22 cephalo-pelvic disproportion (1)

7/30/2019 22 Cephalo-pelvic Disproportion (1)

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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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PELVIS

PHYSICAL EXAMINATION:

HEIGHT: high risk


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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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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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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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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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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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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

22 cephalo-pelvic disproportion (1)

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