ARTHROPOID PELVIS(llike arthropoid apes)
• ANDROID PELVIS(male type)
• PLATYPELLOID PELVIS(flat pelvis)

6. CLASSIFICATION OF CONTRACTED
PELVIS
•Type of distortion of pelvis
architecture
•Degree of contraction

7. TYPE OF DISTORTION OF PELVIC
ARCHITECTURE
• Pelvic aequabilitor justo minor
• Flat pelvis
• simple flat pelvis
• flat rachitic
• Generally contracted pelvis
• Others (rare forms)

8. JUSTO MINOR PELVIS
• General reduction of all dimeters equally shortened
by 1-2 cm.

9. FLAT PELVIS
Reduced anterioposterior diameter with normal
transverse and oblique diameters
further divides into simple flat and flat rachitic
pelvis.

10. SIMPLE FLAT PELVIS

11. FLAT RACHITIC PELVIS

12. GENERALLY CONTRACTED PELVIS
• All diameters are reduced and anterioposterior
diameter are greatly reduced than others .

13. OTHERS (Rare Forms)
OTTO'S PELVIS
BEAKED PELVIS
SPONDYLOLITHETIC PELVIS
OSTEOMALACIC PELVIS
SCOLIOTIC PELVIS

16. DEGREE OF CONTRACTION
TYPE TRUE CONJUGATE
FIRST DEGREE LESS THAN 11 cm but not less than
9cm
SECOND DEGREE 9-7.5 cm
THIRD DEGREE 7.5 cm -6cm
FOURTH DEGREE LESS THAN 6 cm

17. ETIOLOGY
a. CAUSES IN PELVIS
• Congenital or developmental cause(Naegele's
pelvis,Robert's pelvis,high assimilation ,low
assimilat pelvis,generally contracted pelvis)
• Metaboli cause(rickets,osteomalacia)
• traumatic causes(osteoma)

21. ETIOLOGY
• b)CAUSES IN SPINE
• Lumbar kyphosis,lumbar scoliosis,
spondylolithesis,coccygeal deformity
• c)CAUSES IN LOWER LIMBS
• dislocation of femur,atropy of limbs,
poliomyelitis,hipjoint disease

22. DIAGNOSIS
1. HISTORY
• history of rickets,fracture,tuberculosis of
joints,poliomyelitis,infantilism,
• Bad obstetric history of prolonged labour ,difficult
vaginal delivary ,rectovaginal fistula

23. DIAGNOSIS
• GENERAL EXAMINATION
• Abnormal gait,short stature
• Manifestations of rickets
• dystocia dystrophy sundrome

29. DIAGNOSIS
• ABDOMINAL EXAMINATION
• Pendulous abdomen in primigravida
• Non-engagement in last 3-4 weeks in primigravida
• Malpresentation are common

31. DIAGNOSIS
• PELVIMETRY
a. Internal pelvimetry
b. External pelvimetry
c. Imaging pelvimetry

34. IMAGING PELVIMETRY

35. MECHANISM OF LABOUR IN
CONTRACTED PELVIS
FLAT PELVIS
I. Sagittal suture in transverse in transverse
diameter
II. Biparietal diameter in sacrocotyloid diameter
III. Asynclitism leading to exaggerated parietal
presentation
IV. Engagement by super -subparietal diameter

37. CONTD...
GENERALLY CONTRACTED PELVIS
I. Difficulty fom beginning to end of labour

38. EFFECTS OF CONTRACTED PELVIS
PREGNANCY
Retroverted gravid uterus,pendulum abdomen,
Malpresentations
LABOUR
Prolonged labour,Obstructed labour ,cord prolapse,
early rupture of membrane
MATERNAL
injuries ,operative interference ,PPH ,shock

39. CONTD...
FETUS
trauma ,intracranial hemorrhage, skull fracture ,
nerve injuries and asphyxiation
increased mortality and morbidity

40. MANAGEMENT
1. PRETERM INDUCTION OF LABOUR
2. ELECTIVE C/S at term
3. TRIAL OF LABOUR

41. PRETERM INDUCTION
• Only for mild degree of contraction
• Not favoured in present day practice
• With priors history, induction oof labor done 2-3
weeks prior to due date

42. CAESEREAN SECTION
• Indicated in major inlet contraction.
• if maturity is doubtful , withheld till pain starts or
ROM whichever happens early
• Done with moderate degree with complication

43. TRIAL OF LABOUR
• Conduction of spontaneous delivary in a mild and
moderate degree of contraction in an institution
under supervision with watchful expectancy.
• young primi ,vertex presentation ,no outlet
contraction, average sized baby are indications for
TOL.

44. CONTD...
• Contraindications are post caeserean pregnancy
,pre-eclampsia,malpresentation elderly primi
• It shouldn't be done where emergency C/S facilities
is not available

45. INLET CONTRACTION
MILD Vaginal delivery
MODERATE Trial of labor
LSCS if it fails.
SEVERE LSCS
Destructive operations

46. MIDPELVIC CONTRACTION
MILD
Trial of labour with forceps and vaccum
extraction
SEVERE
LSCS

47. OUTLET CONTRACTION
MILD
General episiotomy
SEVERE
LSCS

48. THANK YOU!!!!