Contracted Pelvis

Anatomical definition: It is a pelvis in which one or

more of its diameters is reduced below the normal by one or more centimetres. Obstetric definition: It is a pelvis in which one or more of its diameters is reduces so that it interferes with the normal mechanism of labour.

Factors influencing the size and shape of the pelvis:

Developmental factor: Hereditary or congenital
Nutritional factor: Malnutrition results in a small

pelvis. Racial factors Trauma, diseases or tumours of the bony pelvis, legs or spines. Sexual factors: an excessive androgen may produce android pelvis.

Aetiology of Contracted Pelvis

Causes in the pelvis
Developmental (congenital): Small gynaecoid pelvis

Small anthropoid pelvis

Small platypelloid pelvis (flat pelvis) Roberts Pelvis: absence of both sacral alae Naegeles Pelvis: absence of one sacral ala High (6) and low (4 vertebrae) assimilated pelvis

Aetiology of Contracted pelvis

Metabolic
Osteomalacia: is softening of the bones due to a lack

of vitamin D or a problem with the body's ability to break down and use this vitamin. Symptoms: Bone fractures that happen with very little injury; Muscle weakness. Traumatic (fractures) Neoplastic (osteoma)

 Causes in spine:
Lumbar scoliosis Causes in lower limbs

Dislocation of one/both femurs

Diagnosis of Contracted Pelivc

History Rickets: is expected if there is a h/o delayed walking . Trauma or diseases of pelvis, spine and lower limbs. Bad obstetric hx: Prolonged labour ended up in difficult forceps, caesarean section or still birth.

Examination Gait: abnormal gait suggesting abnormalities in the pelvis, spine and lower limbs. Stature (short women) Pelvimetry Internal pelvimetry In let, cavity and outlet External pelvimetry Inlet and outlet Imaging pelvimetry ( CT ,MRI scan and x-ray) External pelvmetry is of little values as it measures diameters of false pelvis.

 Cephalometry: Ultrasonography is the safe accurate

and easy method . The biparital diameter (BPD) The occipito-frontal diameter The circumference of the head

Cephalopelvic disproportion tests

Done to detect contracted inlet if the head is not

engaged in the last 3-4wks in a primigravida. Pinards method Mullerr- Kerrs method

Degrees of Disproportion
1. Minor disproportion: (the anterior surface of the

head is in line with the posterior surface of the symphysis.) 2.Moderate Disproportion: 1st degree (the anterior surface of the head is in line with the anterior surface of the symphysis. Vaginal degree may o r may not occur. 3.Marked disproportion: 2nd degree (the head overrides the anterior surface of the symphysis. Vaginal delivery cant occur.

 Minor degree: true conjugate is 9-10cm.

Moderate degree: True conjugate 8-9cm Severe degree: True conjugate 6-8cm Extreme degree: True conjugate less than 6cm. NB:The true conjugate (11 cm or more), is the

distance from the upper margin of the symphysis to the sacral promontory. The diagonal conjugate (12.5 to 13 cm) is the distance from the lower border of symphysis pubis to the promontory of the sacrum

Management of contracted Pelvis

Depends on the degree of disproportion .
Minor degree of contracted pelvis: Vaginal delivery Moderate degree; Trail labour, if failed caesarean

section. Severe degree; caesarean section.