The course of pregnancy and childbirth with a narrow pelvis

Narrow pelvis during pregnancy is not affected until her last weeks, when there is a mismatch between the pelvis and the head is not inserted in the narrowed the pelvis.
The fruit is high; in young nulliparous formed pointed stomach, multiparous with loose abdominal wall - pendulous abdomen (figure 3). At the end of pregnancy is highly worthwhile fetus's head is not sufficiently covered by the belt is tight, resulting often pregnancies complicated by premature rupture of water.


Fig. 3. Stomach shape at the end of pregnancy with a significant narrowing of the pelvis: 1 - periodama (pointed abdomen); 2 - nagaragawa (pendulous abdomen).
asinkritos
Fig. 4. Asinkritos: 1 - front (prednamerennoe inserting head); 2 - rear (zaznamenano the insertion of the head).

With a narrow pelvis during disclosure is often the primary weakness of the labour forces, the consequence of which may be delayed disclosure of uterine throat, slow progress of the fetus, the loss of small parts of the fetus and the umbilical cord. At the end of the disclosure period or in the period of exile is often secondary to the weakness of labour forces, it is possible infringement of the bladder, rectum woman, rupture of the uterus (see Childbirth), asphyxia and death of the fetus. In the early postpartum period are observed unusual bleeding, in the late postpartum infectious diseases, 4-7 day - intestinal-urinary fistulas.
The biomechanism of labor when observamanagement the pelvis. 1. Head begins to bend at the entrance to the pelvis, and not in the transition from the widest part of the pelvic cavity in a narrow, as in normal pelvis. The narrower the pelvis, the more pronounced bend. 2. Maximum bending head when moving it from the wide part in narrow. 3. The abrupt change configuration head than compensated by the mismatch of the vessel dimensions of the pelvis and head size. Approaching the exit of the pelvis swept seam in the direct size, head begins to straighten up. On the biomechanism of labor flows as well as in women with normal size of the pelvis (see Childbirth). At fetal pelvic presentation exemption followed head is often hampered due to premature its extension and supraciliary pens for the crown. The fruit in such cases is born in asphyxia or dead.
The biomechanism of labor in the plane pelvis. 1. The head is inserted into swept seam in the transverse size of the pelvis. 2. The head at the entrance slightly bends, mounted above a direct output size of the pelvis small transverse size. 3. Syncleticea inserting head (figure 4).THE further biomechanism of labor flows, as in the normal size of the pelvis.
Labor management with a narrow pelvis is the most complex problem of practical obstetrics. Normal, even a wide pelvis may be "narrow" to a very large head fetus (giant and large fruit, hydrocephalus). Therefore, the birth in women with a narrow pelvis should be conducted in maternity wards and maternity hospitals with a skilled birth attendant; pregnant with a narrow pelvis 2 weeks before the expected delivery date should be directed to maternity hospital. An exception can be made for those pregnant with anatomically narrow pelvis, which in recent weeks, the head already established low in the entrance of the small pelvis, i.e. it is safe to exclude the possibility of its inconsistency with the pelvis. The discrepancy head and pelvis can occur in normal exterior dimensions of the pelvis (clinically narrow basin); in his diagnosis valuable is a sign of Henkel - Vastina: when retired waters and with considerable opening throat obstetrician laid on the region of symphysis and promotes its up - in case of discrepancy head and pelvis felt vastanie the head above the symphysis outwards (positive sign).
If the identification of anatomically narrow pelvis with certain probability perhaps even at usual clinical methods of examination, and when radiography is possible to establish the true size of the pelvis, the question of the correspondence between the pelvis pregnant woman and the fetus's head is often difficult to diagnose and choice of method of delivery. The discrepancy is that in childbirth with good labor activity after ruptured membranes, and when opening the throat, coming to the full, the head continues to stand at the entrance of the small pelvis, outside bout it can even move upwards. It is possible not only when anatomically Suzanna the pelvis, but at its normal size depending on the size of the head, small ability to change the configuration, incorrect insertion (high direct insertion and others).
Most midwives in the conduct of birth when clinically narrow basin continues to maintain a wait-and-see tactics; indications for surgery produce abdominal delivery (see Caesarean section).