Delivery canal abnormalities

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Presentation transcript:

Delivery canal abnormalities Lecturer: Dr. Hui Wang Department of Obstetrics & Gynaecology Tongji Hospital Tongji Medical College HUST, Wuhan, China

Labour canal Bony canal (pelvic cavity) Soft canal: 1. lower uterine segment (isthmus of uterus) 2. cervix 3. vagina 4. perineum

1. Bony canal abnormalities Abnormal shape Abnormal size

Normal shape Only one: Gynecoid pelvis

Abnormal shape Platypelloid pelvis Anthropoid pelvis Android pelvis Miscellaneous: pelvic malformation

Good

The several kinds of pelvic malformation

Michaelis rhomboid The shape of Michaelis rhomboid is a simple standard to judge the pelvic shape is normal or abnormal (malformation). Method: symmetry / asymmetry ↓ malformation

Abnormal size: narrow pelvis Normal pelvic external parameters IS: interspinal diameter: 23 ~26 cm IC: intercristal diameter: 25 ~28 cm EC: external conjugate: 18 ~ 20 cm TO: transverse outlet: 8.5 ~ 9.5 cm (9)

Narrow types Inlet plane narrow: true conjugate diameter ≤ 10 cm (normal 11 cm) Midplane narrow: interspinous diameter ≤ 9 cm (normal 10 cm) Outlet plane narrow transverse outlet ≤ 8 cm (normal 9 cm) Generally contracted pelvis every plane diameter ≤ 2 cm then normal

Clinical presentation & Diagnosis History: dwarf, bony disease Fetal head engagement difficult after 37 GW Abnormal fetal position Cephalopelvic disproportion (CPD) Abnormal pelvimetry (IS,IC,EC,TO) Asymmetry of Michaelis Rhomboid

Maternal and fetal complications Mother: prolonged labour pelvic floor damage, uterine rupture postpartum haemorrhage genital fistula puerperium Infant: premature rupture of membrane (PROM) prolapse of umbilical cord fetal injury, cranial haemorrhage fetal distress, neonatal asphyxia

Treatment Principle Hospitalized in advance Selective cesarean section Avoid vaginal delivery for term normal weight infant

2. Soft canal abnormalities Lower uterine segment: scar, myoma, Cervix: tough, edema, carcinoma Vagina: diaphragm, tumour Perineum, tough, edema Ovarian or other tumour interfere fetal head engagement