Clinical inconsistency in childbirth signs. Size pelvis: norm and deviations

The date: 04.04.2019

During pregnancy, the sizes of the pelvis play an important role. Sometimes it depends on the flow of labor. If the pelvic bones are narrow, then there may be complications during childbirth or they can end the cesarean cross section. Narrow pelvis It is observed about 3% of women during pregnancy, but it is not always an indicator for Cesarean.

When registering for pregnancy, feminine pelvis pay special attention. After its measurement, the gynecologist already at the very beginning of pregnancy will be able to assume how childbirth will occur.

Distinguish anatomical and clinical narrow pelvis during pregnancy.

Anatomical narrow pelvis - Missing at least one parameter by 1.5-2 cm and more from normal. It is a consequence of the impact of some factors on the body in childhood: defective nutrition, frequent infectious diseases, lack of vitamins, hormonal violations During puberty, congenital anomalies, injuries and fractures. Also, the deformation of the pelvic bones may occur as a result of tuberculosis, rickets, poliomyelitis.

If the pregnant woman is diagnosed 1 degree of narrowing out of 4, then natural way Full possible. It is also possible to independently give birth to 2 degrees of narrowing, but taking into account certain conditions, for example, if the fruit is not large. The remaining degrees (3 and 4) are always an indication to Cesarean section.

Clinical narrow pelvis - Non-compliance of the fetus head with the parameters of the Hife pelvic, diagnosed during childbirth. In this case, the pelvis has normal physiological parameters and shape. It is considered narrow, as the fetus is quite large or incorrectly examines his forehead or face. For this reason, the child cannot be born naturally.

Normal sizes of pelvis

The measurement of the pelvis is carried out by a special tool with a basic tool that measure:

The distance between the front upper corners of the iliac pelvic bones. Normally, it is 25-26 cm.
The distance between the remote points of the ridges of the iliac bones. Normally, it is 28-29 cm.
The distance between the big skewers of the femoral bones. Normally, it is 31-32 cm.
The distance of the middle of the upper outer edge of the symphysis to the surrender. Normally, it is 20-21 cm.
Rhombus Michaelis (lumbling rhombus). Normally, its value diagonally is 10 cm, vertically - 11 cm. If an asymmetry is present or its parameters are less than normal values, this indicates improper structure pelvic bones.

Additionally, it is possible to obtain data on the parameters of pelvic bones with the following studies:

X-rayOfeliometry. This study is allowed at the end of the third trimester, when all the fabrics and organs of the fetus are already formed. Thanks to the procedure, it is possible to find out the shape of the bones and the sacrum, to determine the straight and transverse sizes of the pelvis, measure the head of the fetus and install whether it corresponds to its parameters.
Ultrasound procedure. On the ultrasound it is possible to determine the correspondence of the magnitude of the fetus head with sizes of pelvic bones. Also, the procedure allows us to find out the location of the fetus head, because in cases of the frontal or facial preview, it will take more space during childbirth.
Solovyov's index - Measurement of the circumference of the wildliness of the woman, thanks to which you can find out the thickness of the bones and determine the straight size of the input cavity in a small pelvis. Normally, the value of the circumference of the ray-exclusive joint is 14 cm. If it is greater, then the bones are massive, if less, then - thin. For example, with insufficient external sizes of pelvic bones and with a normal Solovyov index, the size of the pelvic ring is sufficient to pass through the child.

Birth with narrow pelvis and possible complications

In women's consultation, all pregnant women with a narrow pelvis are in a special accounting. It is very important, in this case, to determine the date of delivery, since it is extremely undesirable to rebuild the pregnancy. A woman in 1-2 weeks will put in the hospital. Closer to the term of childbirth, doctors will address the question of the way of delivery.

During natural childbirth In the narrow pelvis, the risk of developing complications in the fetus (respiratory disorder, oxygen starvation, generic injury, circulatory disorder in the brain, crook fracture, damage to the bones of the skull and, the worst, intrauterine death) and the mother (weak generic activity, premature expulsion spindle water, postpartum infection, threat of uterus break).

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The anatomical narrowing of the bones of the pelvis provokes the problems of motion of the fetus generic canal. The potential failure of the passage is determined in advance, but the clinically narrow pelvis during childbirth is diagnosed only when the uterus is ready for complete disclosure. The phenomenon occurs in 1.5% of women, in case of survey errors, it causes complications. The future of the child depends on the solution of obstetric gynecologists in childbirth.

During the delivery, the fetus passes a pelvic bone ring. It is formed from smoking, sacral, pubic, sedlication and iliac bones. Combined cartilage cloth and ligaments.

What is a narrow pelvis for childbirth? If the size does not provide a full-fledged outlet for the fetus, the pelvis is considered narrow for labor. The bone distance must comply with standard anatomical standards. If there are deviations at least in one parameter, the ring prevents the passage of the fetal head.

There are two types of changes in standard circumference sizes:

anatomical;
clinical.

In the first case, the diagnosis is placed before or during pregnancy, the deviation from the norm is predetermined. If the fruit of a small size is correctly located and there are no pathological changes, then in 90% of cases, childbirth is allowed independently.

Signs of clinically narrow pelvis at birth are found during the beginning generic activity. Symptoms are often associated with a narrowing of an anatomical nature or a fruit of more than 4 kg.

Pathology:

hydrocephalus (enlarged child's head size);
rear occipital prediction;
unfavorable standing sweat sutures;
pelvic presentation with the extension of the head;
transferred pregnancy;
the narrowing of the vaginal canal.

If there is one of the reasons together with the anatomical indicator of the narrow pelvis during childbirth, the Operal delivery is assigned. Cesarean section Gives a guarantee of a safe birth of a baby.

What should be the pelvis for normal childbirth:

between the upper worship bones -26 cm;
long-range older angles - 29 cm;
femoral - 37 cm;
cross and pubes - 21 cm;
between Symphysome and Cape (the farthest points) should be a true conjugate - 11 cm.

The normal distance between the bones of the circle is determined by the Medical Regulations. Pathology is detected on the basis of measuring several parameters with a special tool - a pazer.

What pelvis is considered narrow for childbirth? A narrowing of 1.5 or more centimeters in one or more parameters. Births with a narrow pelvis pass safely when the size of the fetus and the presence does not deviate from the norms.

Signs and reasons

If the size of the pelvic circle is not narrowed anatomically, the probability of determining the narrow pelvis is less than 0.5%. It is impossible to independently detect pathology, so in most cases the fact is detected during pregnancy. Observations of scientists prove that women who have narrow labor pathways are characteristic of the same physiological differences. The narrowing occurs with wide hips if the bones have a powerful structure.

Physiological differences:

low growth, less than 1.58 m;
growth higher than 1.78 m;
skoliosis, pronounced thinness;
wide waist, at the level of hips;
narrow rib cage and underdevelopment of the breasts;
abundant hair vegetation on male type.

With a small mobility of the joints, the pelvic part is completely or partially atrophy. This leads to the acquired anatomical narrowing.

Multiple pregnancy, child rejunction, improper prediction and other reasons do not always cause clinical pathology narrowing. In most cases, with a diagnosis of 1 degree (the deviation of the conjugates by 2 cm.) Natural labor with a narrow pelvis pass well.

Physiological reasons:

disorders of food and metabolism in childhood;
the development of anorexia;
fractures, dislocations of pelvic bones;
rachiocampsis;
diseases of the musculoskeletal system;
hormonal disorders, the predominance of male hormones;
acceleration;
endocrine diseases;
failure in the exchange of mineral substances;
bone tuberculosis;
rickets.

If the history has fractures of the bones of the circle, less than 6 months before the occurrence of pregnancy, childbirth in a narrow basin are carried out only by cesarean sections. The remaining reasons are applicable in the complex, for example, the predominance of male hormone and endocrine disease Provocates the pathology of the acquired narrow pelvis to 40%.

Diagnostics

The diagnosis of clinically narrow pelvis is stated in the pathology of the third and more degree, or during active generic activity. Only in childbirth is determined by the potential of channel passability. It is forbidden to give birth at the narrow tase of the class from the third degree and above.

Classification depending on the degree:

1 - the offset of the norm of less than 2 centimeters;
2 - by 2 - 4 cm;
3 - by 4-6 cm;
4 - more than 6 cm.

For the rule, the true conjugate of the size of 11 cm is taken. Natural childbirth is possible at the first and second degree (in the absence of pathologies). The value of the pelvis is also the value. This depends on the location of the fetus, proper nutrition Oxygen, the risk of asphyxia.

Shape pelvis:

flat;
transversely narrowed;
uniformly narrowed;
oblique offset;
acquired narrowing due to dislocation, fracture.

The first two forms and a narrow pelvis of 1 degree during childbirth are common. The probability of diagnosis is determined by the vaginal study and palpation of the abdomen. For accurate diagnosis Any form and degree requires a number of surveys.

Diagnostic methods:

collecting the history of the patient's history - past illnesses, fractures, genetic location;
physiology of the urogenital system - the nature of the monthly, other pregnancy and childbirth;
external features - growth, body proportions, correctness of the structure spinal canal, mobility of the joints;
the form abdominal cavity and an angle of the pelvis;
vaginal inspection;
palpation of belly from outside;
measurements of the pyaseomer;
x-ray, from 37 weeks;
ultrasound.

One of the main tasks of studying the size of a narrow pelvis is to determine the degree of narrowing to appoint a type of delivery. The diagnosis of x-ray is permissible only in an emergency when the inspection does not give a specific result or question the diagnosis.

Consequences and complications

Prevent anatomical station of the pelvis is possible with careful health observation with early age. It is necessary on time for the diagnosis and treatment of hormonal nature, infectious diseases, control of labor regime and recreation.

Clinically narrow pelvis is important to suspect during pregnancy. Study of the size of the bone circle, determination of the sizes of deviations, computer diagnostics of the fetal position - all this will help reduce the risk of injury in childbirth to a minimum.

Complications:

incorrect location of the fetus in the womb;
bubble rupture, premature oral influence;
lack of generic activity at the later date;
early branch of the placenta from the uterus;
rupture circumference in ligaments;
injuries of the uterus;
bleeding in childbirth;
fetal asphyxia;
the swelling of the genital organs, the tumor on the child's head.

The first trimester of pregnancy and the beginning of the second pass with a narrowed basin normally, without deviations. But the nature of the flow is aggravated in the third period of gestation. The smaller at this time of provoking factors, the greater the probability to safely give birth to a narrow pelvis.

Gestosis, sex infections, pathology of generic activities are a reason for cesarean section. After the twentieth week, a woman with a narrow pelvis begins to feel pain in the bones other than discomfort in the joints. Pathologies are long-term, suitable.

The load on the pelvic bones increases the voltage of the uterine bundles holding the fruit. If in the womb, each movement is reflected in the dice pressure. Hormones prolactin and relaxin affect the swelling and mitigation of the rods and ligaments of the bone circle, facilitating the path of the fetus. The child begins to put on the bone harder, the pain is enhanced.

add calcium and vitamin D;
increase the consumption of vitamin C (broccoli, cauliflower);
there is more protein - not fatty meat, porridge on milk;
minimize salt and sugar in the diet;
wear a bandage.

In rare cases observed strong pain in the pubic area. If at the same time discomfort enhances, if desired, lift the leg, the pathology of the discrepancies of the laminate bones is possible. It is eliminated by the possibility of self-poring if a narrow pelvis is diagnosed. Caesarean is assigned and after childbirth operates symphysit.

Features of childbirth

In order to have a favorable childbirth and pregnancy, with the pathology of the bone rings, the expectant tactics and active observation are used. Each case is individual, so decisions are accepted during delivery.

Guiding plan:

cesarean section by testimony;
prevention of complications during pregnancy and during childbirth;
study of clinical indicators to establish an accurate diagnosis;
control and prevention of ingress of infenction;
exclusion of the risk of asphyxia of the fetus;
stimulating generic activity, if necessary;
the adoption of a horizontal position with weight on the side of adjacent the child in the womb so that the fruit is completely in the oilyotic waters;
in the case of a clinically narrow pelvis, urination control and analysis of the discharge (bloody or watery) are conducted during childbirth;
at the first degree and enough open cervix uses related methods.

Tactics doctors are aimed at timely response. With urination problems, a catheter is applied, with vulvite, a local impact is carried out before delivery. Pregnant woman is recommended in hospital with 35 weeks of pregnancy.

Can I give birth to a narrow pelvis? If a narrow pelvis of the third and fourth degree, it is impossible to give birth to the most impossible. It is necessarily assigned to the planned operation. In the case of a narrowing of true conjugates up to 4 cm, the success of natural genera depends on the concomitant pathologies of the fetus.

It is important to understand that compliance with the standards of external size does not allow one hundred percent opportunity to understand whether a narrow pelvis for childbirth. When evaluated, the thickness and weight of the bones are taken into account, the structure of fatty tissues, cartilage partitions. The exact measurement is carried out only with the use of thazomer and computer examination.

Narrow anatomically and clinically. The pelvis, which has an outer conjugate less than 18 cm or at least one of the other basic sizes is less than usual by 2 cm (see an obstetric study.), It is called anatomically narrow pelvis. The concept of clinically narrow pelvis means the discrepancy between the fetus head and the pelvic of the woman regardless of the size of the latter, detectable only in the process of childbirth. Thus, anatomically narrow pelvis does not necessarily turn out to be clinically narrow, i.e., which prevents the borrows through the natural generic paths.

The anatomical diseases of the pelvis may be due to: disorders or diseases of bones and joints, transferred to the woman in childhood, during the growth and formation of the pelvis, sometimes the fracture of the pelvis bones in adulthood.

Fig. 1. Entrance to the TAZ is normal and at various anomalies: 1 - normal pelvis; 2 - the general economic; 3 - simple flat; 4 - flat-rachistic; 5-competitive flat pelvis.

Fig. 2. Sressy rhombus: 1 - woman's right physique; 2 - with a deformed basin.

Anatomically narrow pelvis in shape distinguishes: a shared and flat, flat (simple and flat) and nerve flat. Less often meet: ore, across, osteomalamic (Fig. 2, 2.).

A strange-based pelvis is characterized by a decrease in all sizes, a normal pelvic form (Fig. 1.1 and 2). Approximate pelvis dimensions: Distantia Spinarum - 23 cm, Distantia Cristarum - 26 cm, Distantia TroChanterica - 29 cm, Conjugate Externa - 18 cm, Conjugate Diagonalis - 11 cm, Conjugate Vera - 9 cm.

A simple flat pelvis (nerachistic, decenter) is characterized by a significant approach of the sacrum to the front wall of the pelvis, as a result of which the entire direct sizes of the cavity of the small pelvis are shortened, especially a true conjugate (Fig. 1, 3). Approximate dimensions appropriate-28-31-18-11-9 cm.

The flat-rakhic pelvis is characteristic of the deformation: the entrance plane has a queens-like shape - in the transversely located oval deeply goes backwards; The crushes are flattened and rejected by the former; The direct size of the input of the pelvis is significantly shortened (Fig. 1, 4). Approximate pelvis dimensions: 26-26-31-17-9-7 cm.

Non-private flat pelvis. All sizes of the pelvis are reduced, especially the direct size of the entrance to the small pelvis (Fig. 1, 5). Approximate pelvis dimensions: 23-26-29-16-9-7 cm.

The value of true conjugates determine the degree of narrowing anatomically narrow pelvis: 1st - from 9 cm to 11 cm; 2nd - 7 cm to 9 cm; 3rd - from 5 cm to 7 cm; 4-ya-5 cm or less.

At the 1st degree of narrowing, if there are no other complicating circumstances, usually flow normally; With a 2nd degree, they can also end well for mother and fetus, but childbirth are more prolonged, often require applications obstetric operations (, vacuum extractor, etc.); With a 3rd degree of narrowing through natural generic paths, it can be removed in parts (), alive and dumpy fruit can be removed only by caesarean sections; With a 4th degree - the only possibility of a delivery is caesarean section.

The anatomical narrowing of the pelvis indicates below 145 cm. (See), kyphos (see), Lordoz (see), the shortening of one foot indicate the transferred in the past and (most frequent reasons strain pelvis). The upper angle of the sacral rhombus () is usually corresponding to an accelerable process at the lumbar vertebra, the lower - the tip of the sacrum, the side angles - the upper-backs of the iliac bones. The more correctly the woman is folded, the greater the rhombus form approaches the square, (Fig. 2,1). With a simple flat pelvis, the distance between the upper and lower corner of the rhombus is shortened; Rachitically deformed Taza rhombus loses its outlines.

If the degree of anatomical narrowing of the pelvis allows normal delivery, then the generation mechanism is determined by the shape of the pelvis.

Increasingly, with gynecological surveys during pregnancy, doctors say that dimensions female pelvis And the fetus do not correspond to each other. This interferes with the normal course of childbirth. Often this situation is so dangerous that the guinea offers a cesarean section to avoid undesirable consequences. What is the narrow pelvis in pregnancy and what can it harm the baby?

The pelvic bones are a dense ring through which the kid will be passed during his birth. The problem is that this bone formation is almost neraty. It is possible only insignificant discrepancy (only in half a hundredthimeter) due to the fact that the symphiz (cartilage) is slightly softened before childbirth.

At its base, the pelvis is fixed. And if the child's circumference has more than this bone rings, gynecologists are forced to diagnose this anatomical feature of the female skeleton and recommend. What can be the reason for such an unusual pathology?

According to statistics.IN recent times The diagnostic frequency of the narrow pelvis fell compared to the past years. It is only 7%.

Causes

Most of the women who have been identified during pregnancy a narrow pelvis believe that this is an individual feature of the structure of their skeleton with which they were so born. In fact, in 90% of cases, this problem is acquired.

To the main reasons of the narrow pelvis include:

health problems in childhood: suffered rickets, poor nutrition, excessive loads provoke deviations in physical development;
injuries in the field of the pelvis: bone fractures lead to their serious deformation and diminishing reduction;
tumors in this zone: osteomes narrow the lumen between the bones;
hormonal disorders leading to hyperandrode, which is characterized by broad shoulders and a native thawed pelvis;
acceleration of girls in a teenage period, which leads to a transverse-narrowed pelvis;
bone infections: tuberculosis, osteomyelitis, destroying bone fabric and leading to the deformations of the pelvis;
orthopedic diseases (for example, scoliosis).

About the same phenomenon they say in the event that the fruit is too large and risks not to go into a pelvic ring, even if it normal sizes.

Parameters, which pelvis is considered narrow for childbirth, have long been developed in gynecology, so the doctor will answer this question after the corresponding measurements and surveys. Depending on the type of this pathology, a decision will be made how the kid will be born - by cesarean section or.

What's the secret? If earlier, a narrow pelvis was mainly an anatomical feature of a female skeleton, today with this problem, the women in labor have to face due to the fact that large children have become more often born.

Classification

According to the classification, there are two types of pathology - anatomically or clinically narrow pelvis during childbirth that differ in relation to the indicators of the norm.

Anatomical

Gynecologists diagnose anatomically narrow pelvis when there is a narrowing of bones, which is a deviation from the average norm. It does not always serve as a testimony for cesarean section, because the fruit can refuse to be small and free to go through the generic paths without injury. This type of pathology has its own, special classification.

By type of narrowing:

Uniformly narrowed.
Flat.
Cross-narrowed.

According to the degree of narrowing (classification of Litzmann):

1 degree

If a woman has a narrow pelvis 1 degree during pregnancy, it is allowed to give birth independently. However, a young mother and a team of doctors should be prepared for various conjugmentation of labor. In such cases, a surgeon and anesthesiologist is usually warned for the safety net. At any time, their intervention may be needed.

2 degree

A little harder is a situation when women diagnose narrow pelvis 2 degrees during pregnancy: natural labor is allowed, but under certain conditions. Most often it is allowed to give birth independently, if pregnancy is prematched and the fruit is not too large.

3 degree

Natural childbirth is impossible. If a narrow pelvis 3 degree is diagnosed, this is a medical test for cesarean section. A woman is hospitalized in advance (2 weeks before the cherished date), assigning her bed regime and absolute peace.

4 degree

If during pregnancy it turns out that the future mother has a narrow pelvis of 4 degrees, her child can be born only by cesarean sections.

Clinical

If the size of the female in labor is normal, but on the eve of childbirth, it turns out that the fruit is too large and he will not be able to pass through the pelvic ring without injuries, they talk about the clinically narrow tase. However, with subsequent pregnancies, if the child is less, this diagnosis will not be delivered. So if other readings for the cesarean section will not be, the childbirth will be natural through.

Clinically narrow pelvis is diagnosed only in the process. recent months Pregnancy or even immediately before childbirth, and its classification in obstetrics is not developed. The most common causes of clinically narrow pelvis are:

incorrect head insert;
major fetus;
various malformations of the child's development;
misconception.

All these phenomena can be clarified immediately in front of the birth themselves or already in their process. The decision must be made very quickly, the diagnosis of clinically narrow pelvis is based on specific obstetric signs and symptoms. In this case is carried out.

Regardless of his species, narrow pelvis in obstetrics is regarded as a serious complication that may entail dangerous consequences With incorrect approach. An experienced, professional doctor at the first suspicion of this feature of the female skeleton takes appropriate measures and throughout pregnancy controls the size of pelvic bones, so that during the birth of the baby did not arise an unexpected situation. How is this pathology diagnose?

For reference. Hydrocephalus is a dangerous and frequent illness, brain molding at the kid, which is characterized by the huge sizes of his head. It will not pass through the pelvic ring.

Diagnostics

Many business and most active moms are trying to find out on their own, how to determine whether it is a narrow pelvis for childbirth, and whether they can give birth to themselves with certain sizes. In fact, at home, it is impossible to do this. Diagnosis is possible only in the hospital, it is made exclusively by a professional doctor with the help of a specific obstetric tool, which is also called a pomp. With it, the following dimensions are determined:

the inter-distance distance is measured between the front iliacs (connecting the pelvis with the spine) of the absentee (process), the norm must be more than 25 cm;
the gap between the most remote points of the iliac bones, normally more than 28 cm;
the distance between spit (large) femoral bones, the desired norm is more than 30 cm;
the true conjugate is measured during a vaginal examination, this is the distance between the pubic joint and the uppermost point (cape) of the sacral bone; the norm is considered when the obster cannot get this point;
the outer conjugate is a gap between the surcesive pits, which is located in the lumbar-sacral division, and the top corner of the pubic symphima, a certain norm - more than 20 cm;
rhombus Michaelis above the smoking, in the zone of the sacrum, the boundaries of which are well visible in the norm, all sides are symmetrical: transverse are 10 cm, vertical - 11 cm;
solovyov's index allows you to estimate the thickness of the bones, which can also prevent normal Rodam- This is the wrist circumference, the limit norm - no more than 14 cm.

To clarify the parameters in rare cases, radiography is performed, but it can harm the fetus. Assess the dimensions of the narrow pelvis during pregnancy also makes an ultrasound-study. For clinical casesWhen this data is not possible in advance, obstetrics are focused on special signs and symptoms.

According to history pages. S. A. Michaelis - German Gynecologist of the XIX century, whose name is the famous sacral diamond, determining, can give birth to a woman independently or not desirable.

Signs of clinically narrow pelvis

Immediately before childbirth, if the female restaurants detected signs of clinically narrow pelvis, the cesarean section is recommended. These symptoms include the following pathologies and complications:

the head of the kid is not pressed against the pelvic bones at the entrance;
breaking biomechanism of childbirth;
the octoplodic water is poured untoulared;
the cutting of the uterus is violated: the weakening of its activities, discordination, premature appearance of femoch;
the cervix has already fully opened, and the promotion of the fruit has not yet begun;
the head is too long in the pelvic plane;
a protracted flow of labor;
deformation of the head, generic tumor, hematoma ,;
problems with bladder: its pressed, urination delay, blood impurities in the urine;
the threat of rupture of the uterus.

If a woman has a clinically narrow pelvis and a large fruit, at least one sign, a team of doctors in 98% of cases conducts an emergency cesarean section to avoid death or injury to the fetus during its progress by generic paths. This is the only right way out of the current situation, the medical is completely justified and recommended.

Of course, such labor with a narrow pelvis proceeds much more difficult than with anatomical, since the latter can be prepared in advance.

On a note. Inspectorate hypoxia is an oxygen starvation of a child that can end with death, if it does not extract the fruit in time.

Signs of anatomically narrow pelvis

The main feature of anatomically narrow pelvis is the inconsistency of its sizes of the standards mentioned above. But there are such impatient young mothers who cannot wait for measurements in laboratory conditions and want to know in advance whether they are not predisposed to a similar diagnosis. Such signs are, and they are usually attributed to them:

short hands (brushes length - no more than 16 cm);
short fingers: thumb long - no more than 6 cm, average - no more than 8;
little foot size: less than 36;
small height: no more than 150 cm;
curvature of the spine, limbs, chromotype, orthopedic diseases;
injuries pelvis;
complications in previous births;
irregular menstrual cycle;
androgen (male type) Build.

However, it is not necessary to think that if one of the listed features relates to you, this means that you have an anatomically narrow pelvis. These are indicative signs that are celebrated in 98% of women who have been diagnosed with during pregnancy. Just these facts should be borne in mind to prepare in advance to all possible consequences. And you do not need to be afraid: anatomically narrow pelvis has a huge advantage over clinical: it allows you to prepare for childbirth in advance.

Sometimes it happens. Often, small women turn out to be much rustier than those who have more impressive sizes in terms of childbirth. They give birth independently even big kids.

The course of childbirth

Most women who had to face the problem of a narrow pelvis are interested, whether it is possible to give birth to the most diagnosed.

With clinical - no, caesarean can not be avoided, but otherwise the risk of death or injury to the fetus is too large. With anatomical, everything will depend on the degree of pathology. The first, for example, allows you to be born a baby yourself, without surgical intervention. But childbirth with a narrow pelvis of 2 degrees (and above) in most cases ends with a cesarean cross section.

It is very important to listen to the doctor in everything: only he can recommend how to give birth in your case, taking into account all the individual parameters and sizes of the pelvis. If there is at least the slightest threat that the child will suffer when passing through the pelvic ring, it is better not to insist on natural genus. Cesarean section - the only right way out in such a dangerous situation.

If during pregnancy a woman was diagnosed with "narrow pelvis", the doctors will have to make a decision, whether it can give birth to herself, or will have to be Caesar. To do this is carried out a large number of Research, all sorts of frozen bones are made to eliminate the possibility of injury to the mother or child during childbirth. The safe birth of the baby will largely depend on the professionalism of the doctors and in time the right decision.

A narrow pelvis is considered one of the most complex and difficult sections of obstetrics, since this pathology can lead to development. hazardous complications In childbirth, especially if they are incorrect. According to statistics, the anatomical narrowing of the pelvic bones is found in 1-7.7% of cases, while in kinds such a pelvis becomes clinically narrow in 30%. If we take on the total amount of all kinds, then this pathology accounts for about 1.7% of cases.

The concept of "narrow pelvis"

In the period when the fruit is expelled from the uterus or in the waiting period, the child must overcome the bone ring, which is formed by the bones of a small pelvis. It consists of a ring of 4 bones: the tailbone, the sacrum and two pelvic bones, which are formed by sedlicatical, pubic and iliac bones. These bones are connected with each other using ligaments and cartilage. Female pelvis, unlike male, volume and wider, however, has a smaller depth. The pelvis with normal parameters plays an important role in the normal, physiological course of childbirth without complications. If there are deviations in symmetry and pelvis configuration, its dimensions decrease, the bone pelvis serves as a peculiar obstacle when the fetus head passes.

In practical terms, class two types of narrow pelvis are classified:

clinically narrow pelvis occurs in the event of a non-compliance in the genus anatomical size of the pelvic of the woman and the size of the child's head (however, even if there is an anatomical narrowing of the pelvis during childbirth, a functionally narrow pelvis may not always occur, for example, when the fruit has small sizes, or vice versa when functional The pelvis indicators are normal, but the major sizes of the baby lead to the development of clinically narrow pelvis);

anatomically narrow pelvis is characterized by a narrowing of several or one size by 2 or more centimeters.

Causes

The causes of the occurrence of a narrow pelvis are different - in the event of a disproportion of the parameters of the pelvic bones of the mother and the head of the baby or in the presence of anatomical narrowing.

Etiology anatomically narrowed pelvis

The occurrence of anatomically narrowed pelvis can provoke such factors:

severe physical work and insufficient food in childhood;

frequent colds, as well as increased exercise stress in adolescence;

neuroendocrine pathology;

later, the beginning of the monthly, violation of the childbearing function, the failures in the menstrual function.

Anatomical station of the pelvis arises due to such reasons:

dislocations of hip joints;

excess androgens, hyper- and hypoestream;

broken mineral exchange;

professional sports (swimming, gymnastics, lizhi);

psycho-emotional loads I. stressful situationswhich provoke the occurrence of "compensatory hyperfunction of the body", as a result of which the transversely narrowed pelvis is formed;

acceleration (rapid body growth in length amid slow motion increase in transverse pelvic parameters);

damaging factors that influenced the fruit in the antenatal period;

tumors and exostosis pelvis;

polio;

heredity and features of the Constitution;

cerebral palsy;

spinal curvature (cleaner fractures, scoliosis, kyphosis, lordosis);

fractures of pelvic bones;

bone tumors, bone tuberculosis, osteomalacia;

gender lag;

infantilism, both sexual and general.

Etiology functionally narrow pelvis

The disproportion between the maternal pelvis and the child's head in childbirth is called:

remotion of the pelvic end;

atresia (narrowing) of the vagina;

neoplasms of ovarian and uterus;

pathological insertion of the head (frontal insertion, asinclineism);

malposition;

difficulty configuration of the baby skull bones (with true migration);

large weight and size of the fetus;

anatomical thaza narrowing.

Births that are complicated by a clinically narrow pelvis are completed by a cesarean cross section in 9-50% of cases.

Narrow pelvis: varieties

There are many classifications anatomically narrowed pelvis. Quite often in obstetric literature represent a classification that is based on morfootagenological features:

Gynecoid type

Is about 55% of overall Taza, is a normal type of female pelvis. The physique for the future mother of a female type, a thin waist and neck, hips are wide, height and weight are within the limits of average.

Android pelvis

It is a male tase and is found in 20% of cases. A woman has a male physique, namely the wrongness of the waist, a thick neck against the background of the narrow hips and broad shoulders.

Anthropoid pelvis

Inherent in primates and is about 22% of cases. This form is distinguished by an increase in the direct size of the entrance, which significantly exceeds the transverse size. Women who possess such a pelvic configuration have a high height, lean, their shoulders are wide enough, while the thighs and waist are narrow, legs are thin and elongated.

Platinamed pelvis

Form resembles a flat pelvis and occurs in 3% of women. A woman with such a pelvis has a high growth, expressed by thinness, reduced skin elasticity and a weak muscles.

Suggested pelvis: forms

Classification of narrow pelvis in Crassus:

Forms occurring often:

transversely narrowed pelvis (Robertovsky);

uniformly narrowed pelvis (OST) - the most frequent look, which is observed in 40-50% of the total amount of pelvis;

flat pelvis, occurs in 37% of cases, is divided into:

pelvis with a reduced wide part of the cavity of the small pelvis;

flat-stocked;

simple flat (depenter).

Forms found rarely:

deformation of the pelvis with fractures, exhibitions, bone tumors;

square and Koshesty;

other forms:

assimilative;

osteomalamic;

spondylolisthetic form;

kifotic shape;

voronko-shaped;

overaight flat.

Degree of narrowing

The classification proposed by Palmov is based on the degree of narrowing the pelvis:

the length of the true conjugate (normally 11 cm) refers to a flat basin and an orp:

the first degree is less than 11 cm, no shorter 9 cm;

the second degree is the indicators of true conjugates from 9 to 7.5 cm;

the third degree is the length of the true conjugate from 7.5 to 6.5 cm;

the fourth degree is an absolutely narrow pelvis, in short, 6.5 cm.

according to the parameter of the transverse diameter of the small pelvis input (norm - 12.5-13 cm), refers to the cross-like pelvis:

the first degree is a cross dimeter of the entrance to a small pension in the range of 12.4-11.5 cm;

the second degree is a transverse input dimer - 11.4-10.5 cm;

the third degree is the transverse diameter of the entrance in a small pelvis in short, 10.5 cm.

in terms of the diameter of a wide part of the pelvic cavity (rate of 12.5 cm):

the first degree - the diameter is 12.4-11.5 cm;

the second degree is a diameter of less than 11.5 cm.

Dimensions of anatomically narrowed pelvis of various forms

Narrow pelvis: Sizes Table in centimeters

	Shape pelvis
	Simple flat	flature meat		encourage	normal
outdoor					25/26-28/29-30/31
Outdoor conjugate
Diagonal conjugate
True conjugata
Romble Mikhailisa
Vertical diagonal
Horizontal diagonal
Log in
Side conjugate
Transverse

Differential criterion	Reducing direct sizes in all planes	Reducing the direct size of the entrance plane in a small pelvis	Uniform decrease in parameters (all) by 1.5 cm	Shortening of transverse sizes	Absent

Diagnostics

Diagnose and evaluate the narrowed pelvis in the context of women's consultation, on the day of registration of a pregnant woman. To determine the narrow pelvis during pregnancy, the doctor must examine the history, perform an objective study, including a vaginal study, measurement of the pelvis, the palpation of the uterus and the bones of the pelvis, the body inspection, anthropometry. If necessary, can be appointed additional methods Research: Ultrasonic Scanning and X-rayOpeniometry.

Anamnesis

It is important to pay attention and explore the living conditions and illness of a pregnant woman in childhood (chronic pathology and injuries, intense loads in sports, heavy physical work and poor nutrition, hormonal imbalance, bone tuberculosis and osteomyelitis, poliomyelitis and rickets). The data of the obstetric anamnesis are also important:

whether there was a scenery or the death of a newborn in the neonatal period;

what kind of operational delivery was conducted, whether the fetal brain injuries were present in the course of childbirth;

how previous gods proceeded.

Objective research

Anthropometry

Low growth (less than 145 cm) in most cases indicates the presence of a narrowed pelvis. However, it is possible to have a cross-like pelvic and high women.

Evaluation: Silhouette, Team, Gait

It has been proven that in the presence of a strongly discovering belly forward, the seat of the center of the top of the body is shifting, to preserve the equilibrium, the lower back is put forward, increasing lumbar lordosis, as well as an angle of tilt pelvis.

Assessment of the shape of the abdomen

It is known that primary women have an elastic abdominal front wall, as a result of which the belly acquires a pointed form. Multiplaying women have a disgusting stomach, since the head at the end of the hatch period is not inserted into the inlet of the pelvis (narrowed), while the uterine bottom is high, and the uterus itself has a deviation of the kaper and up from the hypochondrium.

Take a rhombus of Mikhailis and inspection.

Detection of signs of virilization and sexual infantilism.

Romble Mikhailisa is formed by such anatomical formations:

on the sides - the top of the rear protrusions (or asset) of the iliac bones;

below - the tops of the sacral bone;

at the top - the lower boundary of the fifth lumbar vertebra.

Palpation pelvis

During palpation of iliac bones, their location, contours and altitude are determined. During the palpation of the hertvugs (large spiers of the femoral bones), it is possible to determine the presence of a space pelvic if the hellors are located at different levels and deformed.

Vaginal research

Allows you to determine the tank capacity, appreciate the form and examine the seats, the presence of bone protrusions, the depth of the sacral depression. It is also possible to determine the deformation of the side walls of the pelvis, determine the diagonal conjugate and the height of the symphima.

Measuring pelvis

Main dimensions:

the uterus is measured to determine the exemplary weight of the fetus;

the height of the LONA joint is established;

a disorder is determined (norm 90 degrees);

measuring the lane-sacrilate size (measuring the segment from the connection of the second and third sacrum vertebrae to the middle of the Symphysia). Normally 21.8 cm;

solovyov's index - measurement of the wrist circumference at the layout level of the forearm. With this index, the thickness of the bones is determined: the small index is responsible for thin bones, and large - in thick, respectively. The norm is 14.5 - 15 centimeters;

measurement of rhombus Michaelis (horizontal diagonal 10 cm, vertical diagonal of 11 cm). The presence of asymmetry rhombus speaks of the curvature of the spinal column or the pelvis;

outdoor conjugate - measurement of the distance from the top edge of the wing to the upper angle of Rhomba Michaelis. Normally 20 centimeters;

Distantia Trohanterica - a segment between the two skewers of the femoral bone, normally - 31-32 centimeters;

Distantia cristarum is a segment between the most remote points of the ridges of the iliac bones. Normally - 28-29 centimeters;

Distantia Spinarum - a segment between the upper front protrusions of the iliac bones. Normally - 25-26 centimeters.

Additional measurements:

in suspected, the presence of asymmetricity of the pelvis is determined by the lateral conjugate kerner and oblique dimensions;

measure the output of the pelvis;

measure the angle of inclination of the pelvis.

Special research methods

X-rayOfeliometry

It is allowed to perform a x-ray study only in childbirth or after 37 weeks of pregnancy. When it is assisted, the nature of the structure of the pelvic walls, the size and shape of the lane arc, the severity of the sacral curvature, the features of the sedlicate bones, also allows this method to determine all the diameters of the pelvis, the size of the fetus head and its position relative to the pelvic planes, the presence of fractures and tumors.

Ultrasound

Allows you to determine the size of the head and its localization, a true conjugate, evaluate the features of insertion into the input of the fetus head. Using a transvaginal sensor, you can install all the necessary pelvic diameters.

Methodology for calculating true conjugates

For this purpose, these methods are used:

on ultrasound examination pelvis;

according to radiopeliviometry;

according to the Mikhailisa rhombus: the upper size of the rhombus corresponds to the indicator of the conjugate (true);

1.5-2 centimeters are torn on the diagonal conjugate indicator (if the Solovyov indicator is 14-16 cm and less, take 1.5 cm, if the Solovyov index exceeds 16 cm, then 2 cm are subtracted);

on the size of the outer conjugate, 9 (the rate of the indicator is at least 11 cm).

Features of the course of pregnancy

In the first half of the period of gestation, the complication in the case of the presence of a narrowed pelvis is not observed. However, the nature of the course of pregnancy in the second half is exacerbated by the influence of the main pathology, which led to the formation of a narrow pelvis, while the emerging complications (intrauterine infection, prestal) and extragationalital pathologies have certain influence. For pregnant women with the presence of a narrow pelvis characteristic:

high standing heads against the absence of the possibility of its insertion into the pelvis. This is due to the high standing of the diaphragm and the uterine bottom, it causes the increase in heartbeat, rapid fatigue and shortness of breath;

quite often, pregnancy can be complicated by premature expulsion of amniotic fluid, due to the lack of contact with the pelvic entrance due to the high stand of the head;

significant fetal mobility may cause an extensive or pelvic preview and improper position of the fetus;

increases the risk of developing premature labor;

the formation of a disgusting belly in repeated and pointed-friendly at primordin can provoke an asclit insertion of the head during labor.

Pregnancy

All pregnant women with a narrow pelvis are put on special accounting from the obstetrician. A few weeks before the start of childbirth, a woman needs to be hospitalized in a planned order to the prenatal department. Here, the term of pregnancy is specified, as well as the calculation of the presumptive weight of the fetus, measure the pelvis, clarify the prevention of the fetus and its condition, against the background of the data obtained, the most appropriate option of the delivery is selected (form a planning plan).

The method of delivery is selected on the basis of the anamnesis data, the degree and forms of the anatomical narrowing of the pelvis, the approximate weight of the child, as well as other pregnancy complications. Natural childbirth can be carried out in the case of prematurity of pregnancy, the first degree of narrowing with a mature neck of the uterus and the normal size of the fetus, in the absence of an agonizing anamnesis.

Planned operational delivery (cesarean section) is performed in the presence of such testimony:

3-4 The degree of narrowing the pelvis (it is very rare);

a combination of any obstetric pathology requiring cesarean section and a narrow pelvis;

the birth of the fetus with the generic injury, complications in previous births, stillbirth in history, age-related guineans;

the combination of the first or second degree of narrowing with the presence of a large fetus, transferred by pregnancy, the abnormal position of the child, a pelvic preview.

Pregnancy and pain in the bone pelvis

Painting the pelvis begins to appear after 20 weeks and can be caused by various reasons:

Lack of calcium

Looking permanent pains that are not associated with changing body position or movement. Recommended to take vitamin D in combination with calcium preparations.

Discrepancy of pelvic bones and stretching of uterine ligaments

Than more Size The uterus, the more severe tension, the uterine bundles, holding it, are manifested by discomfort and pain while walking, as well as at the moments of the chain of the child. Provocateurs of the process are relaxing and prolactin, under the influence of which pelvic cartilage and bundles swell and soften, in order to facilitate the passage of the fetus through the bone ring. To relieve such pain recommend wearing a bandage.

The discrepancy between the Lonnoy Justion

Excessive swelling of the symphima, which is quite a rare pathology, is accompanied by a cutting pain in the pubic area, it also becomes impossible to raise the leg while in a horizontal position. Such pathology is called symphysitis, it is accompanied by a discrepancy between the Lonnoy articulation. Effective treatment by way operational intervention After the delivery.

The course of childbirth

Today, the tactics of conducting labor in the presence of a narrow pelvis implies a significant increase in indications for the performance of abdominal delivery, both planned and emergency, in the presence of complications in childbirth. Natural delivery It is a very difficult task, since the outcome can be both favorable and unfavorable for a child, and for a woman. In the presence of the third and fourth degree of narrowing, the birth of a duddy living child is impossible - only planned operation. If there is a narrowing pelvis to the first or second degree, the successful outcome of natural genera depends on the parameters of the fetus head, its ability to configuration, the nature of the insertion and intensity of the generic activity.

Complications in childbirth with a narrow pelvis

First period

During the disclosure of the uterine session, such a complication of childbirth may occur:

oxygen starvation of the fetus;

loss of small parts or loops of the baby cord;

early oral influence;

weakness of the generic forces (in 10-38% of cases).

Second period

During the expulsion of the fetus by generic paths, such complications may occur:

damage to nerve pellets pelvis;

damage to the LONA joint;

necrosis (motion) of the tissues of the genital tract, followed by the formation of fistula;

birth injury;

the threat of rupture of the uterus;

intrauterine hypoxia;

development of secondary weakness of the generic forces.

Third period

In the last period of birth, as well as in the early postpartum period Bleeding may occur, which occurs due to a long anhydrous gap and the flow of labor.

Knowledge of birth

Today, the most correct tactics of childbirth in the presence of such pathology is active-expectant tactics. At the same time, the tactics of the generic process should be purely individual and based not only to the degree of essential pelvis and the results of an objective study of the future mother, but also on a forecast for a child and a woman. The delivery plan must have such items:

fruent operation with intrauterine fetal death;

conducting cesarean section with the living fruit and the availability of testimony to the operation;

preventive events in the last and early postpartum periods;

determination of signs of the presence of a clinical inconsistency;

prevention of infectious complications;

prevention of intrauterine starvation of a child;

prevention of the development of the weakness of the generic forces;

bed regime in the battle period, thanks to which it is possible to prevent early extinguishing of water (the woman should be on the side to which the back of the child is adjacent).

In childbirth, controls are monitored from sex tract (bleeding, leakage, mucous membaches), urination, vulva state (the presence of swelling). If urination delay is present, Catheterization is carried out bladderHowever, it should be remembered that such a sign can talk about the disproportion of the baby's head and the pelvic sizes of the girlfriend.

The most common complication in kinds in the presence of a narrowed pelvis is the premature oral influence. If there is an "immature" cervix, an operational delivery is required. With a "mature" neck, a generic manipulation is shown (provided that the weight of the child does not exceed 3.6 kg and there is a first degree of narrowing).

In the battle period, in order to prevent their weakness, the creation of an energy background is required, the female has been obtained in a timely manner receives a medical sleep-leisure. In the course of assessing the effectiveness of generic activities, the obstetrician should control not only the dynamics of the opening of the neck, but also the nature of the head of the head of the generic paths.

Stimulation of childbirth should be carried out carefully, and its duration cannot exceed 3 hours (in the absence of effect - cesarean section). In addition, in the first period of childbirth in obligatory Antispasmodics must be administered (with an interval of 4 hours), for the prevention of hypoxia perform the Triad of Nikolaev and prescribe antibiotics with an increase in anhydrous period.

The expulsion period may be complicated by secondary weakness, the development of fetal hypoxia, and in the case of a long stay of the fetus head in the generic pathways, fistulas can be formed. Therefore, a timely liberation of the bladder and episiotomy is required.

Disproportions of the pelvis of the woman in labor and the heads of the child

The emergence of clinically narrow pelvis contributes:

abnormal forms of narrow pelvis;

big Head of the Child in the presence of normal pelvis sizes;

incorrect prevention of the fetus or unsuccessful head insert;

large fruit and slightly narrowing pelvis.

In childbirth, a functional grade of the pelvis must be performed, which is:

in identifying the signs of the Zangemeter and Vasten (after the fattening of the oily water);

in the diagnosis of the generic tumor of soft tissues of the head, the rate of its rise and appearance;

evaluation of the configuration of the child's head;

in determining the features of insertion and the subsequent estimate of the biomechanism of labor on the basis of data on insertion.

Signs of presence of a clinically narrow pelvis:

premature and early strengthening of water;

significant head configuration;

protrack flow 1;

the occurrence of the clinic threat of breaking the uterus;

positive signs in Tsangemeter, Vastena;

symptoms of the removal of urea and soft tissues (the presence of blood in the urine, the retention of urination, edema of the vulva and cervix);

the occurrence of the fence when pressed to the entrance to the pelvis of the fetus head;

the head is not moving at sufficiently strong fights, the existence of waters and the complete disclosure of the uterine zois;

broken biomechanism of birth, does not respond this kind Taste narrowing.

The characteristic of the wasts is determined by palpation (they find out the ratio of the entrance to the pelvis and the kid head). The negative feature of the Wasteten is a condition in which the head was inserted into the pelvis, located below from the Lonatic Menuance (the obstetrician palm drops below the pub). Symptom Left - Doctor's palm is located at the level of the area (Symphysia and head are in the same plane). A positive feature - an obstetrician's palm is located above from the Symphysee (the head is above the plane of the womb).

If a negative feature is present - the childbirth is completed independently (since the sizes of the pelvis and the head correspond). In the presence of a symptom of a closure with an adequate configuration of the head and effective generic activity, childbirth is also independent. With a positive sign independent childbirth excluded.

Kalganov proposed to use three degrees of inconsistency of the head and pelvic sizes:

The first degree or relatively inconsistency.

There is a proper head insertion and adequate configuration. Fights have enough strength and duration, but the head promotion and the separation of the uterus slowed down, in addition, the exhausting of water is inexpressive. Urination is difficult, but the sign of the Vasten is negative. As an option - an independent completion of childbirth.

The second degree, or significant inconsistency.

Inserting the head and biomechanism of childbirth are not normal, the head has a sharp configuration and is in one plane for a long time. The retention of urination, the anomalies of the generic forces (weakness or discoordination) appear. Symptom Westeen - Vrowd.

Third degree, or absolute inconsistency.

Prematurely occur at the background of the complete absence of head promotion, even despite the complete discovery and good contractions. The generic tumor is growing rapidly, signs of the removal of the bladder appear, there is a threat to break the uterus. The sign is positive.

The presence of the second and third degree of inconsistency is an indication of an immediate operational delivery.

Example from practice

A woman with the first birth (20 years) complaints complaints for two hours was received in the maternity hospital. There was no expulsion of water. General state Hoeers are satisfactory, sizes of the pelvis: 24.5-26-29-20, the abdomen circle - 103 centimeters, the height of the bottom of the uterus is 39 centimeters. The location of the fetus is a longitudinal, head pressed to the entrance to a small pelvis. Auscultative: It does not suffer, the heartbeat is clear. Fights have a good duration and strength. The approximate weight of the fetus is 4 kg.

During the vaginal study, it was determined: the opening of the neck 4 cm, which has stretched thin edges, smoothed. The fetal bubble functions normally, water whole. The head is pressed, the cape is not available. Diagnosis: Pregnancy 38 weeks, the first period of the first birth in time. Encouraged pelvis of the first degree, fruit is large.

Upon the expiration of six o'clock active battle, a second vaginal study was carried out: the opening of the neck to six centimeters, the fetal bubble is absent. The head is pressed by sweatshirts in direct size, the placement of a small springs of the Kepened.

Diagnosis: Pregnancy 38 weeks, the first period of the first birth in time. Encouraged pelvis of the first degree, the fruit is large, direct high standing sweat sv.

It was decided to finish childbirth through surgical intervention (large fruit, the escape of the pelvis, incorrect insertion). Caesarean cross-section is made without complications, a child is extracted with a weight of 4.3 kilograms.