CEPHALO-PELVIC CEPHALO-PELVIC DISPROPORTION DISPROPORTION Dr. SKS Dr. SKS TMU TMU
Dec 21, 2015
CEPHALO-PELVIC CEPHALO-PELVIC DISPROPORTIONDISPROPORTION
Dr. SKSDr. SKS
TMUTMU
CPDCPD
“DISPROPORTION IN SIZE BETWEEN THE FETAL HEAD AND THE MATERNAL PELVIC CAVITY, WHICH CAUSES DIFFICULTY IN THE LABOUR AND ENDANGER THE FETAL LIFE”
Cause of CPDCause 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.
FAULTY DEVELOPMENT:FAULTY DEVELOPMENT:
PELVIC ANATOMYPELVIC ANATOMY
PELVIC ANATOMYPELVIC ANATOMY
PELVIC ANATOMYPELVIC ANATOMY
CALDWELL-MOLOY CLASSIFICATION:
AFFECTED BY:
1. Evolutionary Influence
2. Hormonal Influence
3. Nutrition
PELVIC ANATOMYPELVIC ANATOMY
CALDWELL-MOLOY CLASSIFICATION:
1. ANTHROPOID TYPE
2. GYNECOID TYPE
3. ANDROID TYPE
4. PLATYPELLOID TYPE
PELVIC ANATOMYPELVIC ANATOMY
1. ANTHROPOID TYPE
2. GYNECOID TYPE
PELVIC ANATOMYPELVIC ANATOMY
3. ANDROID TYPE
WIDE SUBPUBIC ANGLE IN GYNECOID TYPEWIDE SUBPUBIC ANGLE IN GYNECOID TYPENARROW IN ANDROID TYPENARROW IN ANDROID TYPE
DIAGNOSIS OF CONTRACTED DIAGNOSIS OF CONTRACTED PELVISPELVIS
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.
DIAGNOSIS OF CONTRACTED DIAGNOSIS OF CONTRACTED PELVISPELVIS
PHYSICAL EXAMINATION:
HEIGHT: high risk <140 cm
SPINAL / CHEST WALL DEFORMITIES
WADDLING GATE
OBSTETRIC EXAMINATION:
Unengaged head in the Primi at term
Deflexed attitude at the onset of labour
DIAGNOSIS OF CONTRACTED DIAGNOSIS OF CONTRACTED PELVISPELVIS
EXTERNAL PELVIMETRY:Poor accuracy, no role in modern Obstetrics1. Transverse Diameter of Outlet: between two inner surface of Ischial tuberocities
= 10.5 – 11 cm2. Antero-Posterior Diameter of Outlet: between tip of sacrum to symphysis pubis
= 12.5 cm3. Posterior Saggital Diameter of Outlet:
between the mid point of TD to the sacral tip= 7 cm
DIAGNOSIS OF CONTRACTED DIAGNOSIS OF CONTRACTED PELVISPELVIS
INTERNAL PELVIMETRY:
INSTRUMENTS vs VAGINAL EXAMINATION
VAGINAL ASSESSMENT OF PELVIC CAVITY
CLINICAL PELVIMETRYCLINICAL 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.
VAGINAL ASSESSMENT OF VAGINAL ASSESSMENT OF PELVISPELVIS
CLINICAL PELVIMETRYCLINICAL PELVIMETRY
2. SACRAL CURVATURE
3. 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
DIAGNOSIS OF CONTRACTED DIAGNOSIS OF CONTRACTED PELVISPELVIS
RADIOLOGICAL ESTIMATION:
1. X-RAY PELVIMETRY:
Pelvis- Lateral view, superio-inferior view, Outlet, Antero-posterior View
2. USG
MANAGEMENT OF LABOUR MANAGEMENT OF LABOUR IN CONTRACTED PELVISIN CONTRACTED PELVIS
HIGH RISK PREGNANCY-----REFERRED TO SPECIALISED CENTRE
MODE:
1. ELECTIVE LSCS
2. TRIAL LABOUR
MANAGEMENT OF LABOUR IN MANAGEMENT OF LABOUR IN CONTRACTED PELVISCONTRACTED PELVIS
ELECTIVE LSCS
INDICATIONS:1. Gross CPD2. Elderly Primi gravida3. Toxemia of pregnancy4. BOH5. Post maturity6. Malpresentation
MANAGEMENT OF LABOUR IN MANAGEMENT OF LABOUR IN CONTRACTED PELVISCONTRACTED PELVIS
ELECTIVE LSCS
TIMING:1. Elective setting – planned procedure
2. Emergency setting – onset of Labourlower uterine segment well formedless bleeding – due to contraction adequate intra-uterine time for
maturation
MANAGEMENT OF LABOUR IN MANAGEMENT OF LABOUR IN CONTRACTED PELVISCONTRACTED PELVIS
TRIAL LABOUR
INDICATIONS:
1. Mild / suspicion of CPD
TRIAL LABOUR
GOOD PROGNOSISGood Uterine contractionEarly engagement of HeadRupture after full dilatationGood effacement
&dilatationFlat pelvisVertex presentation with
anterior position
BAD PROGNOSISWeak Uterine contractionSlow descent of the headPremature rupture of
membraneUneffaced cervixOccipito-posterior positionAndroid pelvisOther than vertex
presentation
MANAGEMENT OF LABOUR IN MANAGEMENT OF LABOUR IN CONTRACTED PELVISCONTRACTED PELVIS
THE ROLE OF FORCEPSNO ROLE; DO NOT USE IF HEAD IS NOT
ENGAGED
SYMPHYSIOTOMY - PUBIOTOMYPRIOR TO THE ERA OF ANTIBIOTICS
DESTUCTIVE OPERATION:CRANIOTOMY