Download MBBS (Bachelor of Medicine and Bachelor of Surgery) OBG contracted pelvis and CPD PowerPoint PPT presentation
CONTRACTED PELVIS AND CPD
? DIAGNOSIS
? COMPLICATIONS
? MANAGMENT
DIAGNOSIS
HISTORY
?H/o rickets , TB ,fractures ,poliomyelitis
?Previous difficulty vaginal delivery
? Birth asphyxia
? Still birth
? Previous vaginal delivery of an avg sized baby in good
condition excludes contracted pelvis
GENERAL EXAMINATION
? Short stature
? Abnormal waddling gait
? Pendulous abdomen
? Deformities of limbs or spine
ABDOMINAL EXAMINATION
? Mobile head in a nul ipara at term raises the suspicion of CPD
? Most common cause is occipitoposterior position
ASSESSMENT OF CPD BY MUNRO KERR-MULLER
METHOD
? Bimanual method
? Position : modified dorsal position with legs flexed and the
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
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
RADIOPELVIMETRY
? Not recommended
?
COMPLICATIONS
COMPLICATIONS - MATERNAL
? Premature rupture of membranes
? Malpresentations
? Prolonged labour
? Obstructed labour and rupture uterus
? Increased chance of instrumental delivery
? Intrauterine infections
? Traumatic and atonic PPH
COMPLICATIONS ? FETAL
? Birth asphyxia
? Cord prolapse
? Neonatal sepsis
? Excessive caput and severe moulding
MANAGEMENT
? Elective caesarean section
? Trial of labour
ELECTIVE CAESAREAN SECTION
? Severely contracted pelvis
? Second degree CPD with maternal/fetal complication
? High risk pregnancy
? Previous caesarean section
? Malpresentations
TRIAL OF LABOUR
? With a good uterine contraction, there is a give of the pelvis and
the fetal head moulds to overcome minor degrees of
disproportions.
? Successful ? if healthy baby vaginal y
? Failed ? cs or delivery of dead or deeply compromised baby
SELECTION OF PATIENTS FOR TRIAL LABOUR
? Suspected minor/first degree CPD without any complications
? Facility must provide for emergency CS
CONTRAINDICATION
? Sever contracted pelvics ( midpelvic and outlet contraction )
? Any maternal or fetal complication
? Non availability of emergency CS
MONITORING PROGRESS
? Partogram
? Vaginal examination repeated every 4 hour
? Cervical dilatation, Position of head, moulding noted
? Cardiotocography monitaring
? Intermittent ascultation
? Epidural analgesia is ideal
AUGMENTATION OF LABOUR
? Amniotomy is done
? Nul ipara ? oxytocin used in ineffient uterine contraction
? Multipara ? reassessment from senior person needed
TERMINATE THE TRAIL BY EMERGENCY CS
? No progress in cervical dilatation
? Failure of decent of the head
? Excessive moulding and caput
? Fetal or maternal distress
THANK YOU
This post was last modified on 12 August 2021