METHODS A protocol of internal pelvimetry pelvic inlet
Womens Hospital, Zhejiang University
External pelvimetry pelvic inlet
external conjugate
18cm
The distance in a straight line between the depression under the last spinous process of the lumbar vertebrae and the upper edge of the pubic symphysis
left lateral position - upper leg: extend lower leg: flex
External pelvimetry pelvic inlet
interspinal diameter, IS
23-26cm
between the anterior superior iliac spines.
supine position intercristal diameter, IC
25-28cm
between the most far points on the outer borders of the iliac crests
summary Pelvic inlet Palpation of the pelvic brim: The index and middle fingers are moved along the pelvic brim. Note whether it is round or angulated . Diagonal conjugate: Try to palpate the sacral promontory to measure the diagonal conjugate. Normally, it is 12.5 cm and cannot be reached. If it is felt the pelvis is considered contracted and the true conjugate can be calculated by subtracting 1.5 cm from the diagonal conjugate .This assessment is not done if the head is engaged.
Womens Hospital, Zhejiang University
INTRODUCTION
Transverse diameter of the midpelvis
Bispinous diameter = 10 cm between the tips of ischial spines
Womens Hospital, Zhejiang University
METHODS
A protocol of clinical pelvimetry
Womens Hospital, Zhejiang University
Summary The mid-cavity Shape and inclination of the sacrum. Side walls: To determine whether it is straight, convergent or divergent Ischial spines: Whether it is blunt (difficult to identify at all), prominent (easily felt but not large) or very prominent (large ) The ischial spines can be located by following the sacrospinous ligament to its lateral end. Interspinous diameter: By using the 2 examining fingers, if both spines can be touched simultaneously, the interspinous diameter is 9.5 cm i.e. inadequate for an average-sized baby. Sacrosciatic notch: If the sacrospinous ligament is two and half fingers, the sacrosciatic notch is considered adequate. Womens Hospital, Zhejiang University
INTRODUCTION
Antero-posterior diameter =11.5cm Transverse diameters = 9 cm Anterior sagittal diameter = 6 cm Posterior sagittal diameter = 8.5 cm
Womens Hospital, Zhejiang University
METHODS
A protocol of clinical pelvimetry
Womens Hospital, Zhejiang University
METHODS
Bituberous diameter
Angle of Pubic arch
Womens Hospital, Zhejiang University
SUMMARY Pelvic outlet Subpubic angle: Normally, it is 90 Bituberous diameter: Normally, it admits the closed fist of the hand (4 knuckle). Mobility of the coccyx. by pressing firmly on it while an external hand on it can determine its mobility. Anteroposterior diameter of the outlet: from the tip of the sacrum to the inferior edge of the symphysis (>11.0 cm)
Womens Hospital, Zhejiang University
SUMMARY
Data pelvic brim Diagonal conjugate Symphysis Sacrum Side walls Ischial spines Interspinous diameter Sacrosciatic notch Subpubic angle Bituberous diameter Coccyx Anterposterior diameter of outlet
Finding Round. 11.5 cm. Average thickness, parallel to sacrum. Hollow, average inclination. Straight. Blunt. 10.0 cm. 90 4 knuckles (> 8.0 cm). Mobile. 11.0 cm.
Womens Hospital, Zhejiang University
INTRODUCTION
Imaging pelvimetry: X-ray Computerised tomography (CT) Magnetic resonance imaging (MRI)
Womens Hospital, Zhejiang University
METHOD
A clinical case of contracted pelvis
Womens Hospital, Zhejiang University
Figure 1a Midsagittal
section shows the obstetric conjugate of 8.9 cm and sagittal outlet of 7.6 cm.
Keller T M et al. Radiology 2003;227:37-43
2003 by Radiological Society of North America
sections show the interspinous distance of 8.4 cm, measured at the level of the foveae of the femoral heads (arrows)
Figure 1b Transverse
Keller T M et al. Radiology 2003;227:37-43
2003 by Radiological Society of North America
Figure 1c Transverse
sections show the intertuberous distance of 8.3 cm
