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