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TEXTBOOKS :
F.Garry Cunningham, Norman F.Gant, Kenneth J Leveno, Larry C Gilstrap III, John C Hauth, Katharine D Wenstrom. Williams Obstetrics, 21st ed. ; 2001. Ralph C. Benson. Current Obstetrics & Gynecologic Diagnosis & Treatment, 4th ed ; 1982.
PERINEUM
- THE PELVIC DIAGRAM CONSIST OF
PERINEAL BODY
- Cornua
- Fundus
Before puberty Multiparous : Length 2.5 - 3.5 cm : Length 9 - 10 cm, weight > 80 gram
b. UTERINE CERVIX
PREMENARCHAL GIRL - Body uterus : Length of the cervix NULLIPAROUS WOMEN
= 1:2
= 1:1
myometrium
endometrium
LIGAMENTS
The broad ligaments Infundibulo pelvic ligament (suspensory of the ovary) Cardinal ligament - Mackenrodt ligament The round ligament Utero sacral ligament
POSITION OF UTERUS
- Blood vessels - Lymphatics - Innervation ( Superior and inferior hypo gastric plexus, Nervi
erigentes, common iliac nerves, hypo gastric ganglion).
d. OVIDUCTS ( length 8 - 14 cm )
- Narrowest portion (isthmus) : diameter 2 - 3 mm - Widest portion (ampulla) : diameter 5 - 8 mm
e. OVARIES ( Cortex, Medulla ) Childbearing years : - Length 2.5 - 5 cm , Breadth 1.5 - 3 cm, Thickness 0.6 - 1.5 cm AFTER MENOPAUSE : - Ovarian size diminishes remarkably
- Sacroiliac joints
- Relaxation of the pelvic joints ( especially during pregnancy)
PELVIC SHAPES
CALDWELL - MOLOY CLASSIFICATION (1933 - 34)
Gynecoid pelvis
Android pelvis
Anthropoid pelvis
Platypelloid pelvis
CALDWELL MOLOY
GYNECOID PELVIS
- Almost 50% of white women (Todd Collection study) - Ascertained the frequency of the four parent pelvic types by study of Todds Collection ( Caldwell & CoWorkers,1939)
ANDROID PELVIS
- 1/3 of pure type pelvis ( white women), 1/6 non white women - The extreme android pelvis presages poor prognosis for vaginal delivery - The frequency of difficult forceps operations increases
ANTHROPOID PELVIS
- 1/4 pure type pelvis in white women and nearly 1 1/2 of those in non white women
PLATYPELLOID PELVIS
- Rarest of the pure varieties ( < 3% )
- Engagerment : - with engagerment, the fetal head serves as an internal pelvimeter to demonstrate that the pelvic inlet is ample for that fetus.
PELVIC INLET - Obstetrical conjugate ( normal > 10 cm) - Diagonal conjugate CD - 1.5 to 2 cm = True conjugate
- The shape of the sub pubic arch also can be evaluated at the same time by palpating the pubic rami from the sub pubic region toward the ischial tuberosities. - Estimated by placing a closed fist against the perineum between the ischial tuberosities, after fist measuring the width of the closed fist ( usually > 8 cm )
TENG...