CONTRACTED PELVIS AND CPD
? DIAGNOSIS
? COMPLICATIONS
? MANAGMENT
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DIAGNOSIS
HISTORY
?H/o rickets , TB ,fractures ,poliomyelitis
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?Previous difficulty vaginal delivery? Birth asphyxia
? Still birth
? Previous vaginal delivery of an avg sized baby in good
condition excludes contracted pelvis
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GENERAL EXAMINATION
? Short stature
? Abnormal waddling gait
? Pendulous abdomen
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? Deformities of limbs or spineABDOMINAL EXAMINATION
? Mobile head in a nul ipara at term raises the suspicion of CPD
? Most common cause is occipitoposterior position
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ASSESSMENT OF CPD BY MUNRO KERR-MULLER
METHOD
? Bimanual method
? Position : modified dorsal position with legs flexed and the
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bladder and bowels empty? Left hand over the abdomen pushes the head into the pelvis, while
the fingers of the other hand inserted vaginal y
? If the head can be pushed down to the level of the spines there is
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no CPD? 1st degree CPD : If head can be pushed a little but not upto the
level of ischial spine
? 2nd degree CPD : if head cannot be pushed at al
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RADIOPELVIMETRY? Not recommended
?
COMPLICATIONS
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COMPLICATIONS - MATERNAL
? Premature rupture of membranes
? Malpresentations
? Prolonged labour
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? Obstructed labour and rupture uterus? Increased chance of instrumental delivery
? Intrauterine infections
? Traumatic and atonic PPH
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COMPLICATIONS ? FETAL? Birth asphyxia
? Cord prolapse
? Neonatal sepsis
? Excessive caput and severe moulding
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MANAGEMENT
? Elective caesarean section
? Trial of labour
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ELECTIVE CAESAREAN SECTION? Severely contracted pelvis
? Second degree CPD with maternal/fetal complication
? High risk pregnancy
? Previous caesarean section
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? MalpresentationsTRIAL OF LABOUR
? With a good uterine contraction, there is a give of the pelvis and
the fetal head moulds to overcome minor degrees of
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disproportions.? Successful ? if healthy baby vaginal y
? Failed ? cs or delivery of dead or deeply compromised baby
SELECTION OF PATIENTS FOR TRIAL LABOUR
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? Suspected minor/first degree CPD without any complications? Facility must provide for emergency CS
CONTRAINDICATION
? Sever contracted pelvics ( midpelvic and outlet contraction )
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? Any maternal or fetal complication? Non availability of emergency CS
MONITORING PROGRESS
? Partogram
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? Vaginal examination repeated every 4 hour? Cervical dilatation, Position of head, moulding noted
? Cardiotocography monitaring
? Intermittent ascultation
? Epidural analgesia is ideal
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AUGMENTATION OF LABOUR
? Amniotomy is done
? Nul ipara ? oxytocin used in ineffient uterine contraction
? Multipara ? reassessment from senior person needed
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TERMINATE THE TRAIL BY EMERGENCY CS
? No progress in cervical dilatation
? Failure of decent of the head
? Excessive moulding and caput
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? Fetal or maternal distressTHANK YOU