Contracted pelvis

Contracted pelvis in Obstetrics

1. Contracted Pelvis. Fetal Macrosomia Lecture by Andriy Berbets

2. Measurement of the pelvis

3. Normal pelvis

4. Normal pelvis

5. Anatomically contracted pelvis The diagnosis is correct, if at least one diameter is contracted 2cm + Classification: Generally contracted pelvis Simple flat pelvis Flat rachitic pelvis Transversely contracted pelvis

6. Anatomically contracted pelvis Classification (by degree of contraction) 1 st degree (conjugata vera 11-9 cm) 2 nd degree (conjugata vera 9-7,5 cm) 3 rd degree (conjugata vera 7,5-6,5 cm) 4 th degree (conjugata vera less than 6,5 cm)

7. Generally contracted pelvis

8. Generally contracted pelvis

9. Generally contracted pelvis All the dimensions are equally contracted (longitudinal and transverse) Delivery: over-flexion of the fetal head, passing of the fetal head through the pelvis on oblique dimension, fetal head can’t fixate good enough to pubic symphysis

10. Generally contracted pelvis

11. Generally contracted pelvis

12. Generally contracted pelvis

13. Generally contracted pelvis

14. Simple flat pelvis

15. Simple flat pelvis All longitudinal dimensions are contracted Internal rotation is problematic Moderate extension of fetal head Asynclitism

16. Asynclitism

17. Rachitic flat pelvis

18. Transversely contracted pelvis

19. Alternative classification

20. Alternative classification

21. Michaelis’ rhombus

22. Clinically contracted pelvis Anatomical dimensions are normal But fetus is too big and can’t pass through Conditions for diagnosis: Good regular uterine contractions Cervical dilation 8cm + Absence of amniotic sac Empty urine bladder

23. Clinically contracted pelvis Diagnosis: No fetal head’s descending Cervix is not closed to fetal head High standing of contraction ring Early pushing efforts (head is not in pelvic cavity) Edema of cervix, vagina and vulva Symptoms of urine bladder’s pressure Positive signs of Vasten and Tsangemeister

24. Vasten’s sign

25. Threat of uterine rupture

26. Coxalgic pelvis

27. Ankilotic oblique- deformated pelvis

28. Pelvis due to osteomalatia

29. Scoliotic pelvis

30. Pelvis with no symphysis

31. Pelvis with no symphysis (“cleft”)

32. Osteoma

33. Shoulder dystocia

34. Shoulder dystocia

35. Thank you!