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    1 Bony Pelvis

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    Nicole Ngo
    1. The bony pelvis consists of four planes and its shapes include gynecoid, android, anthropoid, and platypelloid. 2. The pelvic joints include the symphysis pubis and sacroiliac joints, which can relax during pregnancy. 3. Key pelvic measurements include the obstetrical conjugate, biischial diameter, and engagement of the fetal head, which demonstrates adequate pelvic inlet size.

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    1 Bony Pelvis

    Uploaded by

    Nicole Ngo
    71 views50 pages
    1. The bony pelvis consists of four planes and its shapes include gynecoid, android, anthropoid, and platypelloid. 2. The pelvic joints include the symphysis pubis and sacroiliac joints, which can relax during pregnancy. 3. Key pelvic measurements include the obstetrical conjugate, biischial diameter, and engagement of the fetal head, which demonstrates adequate pelvic inlet size.

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    1. The bony pelvis consists of four planes and its shapes include gynecoid, android, anthropoid, and platypelloid. 2. The pelvic joints include the symphysis pubis and sacroiliac joints, which can relax during pregnancy. 3. Key pelvic measurements include the obstetrical conjugate, biischial diameter, and engagement of the fetal head, which demonstrates adequate pelvic inlet size.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    71 views50 pages

    1 Bony Pelvis

    Uploaded by

    Nicole Ngo
    1. The bony pelvis consists of four planes and its shapes include gynecoid, android, anthropoid, and platypelloid. 2. The pelvic joints include the symphysis pubis and sacroiliac joints, which can relax during pregnancy. 3. Key pelvic measurements include the obstetrical conjugate, biischial diameter, and engagement of the fetal head, which demonstrates adequate pelvic inlet size.

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    © All Rights Reserved
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    Download as ppt, pdf, or txt
    of 50

    THE BONY

    PELVIS
    THE BONY PELVIS
    a. Pelvic anatomy
    b. Pelvic joints
    c. Planes & diameters of the pelvis
    d. Pelvic shapes
    e. Pelvic size and its clinical estimation
    a. PELVIC ANATOMY

    b. PELVIC JOINTS
    - Symphysis pubis
    - Sacroiliac joints
    - Relaxation of the pelvic joints
    ( especially during pregnancy)
    PLANES AND DIAMETER OF THE PELVIS

    HAVING 4 IMAGINARY PLANES :


    1. The plane of the pelvic inlet ( Superior strait )
    2. The plane of the pelvic outlet ( Inferior strait )
    3. The plane of the mid pelvis ( least pelvic dimensions )
    4. The plane of greatest pelvic dimensions
    ( Has no obstetrical significance ,
    it is not considered further)
    HODGE PLANE

    I = Pelvic inlet

    II Hodge I through lower margin of


    the symphysis

    III Hodge I through ischial spine

    IV Hodge I through the tip of


    coccygis
    PELVIC SHAPES
    CALDWELL - MOLOY CLASSIFICATION (1933 - 34)

    Gynecoid pelvis
    Android pelvis
    Anthropoid pelvis
    Platypelloid pelvis
    GYNECOID PELVIS
    - Almost 50% of white women (Todd Collection study)
    - Ascertained the frequency of the four parent pelvic types
    by study of Todds Collection ( Caldwell & CoWorkers,1939)

    ANDROID PELVIS
    - 1/3 of pure type pelvis ( white women), 1/6 non white women
    - The extreme android pelvis presages poor prognosis for vaginal
    delivery
    - The frequency of difficult forceps operations increases
    ANTHROPOID PELVIS
    - 1/4 pure type pelvis in white women and nearly
    1 1/2 of those in non white women

    PLATYPELLOID PELVIS
    - Rarest of the pure varieties ( < 3% )

    INTERMEDIATE TYPE PELVIS


    - Mixed type
    - More frequent than pure types
    CALDWELL
    MOLOY
    PELVIC SIZE AND ITS CLINICAL ESTIMATION

    - Pelvic inlet measurements


    - Diagonal conjugate
    - Engagerment : - with engagerment, the fetal head
    serves as an internal pelvimeter to demonstrate
    that the pelvic inlet is ample for that fetus.
    PELVIC INLET
    - Obstetrical conjugate ( normal > 10 cm)
    - Diagonal conjugate
    CD - 1.5 to 2 cm = True conjugate
    PELVIC OUTLET MEASUREMENTS
    ( diameter between the ischial tuberosities )
    Called as :
    - Biischial diameter , Inter tuberous diameter, Transverse
    diameter of the outlet

    - The shape of the sub pubic arch also can be evaluated


    at the same time by palpating the pubic rami from the
    sub pubic region toward the ischial tuberosities.
    - Estimated by placing a closed fist against the
    perineum between the ischial tuberosities, after fist
    measuring the width of the closed fist ( usually > 8 cm )
    MID PELVIS ESTIMATION
    - Clinical estimation of mid pelvis capacity by any
    direct form of measurement is not possible -

    Suspicion contracted pelvis in this region :


    - Ischial spines are quite prominent
    - The side walls are felt to converge
    - The concavity of the sacrum is very shallow
    - Ischial diameter of the outlet < 8 cm
    Outer measurement
    Distantia spinarum
    Distantia cristarum
    External conjugate (Baudelaque)

    Vaginal examination
    95 % of all labors is in vertex presentation and most
    commonly ascertained by abdominal palpation and
    confirmed by vaginal examination
    Majority of cases the vertex enters the pelvis with the
    sagittal suture in the transverse pelvic diameter
    The fetus enters the pelvis in the Left Occiput
    Transverse Position / LOT (40% of labors) & 20% ROT.
    The head either enters the pelvis with the occiput
    rotated 45o anteriorly from the transverse position
    20 % of all labors the fetus enters the pelvis in an
    Occiput Posterior (OP) position.
    The ROP is slightly more common than LOP and
    posterior positions are more often associated with a
    narrow forepelvis
    The head either enters the pelvis with the occiput
    rotated 45o anteriorly from the transverse position
    THE CARDINAL MOVEMENTS OF LABOR ARE :

    ENGAGEMENT
    DESCENT
    FLEXION
    INTERNAL ROTATION
    EXTENSION
    EXTERNAL ROTATION
    EXPULSION
    ENGAGEMENT
    The biparietal diameter, the greatest transverse
    diameter of the fetal head in occiput presentations,
    passes through the pelvic inlet is designated
    engagement (during the last few weeks of pregnancy)
    A normal sized head usually does not engage with
    its sagittal suture directed anteroposteriorly.
    Instead, the fetal head usually enters the pelvic
    inlet either in the transverse diameter or in one of the
    oblique diameters.
    ASYNCLITISM
    Although the fetal heads tends to accommodate to the
    transverse axis of the pelvic inlet, the sagittal suture , while
    remaining parallel to that axis, may not lie exactly midway
    between the symphysis and sacral promontory
    The sagittal suture frequently is deflected either
    posteriorly toward the promontory or anteriorly toward
    the symphysis.
    Such lateral deflection of the head to a more anterior
    or posterior position in the pelvis is called asynclitism
    Moderate degrees of asynclitism are the rule in normal
    labor, but if severe , may lead to CPD
    DESCENT
    In nulliparas, engagement may take place before the onset
    of labor and further descent may not follow until the onset
    of second stage. In multiparous women, descent usually
    begins with engagement.
    Descent is brought about by one or more of four forces :
    Pressure of the amniotic fluid
    Direct pressure of the fundus upon the breech with
    contractions
    Bearing down efforts with the abdominal muscles
    Extensions and straightening of the fetal body

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