Please enable JavaScript.
Coggle requires JavaScript to display documents.
Pelvic assessment & CPD (Cephalo-pelvic disproportion (CPD) …
Pelvic assessment
& CPD
Cephalo-pelvic disproportion (
CPD
) :strawberry:
Definition
Disproportion between fetal head and maternal pelvis
Cause
Fetal position
Fetal diameter
Maternal pelvis
:strawberry:
Dx
criteria (need 3/3)
Cervical opening
at least 4 cm
OR
at least 80% effacement
Regular and adequate UC
at least 2 hrs
(interval 2.5-3 min, duration 40-60 sec, power > 50 mmHg)
Protraction disorders / Arrest disorders / Second Stage disorders
Intrapartum assessment
for Dx
Fetal head descent
Station
Plane of biparietal
Head fitting test
Pawlik’s grip
Muller-Hillis Maneuver (fundus)
Munro Kerr Maneuver (suprapubic)
Classification
Absolute CPD/True mechanical obstruction
Permanent (maternal)
:star: Contracted pelvis
Definition
Anatomy
Obstetric def
Pelvis in which 1or more of its diameter is reduced -> interferes with normal mechanism of labor
Degrees
Minor
Moderate
Severe
Extreme
Types
Contracted pelvis
inlet
Shortest AP diameter < 10 cm
Diagonal conjugate < 11.5 cm
Greatest transverse diameter < 12 cm
:star: Contracted
mid
pelvis more common than inlet
Interspinous diameter + Posterior sagittal diameter < 13.5 cm (normal = 15.5 cm)
Interspinous diameter < 10 cm
Contracted pelvis
outlet
Interischial tuberous diameter < 8 cm
AP diameter < 9 cm
Suprapubic arch < 85 degree
Management
Minor deg: spontaneous delivery
Moderate deg: trial delivery
Severe and Extreme deg: C/S
Pelvic exostoses
Spondylolisthesis
Anterior saccrocygeal tumors
Temporary (fetal)
Hydrocephalus
Large infant
Relative CPD
Brow presentation
Face presentation (mentoposterior)
Occipitoposterior position
Deflexed head
Pelvic Assessment
:koala:
Anatomy
Pelvis
True pelvis
False pelvis
Pelvic examination
Internal Pelvimetry :mahjong:
Plane of pelvis
Plane of
pelvic inlet
enters true pelvis
4 diameters
Anteroposterior diameter (AP)
True conjugate
Obstetric conjugate
Normal range: 10 cm (less than DC 1.5-2 cm)
:star: Diagonal conjugate
Normal range: 10.5 cm
:star2: clinical วัดได้แค่นี้
Transverse diameter
Widest of inlet > 12 cm (วัดได้จาก imaging)
Left oblique diameter
Right oblique diameter
Plane of greatest pelvic dimensions
No roles in labor
Normal range: 12.5 cm
Plane of mid pelvis
3
diameters
:star: Interspinous diameter = 10 cm
Posterior sagittal diameter = 4.5 cm
Anteroposterior diameter = 11.5 cm
Plane of pelvic outlet
Divided into 2 triangles
Transverse (interischial tuberous diameter)
Anteroposterior diameter = 11.5 cm
Summary
External Pelvimetry :mahjong:
Suprapubic arch
Intertuberous diameter
Imaging Pelvimetry :mahjong:
X-ray pelvimetry: I/C: abnormality of pelvic, breech
CT scan
MRI
Fetal-pelvic index (ultrasound head and abdomen measurement, X-ray pelvimetry) I/C: Fetal > 4,000 gm
I/C
:check:
First gravida
Previous preterm or Birth weight < 3,000 gm
Previous instrumental labor
Hx of death at birth
Abnormal pregnancy