clinical pelvimetry
TRANSCRIPT
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Womens Hospital Zhejiang University
Clinical Pelvimetry
Xiu Xiu Jiang
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Womens Hospital, Zhejiang University
pelvi- Latin word pelvis (basin)
metron - Greek word for measure
pelvimetry means to measure the pelvis.
INTRODUCTION
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INTRODUCTION
Clinical pelvimetry:
Internal pelvimetry (manually )
pelvic inlet
mid-cavity pelvic outlet
External pelvimetry Pelvimeter pelvic inlet
pelvic outlet
Imaging pelvimetry:
X-ray Computerised tomography (CT)
Magnetic resonance imaging (MRI)
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METHODS A protocol of clinical pelvimetry
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INTRODUCTION
anteroposterior 11cm
transverse 13cmoblique 12.5cm
Pelvic inlet
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INTRODUCTION
Three anteroposterior diameters of the pelvic inlet
true conjugate
obstertrical conjugate
diagonal conjugate
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Diagonal conjugate (DC) 12.5~13cm
Obstetrical conjugate = DC -1.5 ~ 2cm
Internal pelvimetry
------ anterposterior diameter of Pelvic inlet
11.5cm
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METHODS
A protocol of internal pelvimetry pelvic inlet
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cm
external conjugate
External pelvimetry pelvic inlet
The distance in a straight line between
the depression under the last spinous
process of the lumbar vertebrae and
the upper edge of the pubic symphysis
left lateral position - upper leg: extend
lower leg: flex
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External pelvimetry pelvic inlet
interspinal diameter, IS
intercristal diameter, IC
23-26cm
25-28cm
between the anterior superior iliac spines.
between the most far points on the outerborders of the iliac crests
supine position
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summary
Pelvic inlet
Palpation of the pelvic brim:
The index and middle fingers are moved along the pelvic brim.
Note whether it is round or angulated.
Diagonal conjugate:
Try to palpate the sacral promontory to measure the diagonal conjugate.Normally, it is 12.5 cm and cannot be reached. If it is felt the pelvis is
considered contracted and the true conjugate can be calculated by
subtracting 1.5 cm from the diagonal conjugate .This assessment is not
done if the head is engaged.
INTRODUCTION
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INTRODUCTION
Transverse diameter of the midpelvis
Bispinous diameter = 10 cm
between the tips of ischial spines
METHODS
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METHODS A protocol of clinical pelvimetry
S
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Summary
The mid-cavity
Shape and inclination of the sacrum. Side walls:
To determine whether it is straight, convergent or divergent
Ischial spines:
Whether it is blunt (difficult to identify at all), prominent (easily felt
but not large) or very prominent (large )
The ischial spines can be located by following the sacrospinous
ligament to its lateral end. Interspinous diameter:
By using the 2 examining fingers, if both spines can be touched
simultaneously, the interspinous diameter is 9.5 cm i.e. inadequatefor an average-sized baby.
Sacrosciatic notch:
If the sacrospinous ligament is two and half fingers, the sacrosciatic
notch is considered adequate.
INTRODUCTION
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INTRODUCTION
Antero-posterior diameter =11.5cm
Transverse diameters = 9 cm
Anterior sagittal diameter = 6 cm
Posterior sagittal diameter = 8.5 cm
METHODS
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METHODS A protocol of clinical pelvimetry
METHODS
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METHODS
Bituberous diameter Angle of Pubic arch
SUMMARY
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SUMMARY
Pelvic outletSubpubic angle:
Normally, it is 90
Bituberous diameter:Normally, it admits the closed fist of the hand (4 knuckle).
Mobility of the coccyx.by pressing firmly on it while an external hand on it can
determine its mobility.
Anteroposterior diameter of the outlet:
from the tip of the sacrum to the inferior edge of the symphysis
(>11.0 cm)
SUMMARY
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SUMMARY
Data Finding
pelvic brim
Diagonal conjugate
Symphysis
Sacrum
Side wallsIschial spines
Interspinous diameter
Sacrosciatic notchSubpubic angle
Bituberous diameter
CoccyxAnterposterior diameter of outlet
Round.
11.5 cm.Average thickness, parallel tosacrum.
Hollow, average inclination.
Straight.
Blunt.
10.0 cm.
90
4 knuckles (>
8.0 cm).
Mobile.
11.0 cm.
INTRODUCTION
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INTRODUCTION
Imaging pelvimetry:
X-ray
Computerised tomography (CT)
Magnetic resonance imaging (MRI)
METHOD
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METHOD
A clinical case of
contracted pelvis
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Figure 1a Midsagittal section shows the obstetric conjugate of 8.9 cm and
sagittal outlet of 7.6 cm.
Keller T M et al. Radio logy 2003;227:37-43
2003 by Radiological Society of North America
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Figure 1b Transverse sections show the interspinous distance of 8.4 cm,
measured at the level of the foveae of the femoral heads (arrows)
Keller T M et al. Radio logy 2003;227:37-43
2003 by Radiological Society of North America
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Figure 1c Transverse sections show the intertuberous distance of 8.3 cm
Keller T M et al. Radio logy 2003;227:37-43
2003 by Radiological Society of North America