Female Pelvis & Fetal Head _ خلود Flashcards
what’re the types of the female pelvis ?
1- Gynaecoid pelvis
normal female pelvis. Its inlet is either slightly oval, with a greater transverse diameter and the plevic outlet is oval with anterioposterior diameter is greater than the transverse
2- Android pelvis
The android pelvis is a female pelvis with masculine features, including a wedge or heart shaped inlet caused The reduced pelvis outlet often causes problems during child birth.
3- Anthropoid pelvis
anthropoid pelvis is characterized by an oval shape with a greater anteroposterior diameter. the sacrum is usually straight resulting in deep non-obstructed pelvis.
4- Platypelloid pelvis
it has a kidney-shaped inlet and the pelvic cavity is usually shallow and may be narrow in the antero-posterior (front to back) diameter. The outlet is usually roomy. … Only the forces created by mother and baby during birth will allow the pelvis to open to its full potential
From which the pelvic bone consist of ?
1- hip bone ( ilium / ischaim /pubic bone )
2- sacrum
3-occyx
join by ANT by the pubic symphesis
POST by the sacroillic joint
what’s the false pelvis ?
its called Greater Pelvis or pelvis major
what’s the boundaries of the false pelvis ?
Anteriorly:- abdominal wall
Posteriorly:- vertebrae L5, S1
Postero-laterally:- iliac fossa
what’s the true pelvis ?
its called Lesser Pelvis (pelvis minor)
what’re the parts of the true pelvis ?
inlet (brim)
cavity
outlet
what’re the boundaries of the true pelvis ?
1- promentary of sacrum 2- alla 3- sacroillic joint 4-illiopectinla line 5- illiopectinla emenance 6- upper border of the sup pubic ramus 7-pubic crest and pubic tubercle 8- upper border of pubic symphesis
what’re the contents and the boundaries of the cavity of the true pelvis?
it’s consist of the hip bone( ilium / ischaim /pubic bone )
and the scarum
with the pelvic viscera as the RECTUM URINARY BLADDER UTERUS OVERY
what’re the boindaries of the outlet
it’s dimond in shape
it’s consist of the :
1- cocyx (5th segment of the sacrum)
2-sacrospinous and scarotuberus ligments
3- isheal tuberosity and ishial spine
4-the lower border of the inf ramus of the pubic bone
5- lower border of the symphesis pubic
what’re the diameters of the pelvic inlet ?
A-P diameter:-it is the distance between mid point of sacral promontory to the mid point of upper border of pubic symphysis.
Transverse diameter:- distance between the iliopectineal lines.
Oblique diameter:- distance between one sacro –iliac joint to opposite ilio-pubic eminence.
in inlet the transverse diameter is larger than the AP diameter (11X13) while the oblique diameter is 12
while the pelvic outlet it has the AP diameter greater than the transverse so than the fetus rotate inside the cavity (11x13)
the cavity diameter is (12.5X12.5)
what’s the Occiput ?
is the occipital bone/external occipital protuberance
Sinciput ?
is the forehead region of fetal head.
Parietal eminences ?
are the eminences of parietal bone on either side.
Mentum ?
chin
Vertical point?
center of sagittal suture
Frontal point ?
root of nose
Sub occiput?
the junction fetal neck and Occiput
Sub mentum?
the junction between neck and chin
Bi parietal ?
the transverse distance between two parietal eminences.
Bi temporal ?
distance between two lower end of coronal suture
Sagittal suture?
This lies in between two parietal bone
Coronal suture?
between the frontal and parietal bone on either side
frontal suture ?
This lies in between two frontal bone.
Lambdoid suture?
It lies in between the parietal and occipital bone on either side
WHAT’RE CLINICAL IMPORTANCE OF SUTURE ?
مطوله
- These suture permit gliding movement of one bone over other during moulding of the head in the vertex presentation , as a result the diameter of the head get smaller so passage of head through the birth canal become easier.
- Position of fontanelle and sagittal suture can identify attitude and position of vertex.
- From the digital palpation of the sagittal suture during labour, degree of internal rotation and degree of moulding of the head can be noticed
- In deep transverse arrest, this sagittal suture lies transversely at the level of the ischial spines
WHAT’RE CLINICAL IMPORTANCE OF SUTURE ?
مختصره
1- molding
2- the sagital and fontanelle help to identify the vertex position
3- in the the digital examination to see th edegree of the molding and the internal rotation
3- to know if there is deep transverse arrest to the fetal head when the sgital sture lie transversaly to the ishial spine
what’s the vertex ?
it’s quadrangular area منطقة رباعي الزوايا
bounded by :
ANT bregma and coronal sutures
POST lambda and the lambdoid sutures
LAT line passing through the parietal eminences.
what’s the brow diffintion ?
bounded by :
one side by ; bregma and the coronal sutures
the other side by ; the root of the nose and supra-orbital ridges
what’s the face diffintion area ?
one side by ; the root of the nose and the supra-orbital ridges
other side by; t the floor of mouth with neck.
what’s the diffintion of the bregma ?
it’s Anterior fontanelle
it’s diamond shaped of unossified membrane
what’re the boundaries of the bregma ?
formed by the junction of 4 suture. The suture are:- Anteriorly:- frontal suture Posteriorly:- sagittal suture Laterally, on both side:-coronal suture.
when the bregma and the lambda ossified ?
bregma ossifies by 18 months after birth
سنه ونص (سنه وسته اشهر)
while he lambda ossified at term after 40 weeks
what’re the clinical importance of the bregma ?
1- help with molding
2-assess the head flexion by vaginal examination if felt means the head isn’t well flex
3- assess the interanal rotation from it position
4-assess the intracrainal pressure after birth.Depression in dehydration and bulging in raised ICP
5- to collect the CSF from it
(from the lateral angle of the bregma and reach the lateral ventricle and collect the CSF )
what’s the lambda ?
It is the triangular depressed area
what’re the boundaries of the lambda ?
it form from three suture.
The suture are:-
Anteriorly:-sagittal suture
Posteriorly:-2 lambdoid sutures at both side.
what’s the diffention of the enagment ?
it’s the passage of the widest diameter of the presenting part through the pelvic inlet
the engagment diameter depond on the degree of head flexion
what’r the diameters of the fetal skull ?
1- AP diameter
2- Transverse diameter
what’re the the AP diameter of the skull ?
- Sub-occipito bregmatic
- Suboccipito frontal
3-.boccipito frontal
4-Mento-vertical
5-Mento-vertical
6.Sub-mento bregmatic:-
what’s the suboccipto-begmatic ?
- extend from below of the occiptal emenance (nab of the neck ) to the center of the neck
- (attitude )this happen if the head is flex
- the presnenting part id the vertex
- length is 9.5 is the smallest diameter
In which diameter the head will engage if the head is incomplete flexion ?
- the engage diameter is suboccipto-frontal
extend from the nap of the neck to ant to the bregma (root of the nose ) - the presenting part is vertex
- length is 10cm
In which diameter the head will engage if the head is marked deflexion ?
-the head will engage at the occipto-frontal diameter
extended from from the occiptal emenance to the root of the nose (GLABELA)
- presenting part is vertex but there will be prolong labor
- length is 11.5
In which diameter the head will engage if the head is partial extension ?
-the head will engage at the mento-vertical
from the mid point of chin to vertex (the mid point of the sagital suture between the bregma and lambda )
- presenting part is brow
- length is 14 cm so we do CS
In which diameter the head will engage if the head is incomplete extension ?
-the head engage at submento -vertical
from junction of the floor of the mouth and neck to the center of the sgital suture
- presenting part is the face
- length is 11.5cm also deliver by CS
In which diameter the head will engage if the head is complete extension ?
_the head engage at the the submento- bregmatic
from the junction between the floor of the mouth and the neck and the center if bregma
_ presenting part is the face
- length is 9.5cm deliver by the CS
what’re the transvese daimeter of fetal skull ?
- Bi parietal diameter
2- 2. Bi temporal diameter
which diameter is always engaged whatever the postiotion of the head ?
- its the Bi parietal diameter It extend between 2 parietal eminences.
- length is 9.5 cm
what’s the Bi temporal diameter ?
its between the anterior-inferior ends of the coronal suture.
Length:- 8.5 cm
usually the head engaged at …
AP diameter is suboccipto-verical
while the transvese is Bi partial
Moulding?
It is the changes in shape of the head in vertex presentation during labour while passing through the resistant birth canal
–It is physiological, harmless and disappears within a few hours after birth
what’s the mechanism of molding ?
_Overlapping of cranial bones at the membranous joints due to compression of the engaging diameter of the head.
grade0
bones lies side by side having an intervening membrane
grade 1
bone touching but not overlapping
grade 2
overlapping but easily separated by pressure.
grade 3
fixed overlapping and cannot be separated
1-Pressure effect of dilated cervical ring and vaginal introitus on descending head
2-interference normal venous return and lymphatic drainage
3-stagnation of fluid
4-appearance of swelling in the scalp
whats the Cephalhematoma ?
It is a collection of blood between periosteum and skull bone which is limited by the periosteal attachments at the suture lines.
whats the charector of the Cephalhematoma ?
- Appears after 12 hours of birth.
- Limited by suture lines.
- Tends to grow larger.
- Disappears within 6-8 weeks.
- It is circumscribed, soft and non pitting.
- May be associated with skull bone fracture
whats the charector of the Cephalhematoma (CEPHAL HAEMATOMA)?
- after noramal vaginal delivery and forecps
- Appears after 12 hours of birth
- Limited by suture lines.
- Tends to grow larger gradually developing hard edge.
- Disappears within 6-8 weeks.
- It is circumscribed, soft, elastic and non pitting.
- May be associated with skull bone fracture
- No skin change.
whats the treatment of Cephalhematoma (CEPHAL HAEMATOMA)?
No treatment required. The blood is absorbed and the swelling subside.
what’s the charecctors of CAPUT SUCCEDANEUM ?
- It is physiological, present at birth and disappears within 24 hours.
- It is soft, diffuse and pits on pressure.
- No underlying skull bone fracture
what’s the charecctors of CAPUT SUCCEDANEUM ?
- It is physiological, present at birth and disappears within 24 hours. from normal vaginal delivery
- It is soft, diffuse and pits on pressure.
- No underlying skull bone fracture
- Skin ecchymotic
- Size largest at birth , gradually subsides within a day
- . No treatment required
1-Average length of the true conjugate: A- 10 cm B-11 cm C-12 cm D-13 cm
B
2-If the diagonal conjugate is greater than 11.5 cm, it is justifiable to assume that the pelvic inlet is of adequate size for vaginal delivery of a normal-sized fetus.
- True
- False
TRUE
3-Boundaries of the pelvic inlet: A-Sacral promontory B-Iliopectineal lines C-Pubic symphysis D-All of the above2
D
4-It is the landmark used in assessing the level to which the presenting part of the fetus has descended into the true pelvis: A-Iliac spines B-Ischial tuberosity C-Iliopectinate line D-Ischial spines
D
5-triangular shaped space at the back of the skull A-anterior fontanelle B-parietal bones C-biparietal diameter D-posterior fontanelle
D
6-length of sub-occipitobregmatic, sub-mentobregmatic and biparietal diameters A-10 cm B-9.5 cm C-13.5 cm D-11.5 cm
B
7-measured from below the occipital protuberance and the centre of the frontal suture A-sub-mentobregmatic diameter B-sub-mentovertical diameter C-sub-occipitofrontal diameter D-occipitofrontal diameter
C
8-single bone located at back of fetal skull A-occipital B-occipital protuberance C-synciput D-occiput
A
1-measure from the occipital protuberance to the glabella or root of the nose → mentovertical diameter
- True
- False
FALSE
2-raised area in the centre of the parietal bone → parietal eminence
- True
- False
TRUE
3-membrane between posterior margins of parietal bones and upper margin of occipital bones → sagittal suture
- True
- False
FALSE
4-kite or diamond shaped space at the front of the skull → anterior fontanelle
- True
- False
TRUE
5-mentovertical diameter (cm) → 11.5
- True
- False
FALSE
