Narrow pelvis during pregnancy - how to give birth to the most difficult?
important role during pregnancy play a size of the pelvis.The presence of a narrow pelvis during pregnancy may affect the process of delivery, be the cause of injury of the fetus, or childbirth is completed by cesarean section.Therefore, one of the moments when registering at the antenatal clinic is to measure the size of the pelvis and further prognosis for pregnancy and childbirth.
What is the pelvis bone
pelvis consists of two iliac two ischial pubic bone and two.During birth the baby passes through the bony pelvic ring in the structure of which has involved the sacrum and coccyx.
Classification narrow pelvis
There are anatomically and clinically narrow pelvis (functionally), narrow pelvis.
- anatomically narrow pelvis - a basin in which at least one of the main dimensions of less than 1.5-2 cm. Depending on the restriction of a certain size is isolated obscheravnomernosuzhenny, poperechnosuzhenny simple flat and ploskorahitichesky pelvis.Also rare forms of narrow pelvis: kososuzhenny, kosopostavlenny and others.
- reduced pelvis - all sizes are reduced uniformly.
- simple flat pelvis - decreased only direct size.
- Poperechnosuzhenny pelvis - reduced lateral dimensions.
Depending on how much narrowed the pelvis, there are four degrees of restriction.
clinically narrow pelvis - a mismatch of the fetal head and the mother's pelvis, regardless of its size.That is, clinically narrow pelvis can be diagnosed only in labor, even in the absence of his anatomical narrowing.Functionally narrow pelvis is also divided into three degrees of severity of symptoms.
reasons anatomically narrow pelvis
reasons for narrowing the pelvis much they are likely to be found in childhood or adolescence:
- childhood diseases associated with metabolic disorders Metabolism: The basis of life of all living (rickets, polio);
- hormonal disorders (menstrual disorders, hyperandrogenism);
- active sports during childhood and adolescence;
- poor diet in childhood;
- injuries and fractures of the pelvis, tuberculosis Tuberculosis - a full recovery is not guaranteed pelvis;
- tumors of the pelvis;
- deformity of the spine (kyphosis, scoliosis);
Causes clinically narrow pelvis
Since clinically narrow pelvis can only speak in childbirth, and the reason most often associated with the passage of birth:
- incorrect insertion of the head;
- anomalies of labor activity;
- large fruit;
- prolonged pregnancy (fetal skull bone is too dense and unable to be configured);
- anatomically narrow pelvis;
- tumors of the uterus;
- congenital malformations of the fetus Fetal development - week after week .
When a woman gets in the registration of pregnancy, the doctor evaluates the set of indicators and data.If any of the narrow pelvis pregnant entered in the high risk group, and carefully observed the entire pregnancy and childbirth:
- medical history (chronic diseases, deferred childhood diseases, the emergence of menstrual function, puberty);
- external examination (presence of lameness, gait disturbance, the curvature of the limbs);
dimension size of the pelvis:
- mezhostny size - normal is 25-26 cm;
- distance between the most distant points of the iliac crests - is 28-29 cm;
- distance between the trochanter - 30-31 cm;
- outer conjugate (distance from suprasacral pit to the top of the pubic symphysis) - 20-21 cm.
- Record dispensary map pregnant with normal pelvic dimensions would look like: 26-29-31-21.
- measurement of anthropometric data (narrowing of the pelvis indicate: growth below 160 cm, shoe size is less than 36, the length of the brush is less than 16 cm);
- measurement index Solovyov (wrist circumference) when the size of more than 14 cm, it shows massive contraction of the pelvic bone and pelvis;
- vaginal examination;
- radiographs of the pelvis (if indicated) and ultrasound.
management of pregnancy and childbirth in women with narrow pelvis
course of pregnancy is not particularly differences only in the later stages of the fetal head is not pressed against the entrance to the pelvis and a woman appears dyspnea.Sometimes beremennostoslozhnyaetsya malposition (lateral or oblique).The birth in women with narrow hips are active-expectantly, carefully monitoring contractions and fetal heart rate behavior of women.It is mandatory to carry out prevention of intrauterine fetal hypoxia and skin therapy.If you deviate from the normal course of doing a cesarean birth.
complications in childbirth are numerous and depend on the degree of narrowing, the nature of labor and size of the fetus:
- prenatal outpouring of water;
- loop of umbilical cord prolapse;
- injury of the fetus;
- weakness of labor activity;
- postpartum infection;
- intrauterine fetal hypoxia fetal hypoxia - the consequences of lack of oxygen in the body ;
- hypotonic bleeding in the postpartum period;
- threat or uterine rupture.
Currently, more often erased form of narrowing of the pelvis, which in no vigorous labor than not manifest itself, and childbirth end in quite well.