22 cephalo-pelvic disproportion (1)
TRANSCRIPT
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CEPHALO-PELVIC
DISPROPORTIONDr. SKS
TMU
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CPD
DISPROPORTION IN SIZE BETWEEN
THE FETAL HEAD AND THE MATERNALPELVIC CAVITY, WHICH CAUSES
DIFFICULTY IN THE LABOUR AND
ENDANGER THE FETAL LIFE
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Cause of CPDI. Maternal :-
Contracted pelvis:-
a. Developmental:- android, anthropoid and
platypelloid pelvis.
b. Congenital defect
c. Acquired defect:- rachitic pelvis,
osteomalacic pelvis, any disease or injury
of bone.
II. Foetal:- Malpresentation, malposition,
hydrocephaly, Macrosomic baby.
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FAULTY DEVELOPMENT:
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PELVIC ANATOMY
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PELVIC ANATOMY
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PELVIC ANATOMY
CALDWELL-MOLOY CLASSIFICATION:
AFFECTED BY:1. Evolutionary Influence
2. Hormonal Influence
3. Nutrition
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PELVIC ANATOMY
CALDWELL-MOLOY CLASSIFICATION:
1. ANTHROPOID TYPE
2. GYNECOID TYPE
3. ANDROID TYPE
4. PLATYPELLOID TYPE
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PELVIC ANATOMY
1. ANTHROPOID
TYPE
2. GYNECOID TYPE
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PELVIC ANATOMY
3. ANDROID TYPE
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WIDE SUBPUBIC ANGLE IN GYNECOID TYPE
NARROW IN ANDROID TYPE
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DIAGNOSIS OF CONTRACTED
PELVIS
Contraction may be at the level of brim,
cavity, outlet or combined.
HISTORY:
GENERAL: Rickets, Osteomalacia, Poliomyelitis, TB
OBSTETRIC: Previous Deliveries
Diagnosis of CPD is very difficult. This is because it is
difficult to estimate exactly how much the mother's
ligaments and joints will 'give' or relax before labor
starts.
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DIAGNOSIS OF CONTRACTED
PELVIS
PHYSICAL EXAMINATION:
HEIGHT: high risk
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DIAGNOSIS OF CONTRACTED
PELVIS
EXTERNAL PELVIMETRY:
Poor accuracy, no role in modern Obstetrics
1. Transverse Diameter of Outlet: between two
inner surface of Ischial tuberocities= 10.5 11 cm
2. Antero-Posterior Diameter of Outlet:between tip of sacrum to symphysis pubis
= 12.5 cm
3. Posterior Saggital Diameter of Outlet:
between the mid point of TD to the sacral tip
= 7 cm
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DIAGNOSIS OF CONTRACTED
PELVIS
INTERNAL PELVIMETRY:
INSTRUMENTS vs VAGINAL
EXAMINATION
VAGINAL ASSESSMENT OF PELVICCAVITY
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CLINICAL PELVIMETRY
DORSAL LITHOTOMY POSITION
ASK TO EMPTY BLADDER
USE INDEX & MIDDLE FINGERS
1. SACRAL PROMONTARY
DIAGONAL CONJUGATE (12.5 cm)
TRUE CONJUGATE = DC 1.5 -2 cm
diagonal conjugate
a radiographic measurement of the distance from the inferior border of
the symphysis pubis to the sacral promontory. The measurement, may
also be determined by vaginal examination.
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VAGINAL ASSESSMENT OF
PELVIS
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CLINICAL PELVIMETRY
2. SACRAL CURVATURE3. PELVIC SIDE WALLS
4. SACRO-SCIATIC NOTCH (Length of the
sacro-tuberous Ligaments)5. ISCHIAL SPINES: BISPINOUS
DIAMETER
6. SUB-PUBIC ARCH:
7. FIST IN BETWEEN THE ISCHIAL
TUBEROSITIES
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DIAGNOSIS OF CONTRACTED
PELVIS
RADIOLOGICAL ESTIMATION:
1. X-RAY PELVIMETRY:
Pelvis- Lateral view, superio-inferior view,
Outlet, Antero-posterior View
2. USG
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MANAGEMENT OF LABOUR
IN CONTRACTED PELVIS
HIGH RISK PREGNANCY-----REFERRED
TO SPECIALISED CENTRE
MODE:
1. ELECTIVE LSCS
2. TRIAL LABOUR
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MANAGEMENT OF LABOUR IN
CONTRACTED PELVIS
ELECTIVE LSCS
INDICATIONS:1. Gross CPD
2. Elderly Primi gravida
3.Toxemia of pregnancy
4. BOH
5. Post maturity
6. Malpresentation
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MANAGEMENT OF LABOUR IN
CONTRACTED PELVIS
ELECTIVE LSCS
TIMING:1. Elective settingplanned procedure
2.Emergency setting
onset of Labourlower uterine segment well formed
less bleeding due to contraction
adequate intra-uterine time for maturation
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MANAGEMENT OF LABOUR IN
CONTRACTED PELVIS
TRIAL LABOUR
INDICATIONS:1. Mild / suspicion of CPD
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TRIAL LABOUR
GOOD PROGNOSIS
Good Uterine contraction
Early engagement of Head
Rupture after full dilatationGood effacement
&dilatation
Flat pelvis
Vertex presentation withanterior position
BAD PROGNOSIS
Weak Uterine contraction
Slow descent of the head
Premature rupture ofmembrane
Uneffaced cervix
Occipito-posterior position
Android pelvis
Other than vertexpresentation
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MANAGEMENT OF LABOUR IN
CONTRACTED PELVIS
THE ROLE OF FORCEPS
NO ROLE; DO NOT USE IF HEAD IS NOT
ENGAGEDSYMPHYSIOTOMY - PUBIOTOMY
PRIOR TO THE ERA OF ANTIBIOTICS
DESTUCTIVE OPERATION:
CRANIOTOMY