Contracted labor

abnormal Labour
Midwifery

1. CONTRACTED PELVIS Sarju Maharjan S ujeeta shrestha BSN 3rd Year

2. CONTENTS DEFINITION CLASSIFICATION ETIOLOGY DIAGNOSIS MECHANISM OF LABOUR EFFECTS 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

14. 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

15. ETIOLOGY 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)

16. 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

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

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

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

20. DIAGNOSIS PELVIMETRY Internal pelvimetry External pelvimetry Imaging pelvimetry

21. IMAGING PELVIMETRY

22. MECHANISM OF LABOUR IN CONTRACTED PELVIS FLAT PELVIS Sagittal suture in transverse in transverse diameter Biparietal diameter in sacrocotyloid diameter Asynclitism leading to exaggerated parietal presentation Engagement by super -subparietal diameter

23. CONTD... GENERALLY CONTRACTED PELVIS Difficulty fom beginning to end of labour

24. 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

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

26. MANAGEMENT PRETERM INDUCTION OF LABOUR ELECTIVE C/S at term TRIAL OF LABOUR

27. 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

28. 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

29. 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.

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

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

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

33. OUTLET CONTRACTION MILD General episiotomy SEVERE LSCS

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