Clinical Pelvimetry

8/12/2019 Clinical Pelvimetry

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Womens Hospital Zhejiang University

Clinical Pelvimetry

Xiu Xiu Jiang


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Womens Hospital, Zhejiang University

pelvi- Latin word pelvis (basin)

metron - Greek word for measure

pelvimetry means to measure the pelvis.

INTRODUCTION


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INTRODUCTION

Clinical pelvimetry:

Internal pelvimetry (manually )

pelvic inlet

mid-cavity pelvic outlet

External pelvimetry Pelvimeter pelvic inlet

pelvic outlet

Imaging pelvimetry:

X-ray Computerised tomography (CT)

Magnetic resonance imaging (MRI)


4/24Womens Hospital, Zhejiang University

METHODS A protocol of clinical pelvimetry



INTRODUCTION

anteroposterior 11cm

transverse 13cmoblique 12.5cm

Pelvic inlet



INTRODUCTION

Three anteroposterior diameters of the pelvic inlet

true conjugate

obstertrical conjugate

diagonal conjugate


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Diagonal conjugate (DC) 12.5~13cm

Obstetrical conjugate = DC -1.5 ~ 2cm

Internal pelvimetry

------ anterposterior diameter of Pelvic inlet

11.5cm



METHODS

A protocol of internal pelvimetry pelvic inlet


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cm

external conjugate

External pelvimetry pelvic inlet

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


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External pelvimetry pelvic inlet

interspinal diameter, IS

intercristal diameter, IC

23-26cm

25-28cm

between the anterior superior iliac spines.

between the most far points on the outerborders of the iliac crests

supine position



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.

INTRODUCTION



INTRODUCTION

Transverse diameter of the midpelvis

Bispinous diameter = 10 cm

between the tips of ischial spines

METHODS




S


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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. inadequatefor an average-sized baby.

Sacrosciatic notch:

If the sacrospinous ligament is two and half fingers, the sacrosciatic

notch is considered adequate.

INTRODUCTION


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INTRODUCTION

Antero-posterior diameter =11.5cm

Transverse diameters = 9 cm

Anterior sagittal diameter = 6 cm

Posterior sagittal diameter = 8.5 cm

METHODS


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METHODS


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METHODS

Bituberous diameter Angle of Pubic arch

SUMMARY


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SUMMARY

Pelvic outletSubpubic 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)

SUMMARY


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SUMMARY

Data Finding

pelvic brim

Diagonal conjugate

Symphysis

Sacrum

Side wallsIschial spines

Interspinous diameter

Sacrosciatic notchSubpubic angle

Bituberous diameter

CoccyxAnterposterior diameter of outlet

Round.

11.5 cm.Average thickness, parallel tosacrum.

Hollow, average inclination.

Straight.

Blunt.

10.0 cm.

90

4 knuckles (>

8.0 cm).

Mobile.

11.0 cm.

INTRODUCTION


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INTRODUCTION

Imaging pelvimetry:

X-ray

Computerised tomography (CT)

Magnetic resonance imaging (MRI)

METHOD


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METHOD

A clinical case of

contracted pelvis


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Figure 1a Midsagittal section shows the obstetric conjugate of 8.9 cm and

sagittal outlet of 7.6 cm.

Keller T M et al. Radio logy 2003;227:37-43

2003 by Radiological Society of North America


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Figure 1b Transverse sections show the interspinous distance of 8.4 cm,

measured at the level of the foveae of the femoral heads (arrows)




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Figure 1c Transverse sections show the intertuberous distance of 8.3 cm



Clinical Pelvimetry

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