Clinical Pelvimetry

Xiu Xiu Jiang

Womens Hospital

Zhejiang University

INTRODUCTION

pelvi- Latin word pelvis (basin) metron - Greek word for measure pelvimetry means to measure the pelvis.

Womens Hospital, Zhejiang University

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)

Womens Hospital, Zhejiang University

METHODS

A protocol of clinical pelvimetry

Womens Hospital, Zhejiang University

INTRODUCTION

Pelvic inlet

anteroposterior 11cm transverse 13cm oblique 12.5cm

Womens Hospital, Zhejiang University

INTRODUCTION
Three anteroposterior diameters of the pelvic inlet

true conjugate obstertrical conjugate diagonal conjugate

Womens Hospital, Zhejiang University

Internal pelvimetry ------ anterposterior diameter of Pelvic inlet

Diagonal conjugate (DC) 12.5~13cm Obstetrical conjugate = DC -1.5 ~ 2cm

11.5cm

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

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

2003 by Radiological Society of North America