Cephalopelvic Disproportion Flashcards
(12 cards)
Dystocia dysmorphia syndrome
Short stocky individual with male distribution of hair who may have android pelvis
Abdominal method for diagnosing CPD
Patient should be in the dorsal position with legs flexed and knee and hip
Then the left hand should be placed on the abdomen and index and middle finger just above the pubic symphysis
Then the head is pushed down
• head can be pushed into the pelvis - no CPD
•head is flush with pubic symphysis -mild CPD
•head cannot be pushed down and there is overriding of head and pubic symphysis - major CPD
What is the Ian Donald method?
The patient in dorsal position, knees widely spread
Using 3rd,4th and 5th fingers of both hands grasp the occiput and sinciput
Index finger near ps
Thumbs of both hands are kept on parietal eminence and press the head down
Can assess the degree of CPD
Munro kerr- muller method
Keep the thumb at ps
Middle and index finger at ischial spines
Interpretation
• when the foetal head is pushed upto ischial spines and no overlapping of parietal bone occurs over the pubis - no CPD
• head can be pushed little bit not till ischial spines and parietal bone flush with ps - mild degree of CPD
• head cannot be pushed down and there is overriding of the parietal bone over ps- major degree of CPD
Factors to assess pelvis
Sacral promontory reached easily or not and well curved or not
Sacroiliac notch admits two fingers
Pelvic side walls are parallel or convergent
Ischial spines are prominent or not
Pubic angle is acute or obtuse
When clenched fist is admitted between ischial tuberosity can it admit 4 knuckles
Coccyx is mobile or tipped
Cadwell moloy classification
To classify pelvis based on shapes : gynaecoid, android, platypoid and anthropoid
Causes for mobile head term in primi
Wrong dates
Multiple pregnancy
Placenta previa
Cord around neck
Polyhydramnios
Prematurity
Contracted pelvis or CPD
Causes for contacted pelvis
Developmental
Robert’s pelvis- absence of two alae
Naegele’s pelvis -absence of a single alae
Generally contracted pelvis
Deformity
Spines - khyphosis scoliosis
Rickets and osteomalacia
Ll short due to residual polio
Indications for trial of labour
Minor CPD, average fetal size , no obstetric complications
Factors affecting trial of labour
Can be assessed only before labour
Uterine contractions
Moulding of the foetal head
Yield of pelvis at sacroiliac joints and pubic symphysis
Favourable signs of trial of labour
Good uterine contractions
Early engagement of head
Closely applied cervix
Rupture of membranes
Complications of CPD
Maternal -
PROM, cord prolapse
Prolonged labour
PPH
Fetal-
Asphyxia
Hypoxia
IUD
