KURSK STATE MEDICAL UNIVERSITY
DEPARMENT OF OBSTETRICS AND GYNECOLOGY
IV YEAR VII SEMESTER
CONTRACTED PELVIS
Профессор кафедры акушерства и гинекологии
Хурасева Анна Борисовна
KURSK 2013
Anatomically contracted pelvis – pelvis
which has at least one diameter 1.5 –
2cm lesser than normal
Clinically contracted pelvis - alteration in
size or shape of pelvis of sufficient degree
so as to alter normal mechanism of labor
due to disproportion between fetal head
and maternal pelvis
Definition
Incidence of contracted pelvis – 3-5%
Etiology: - constitution (short stature)
- trauma
- abnormal development in
childhood (malnutrition, heavy work)
- rickets
- diseases of spinal column
- hypotrophy of thyroid gland
- infectious diseases (TB)
Incidence, etiology
1) According to pelvic type (Caldwell
and Maloy): - Gynecoid
- Android
- Antropoid
- Platypelloid
There are intermediate forms :
anthropoid-gynecoid, android-anthropoid,
platypelloid-gynecoid
Classification
2) Types caused by Disease of pelvic
bones & joints
Pelvic osteomalaticus
Congenital (marfan syndrome)
Osteoporosis
Pelvic ricketsicus
Pelvic traumaticus
Inflammatory(TB)
Classification
3) Types caused by abnormalities of spinal
column
Kyphotic
Scoliotic
Kyphoscoliotic
Spondylolisthetic
4) Types caused by abnormalities of lower
extremities
Femoral luxation
atrophy
loss of extremity
Classification
5) According to narrowing of planes
contraction of pelvic inlet
contraction of midpelvis
contraction of pelvic outlet
general contracted pelvis
Classification
6) Acc to degree of narrowing of anteroposterior
diameter of inlet (conjugata vera)
I degree : CV <11cm, >9cm
II degree : CV <9cm,>7.5cm
III degree : CV <7.5cm,>6.5 cm
IV degree : CV <6.5cm ( III’ & IV’ are considered to be
anatomically &clinically contracted pelvis)
7) Acc to degree of narrowing of transverse
diameter of pelvic inlet ( by X-ray/CT)
only for anthropoid pelvis because in this type of pelvis
ant-post dimension is ↑but transverse ↓
I degree : 12.4-11.5 cm
II degree : 11.4-10.5 cm
III degree: <10.5 cm
Classification
1)Past history :
Medical- past history of
rickets,osteomalacia, TB of pelvic
joints/spine, trauma
Obstetric history of prolonged labour,
instrumental delivery, difficult vaginal
delivery ending in stillbirth/early
neonatal death
Diagnosis
2) Physical examination :
- Stature- short women
- Congenital abnormalities in pelvic bones/hip joints
- rickets wit presence of deformity of bones
- dystocia dystrophia syndrome ( android pelvis,obese
women)
3) abdominal examination : Inspection – pendulous
abdomen esp in primigravida ( suspect inlet contraction)
Obstetrical : In primigravida- non-engagement of head
beyond 37th week ( contracted inlet).
Malpresentation also rises suspicion of pelvic contraction
Diagnosis
4) Pelvimetry
Distancia spinarum – 25-26cm
Distancia cristarum – 28-29cm
Distancia trochanterica – 30-31cm
External conjugate – 20-21cm
Frank’s index – 11cm
Wrist index – 14-16cm
Michaelis rhombus: vertical diameter – 11cm, horizontal –
10cm
Lateral conjugate (between anterior superior and posterior
superior iliac spines) – 14-15cm
Diagonal conjugate – 12.5-13cm
Pubic height – 4-5cm
Diagnosis
Pelvimetry
Pelviometry
Estimation of diagonal conjugate
X-ray or MRI
By external conjugate:
If wrist index=14cm, CV=[Link]-9cm
If wrist index>14cm, CV=[Link]-10cm
If wrist index<14cm, CV=[Link]-8cm
By diagonal conjugate:
If pubic height=4cm, CV=[Link]-1.5cm
If pubic height>4cm, CV=[Link]-2cm
By Frank’s index (CV=Frank’s index)
By Mickaelis rhombus (CV=vertical diameter)
By lateral conjugate (if [Link]<14cm,
CV<11cm)
Methods of estimation of
conjugata vera (CV)
During pregnancy:
Complaints of dispnoa, palpitation due to high uterine fundus
Malpresentation
PROM
During labor:
PROM
Anomalies of uterine activity
Overdistension of lower uterine segment and uterine rupture
PPH
Prolonged labor
Arrest disorder
Cephalo-pelvic disproportion
Fetal distress
Maternal and fetal trauma (Injuries of birth canal, intracranial hemorrhage,
cephalohematoma, fractures)
Compression of soft tissue of birth canal and bladder between fetal head and pelvic
bones followed by necrosis and formation of fistula
Clinical picture
I and II degree of contracted pelvis –
labor trial, rule out CPD and fetal distress
III and IV degree of contracted pelvis are
absolute indications to C-section
Management
Clinically contracted pelvis =
cephalo-pelvic disproportion
CPD
I degree II degree III degree
(relative CPD (severe CPD) (absolute CPD)
Classification of CPD
Clinical I degree II degree III degree
features
Uterine Good Anomalies of Strong
contractions uterine contractions,
contractions:
uterine inertia,
early
secondary unsuccessful
arrest of pushing effort
dilatation,
discoordinatio
n of
[Link]
Classification of CPD
Clinical I degree II degree III degree
features
Mechanism According According Not in
of labor to pelvic to different accordance
type pelvic types with pelvic
type
Engageme Presents Presents Absent
nt of head
Classification of CPD
Clinical I degree II degree III degree
features
Moulding + ++ +++
Descent of Prolonged Prolonged Absent
fetal head station in
the same
pelvic
plane
Classification of CPD
Clinical I degree II degree III degree
features
Overlaping Absent -+ Present
sign
(Vasten’s
sign)
Symptoms of Absent Urination is Urination and
bladder difficult, catheterizatio
compression catheterizatio n are
n is possible impossible
Classification of CPD
Clinical I degree II degree III degree
features
Symptoms of Absent Absent Present
impending
uterine rupture
Duration of Prolonged Prolonged Prolonged
labor
Outcome Vaginal C-Section C-Section
delivery is
possible
THANK YOU!
