CONTRACTED PELVIS

KABERA René,MD
Resident- PGY II
Ruhengeri Hospital
Family and Community Medicine
National University of Rwanda
Plan

Introduction

Definition

Types of Pelvis

Risk factors

Diagnosis

Management

References

Contracted Pelvis 10/5/2010

 Introduction
Knowledge of the shape and dimensions of the
normal female pelvis is essential for a proper
understanding of the second stage of labour and its
abnormalities since the body pelvis is an important
component which determines the birth canal
structure.

Contracted Pelvis 10/5/2010

Definition

Anatomical definition: It is a pelvis in which

one or more of its diameters is reduced below
the normal by one or more centimeters.

Obstetric definition: It is a pelvis in which
one or more of its diameters is reduced so
that it interferes with the normal mechanism
of labour.

Contracted Pelvis 10/5/2010

Major types of pelvis

Gynecoid

Anthrapoid
Android

PlatypelloidContracted Pelvis 10/5/2010

Risk factors

Factors influencing the size and shape of the

pelvis

Developmental factor: hereditary or congenital.

Racial factor.

Nutritional factor: malnutrition results in small
pelvis.

Sexual factor: as excessive androgen may
produce android pelvis.

Metabolic factor: as rickets and osteomalacia.

Trauma, diseases or tumors of the bony pelvis,
legs or spines.
Contracted Pelvis 10/5/2010
Diagnosis

History

Trauma or diseases: of the pelvis, spines or
lower limbs.

Bad obstetric history: e.g. prolonged labour
ended by difficulty; forceps, caesarean
section or still birth.

Contracted Pelvis 10/5/2010

Diagnosis

Examination
General examination

Abnormal gait.

Stature: women < 150 cm.
Abdominal examination

Pendolous abdomen in primigravida.

Non engagement in last 3-4 wks of pregnancy
in primigravida.

Contracted Pelvis 10/5/2010

 Diagnosis
Pelvimetry
 External pelvimetry is of little value as it measures
diameters of the false pelvis.

 Internal pelvimetry (done by per vagina exam)

The inlet:

Palpation of the forepelvis (pelvic brim): V-shaped
depression.

Diagonal conjugate: <11.5 cm (not used if the head is
engaged).
Contracted Pelvis 10/5/2010
Diagnosis

Forepelvis Diagonal conjugate

Contracted Pelvis 10/5/2010
 Diagnosis

The outlet:

Bituberous diameter : ≤8 cm

Mobility of the coccyx: fixed

Contracted Pelvis 10/5/2010

Management
The true Bituberous Decision
conjugate diameter
>9 > 8 cm Vaginal delivery

8-9 cm > 8 cm Trial of labour

8-9 cm ≤ 8 cm C-section

< 8 cm > or < 8cm C-section

N.B: The fetal measurements must be considered!!!

Contracted Pelvis 10/5/2010
References

Geneva Foundation for Medical Education

and Research, Contracted Pelvis, Obstetrics
Simplified - Diaa M.EI-Mowafi.2009

Williams Obstetrics .Section IV. Labor and
Delivery. Chapter 20. Dystocia: Abnormal
Labor, 22nd ed. 2005.

Current Obstetrics and Gynecologic diagnosis
and treatment. Section III Pregnancy at risk.
Abnormalities of the passage, 9th ed. 2003.
Contracted Pelvis 10/5/2010

Thank you

Contracted Pelvis 10/5/2010