1. CONTRACTED PELVIS

2. DEFINITION
A contracted pelvis may be defined as one in which there is alteration in the size and shape of the pelvis of sufficient degree so as to alter the normal mechanism of labour in an average size baby.

3. ETIOLOGY NUTRITIONAL AND ENVIRONMENTAL DEFECTS
Rachitic - a flat pelvis distorted as a result of rickets.
Osteomalacic- Softening of the bones, typically through a deficiency of vitamin D or calcium.

4. DISEASES OR INJURIES AFFECTING THE BONES OF THE PELVIS
Fracture, tumour, TB, poliomyelitis, hip joint disease
DEVELOPMENTAL DEFECTS
Naegele’s pelvis-It is produced due to arrested development of one ala
of the sacrum

5. Robert’s pelvis- Ala of both sides are absent and sacrum is fused to the innominate bone
Kyphotic pelvis
a deformed pelvis associated with a kyphotic deformity of the spine.

6. DIAGNOSIS
Medical history- Fracture, tumour, TB, poliomyelitis, hip joint disease
Obstetric history
Previous prolonged labour
Previous still birth
Baby born with asphyxia
History of neonatal convulsion and mental retardation
Instrumental delivery
Maternal injury
Appearance of the patient

7. Contd…. Contracted pelvis should suspected in following cases
Small stature
Pendulous abdomen
Exaggerated spinal curvature
Deformities of the limb

8. Contd…. ABDOMINAL EXAMINATION Posterior position – common
Pendulous abdomen
Badly flexed head
VAGINAL EXAMINATION
CLINICAL PELVIMETRY

9. HAZZARDS
radiation exposure to the mother and the fetus

10. CEPHALOPELVIC DISPROPORTION
The disparity in the relation between the head and the pelvis is called CPD

11. DIAGNOSIS Clinical- Abdominal and Abdomino-vaginal method
Imaging pelvimetry
Cephalometry –USG, MRI, X-ray

12. MANAGEMENT Preterm induction of labour TRIAL OF LABOUR
CAESAREAN SECTION
Severely contracted pelvis
Elderly primi gravida
Breech
Previous LSCS
Failed trial of labour
If disproportion due to fetal cause,
Craniotomy
Symphysiotomy
Manipulative correction

13. TRIAL OF LABOUR
It is the conduction of spontaneous labour in a moderate degree of CPD, in an institution under supervision with watchfull expectancy, hoping for a vaginal delivery

14. Aims – avoiding unnecessary CS and at delivering a healthy baby
Contraindications
midpelvic and outlet contraction
Complicating factors like elderly primigravida, malpresentation, postmaturity, post CS, pre-eclampsia, medical disorders
Facilities of CS is not available

15. Conduction of trial labour
Labour should ideally spontaneous
Hydration maintained by IV drip
Progress of labour is observed-descent of fetus, dilatation of cervix
No procedure should be employed before the cervix is at least 3cm dialated
Watch maternal and fetal condition
After the membranes are ruptured, pv is to be done
Cord prolapse
Colour of liquor
Assess the pelvis and cervix

16. Successful outcome depends on-
Degree of pelvic contraction
Shape of the pelvis
Favourable vertex presentation
Intact membranes till the full dilatation of cervix
Effective uterine contractions
Tolerance of the patient

17. Trial labour to be continued till evidence of descent of the head and progressive cervical dilatation and maternal and fetal condition remain good

18. Termination of trial labour
Spontaneous delivery with or without episiotomy
Forceps or ventouse
Caesarean section
Successful trial labour- a healthy baby is born vaginally, spontaneous or by forceps or ventouse with the mother in good condition
Advantages –
eliminates unnecessary CS
Eliminates injudicious use of premature induction of labour
Ensures the woman a good future obstetrics

19. Disadvantages
Test of disproportion remains unproven
Increased perinatal morbidity or mortality