CONTRACTED PELVIS DEFINITION A contracted pelvis may be

CONTRACTED PELVIS

DEFINITION A contracted pelvis may be defined as one in which there is alteration in the size and shape of the pelvis of sufficient degree so as to alter the normal mechanism of labour in an average size baby.

ETIOLOGY q NUTRITIONAL AND ENVIRONMENTAL DEFECTS Ø Rachitic - a flat pelvis distorted as a result of rickets. Ø Osteomalacic- Softening of the bones, typically through a deficiency of vitamin D or calcium.

q. DISEASES OR INJURIES AFFECTING THE BONES OF THE PELVIS Ø Fracture, tumour, TB, poliomyelitis, hip joint disease q. DEVELOPMENTAL DEFECTS Ø Naegele’s pelvis-It is produced due to arrested development of one ala of the sacrum

Ø Robert’s pelvis- Ala of both sides are absent and sacrum is fused to the innominate bone Ø Kyphotic pelvis a deformed pelvis associated with a kyphotic deformity of the spine.

DIAGNOSIS ü Medical history- Fracture, tumour, TB, poliomyelitis, hip joint disease ü Obstetric history o Previous prolonged labour o Previous still birth o Baby born with asphyxia o History of neonatal convulsion and mental retardation o Instrumental delivery o Maternal injury o Appearance of the patient

Contd…. ü o o Contracted pelvis should suspected in following cases Small stature Pendulous abdomen Exaggerated spinal curvature Deformities of the limb

Contd…. q ABDOMINAL EXAMINATION ü Posterior position – common ü Pendulous abdomen ü Badly flexed head q VAGINAL EXAMINATION q CLINICAL PELVIMETRY

HAZZARDS radiation exposure to the mother and the fetus

CEPHALOPELVIC DISPROPORTION The disparity in the relation between the head and the pelvis is called CPD

DIAGNOSIS Ø Clinical- Abdominal and Abdomino-vaginal method Ø Imaging pelvimetry Ø Cephalometry –USG, MRI, X-ray

MANAGEMENT q. PRETERM INDUCTION OF LABOUR q. TRIAL OF LABOUR q CAESAREAN SECTION ü Severely contracted pelvis ü Elderly primi gravida ü Breech ü Previous LSCS ü Failed trial of labour If disproportion due to fetal cause, q Craniotomy q Symphysiotomy q Manipulative correction

TRIAL OF LABOUR It is the conduction of spontaneous labour in a moderate degree of CPD, in an institution under supervision with watchfull expectancy, hoping for a vaginal delivery

ØAims – avoiding unnecessary CS and at delivering a healthy baby ØContraindications ü midpelvic and outlet contraction ü Complicating factors like elderly primigravida, malpresentation, postmaturity, post CS, pre-eclampsia, medical disorders ü Facilities of CS is not available

Conduction of trial labour ØLabour should ideally spontaneous ØHydration maintained by IV drip ØProgress of labour is observed-descent of fetus, dilatation of cervix ØNo procedure should be employed before the cervix is at least 3 cm dialated ØWatch maternal and fetal condition ØAfter the membranes are ruptured, pv is to be done ü Cord prolapse ü Colour of liquor ü Assess the pelvis and cervix

Successful outcome depends onü Degree of pelvic contraction ü Shape of the pelvis ü Favourable vertex presentation ü Intact membranes till the full dilatation of cervix ü Effective uterine contractions ü Tolerance of the patient

Trial labour to be continued till evidence of descent of the head and progressive cervical dilatation and maternal and fetal condition remain good

Termination of trial labour ØSpontaneous delivery with or without episiotomy ØForceps or ventouse ØCaesarean section Successful trial labour- a healthy baby is born vaginally, spontaneous or by forceps or ventouse with the mother in good condition Advantages – ü eliminates unnecessary CS ü Eliminates injudicious use of premature induction of labour ü Ensures the woman a good future obstetrics

Disadvantages ü Test of disproportion remains unproven ü Increased perinatal morbidity or mortality