Narrow pelvis: how to give birth yourself. Pregnancy and childbirth with a narrow pelvis

The doctor’s words that a woman has a narrow pelvis cause a lot of concern: expectant mothers believe that in this case they have only one path - to the operating table for a caesarean section. In fact, it’s not all that scary, because pelvic bone anomalies are a common occurrence, and many women give birth on their own without unnecessary incidents.

Until the 16th century, scientists believed that during childbirth the pelvic bones could diverge to the desired size, and the fetus was born resting on the bottom of the uterus with its legs. However, after the anatomist Vesalius presented evidence in 1543 that the pelvic bones were fixedly connected, doctors started talking about the problem of a narrow pelvis.

How is the pelvis measured?

There is such a thing as the large and small pelvis, the latter is very important for normal childbirth - it is through this canal that the child will pass. If the diameter of the pelvic bone ring is smaller than the fetal head, this is an indication for surgery. To avoid unforeseen situations during pregnancy and childbirth, upon registration, each woman has her pelvis measured. This requires a pelvis gauge and a measuring tape. A deviation from the norm of more than 2 centimeters is called an anatomically narrow pelvis.

4 numbers are entered into the pregnant woman’s card, and the diagnosis is determined from them.

• The first number is the distance between the protruding bones. The norm is 25-26 centimeters or more;
• The second number is the measurement of the iliac crest points below the navel.

  The norm is 28-29 centimeters;

• The third number is the measurement of the widest part of the bone. The norm is 30-31 centimeters;
• The fourth number is the distance between the upper corner of the Michaelis diamond and the upper part of the pubis. The norm is 20-21 centimeters.



Also, the size of the pelvis can be determined during an ultrasound or x-ray. Indirect signs may also indicate a predisposition to a narrow pelvis:

• Small stature (up to 1.5 m);
• Shoe size smaller than 36;
• Thin wrist (Soloviev index less than 14 centimeters);
• Orthopedic diseases;
• Short fingers and hands;
• Male physique.

Anatomically narrow pelvis

This is clear to the doctor after the measurements, since there is a clear connection between the numbers. A narrow pelvis comes in different forms: regular, transversely narrowed, flat, uniformly narrowed, flat-rachitic, osteomatic, obliquely narrowed. An anatomically narrow pelvis is not an automatic indication for a cesarean section, it’s just that the risk of childbirth complications is slightly higher, which is why such women are prescribed consultations with a gynecologist more often and are hospitalized for childbirth earlier.

There are many reasons for an anatomically narrow pelvis: previous diseases, injuries, pathologies, lack of microelements in childhood. There are four degrees of anatomically narrow pelvis, 3 and 4 degrees are indications for cesarean section.

Clinically narrow pelvis

It is diagnosed only after the onset of labor. There are several reasons for its occurrence:

• Large fetal head;
• Post-term pregnancy;
• Incorrect position of the child;
• Deformations of the pelvic bones;
• Formations and tumors on the bones.

After assessing the fetal head and pelvic ring, doctors can confidently answer whether the woman in labor can give birth to the baby herself or needs the help of surgeons.

Pregnancy and childbirth with a narrow pelvis

In general, pregnancy with a narrow pelvis does not cause discomfort, but in order to avoid possible complications, mothers are taken under special control: the due date is calculated as accurately as possible, and they are hospitalized 1-2 weeks before “day X.” Immediately before birth, another control ultrasound or MRI is prescribed (more expensive, but safer).

If the narrowing is insignificant and the fetus is not too large, then natural childbirth will also take place without complications, but the child’s condition is constantly monitored using a cardiotocograph. To prevent labor from weakening, it is stimulated. If unforeseen circumstances arise - umbilical cord clamping, asphyxia, etc., then doctors perform an emergency caesarean section. Childbirth with a narrow pelvis may last longer, but it can also proceed rapidly. The doctor delivering the baby must be an experienced and qualified specialist, since a successful outcome will largely depend on him.

Indications for caesarean section:

• Serious pelvic deformities;
• Narrowing of 3-4 degrees;
• The presence of tumors and growths in the pelvis;
• Damage, scars and tears in the pubic area. uterus and pelvis during previous births;
• Post-term pregnancy;
• Large fruit size;
• Hypoxia;
• Breech presentation;
• Age over 35.

A normal pregnancy and childbirth with a narrow pelvis are quite possible, don’t panic and don’t stress yourself out needlessly! After all, the most important meeting is ahead - with your baby, so be patient!

During the period of “interesting situation”, the dimensions of the pelvis play a very important role, because the specialist, based on them, chooses delivery tactics. If the pelvis is narrow, complications may occur during childbirth. In some cases, natural childbirth is not possible at all. The only way to give birth to a child (if a narrow pelvis is diagnosed during pregnancy) is a caesarean section.

What kind of pelvis do doctors consider narrow and how do they determine it? How will pregnancy proceed with this diagnosis? Let's try to find answers to all these questions.

A little bit of anatomy: the female pelvis

Every person knows perfectly well such a part of the skeleton as the pelvis. It is conventionally divided into small and large. The large pelvis of a pregnant woman houses the uterus and fetus.

The small pelvis is the birth canal. The baby is positioned head down towards the pelvic opening at 7-8 months of pregnancy. With the onset of labor, the fetus enters the pelvis.

The birth of a baby is a rather complex process. The fetus makes various movements in order to adapt to the shapes and sizes of the passage. Before birth, the baby's head is pressed to the chest.

It then turns to the left or right side as it wedges into the pelvic opening. After this, the head makes another turn. Thus, the child, passing through the pelvis, changes the position of the head twice.

It is worth noting that the head is the largest part of the baby. Its passage along the birth canal is ensured by:

• contractile movements of the uterine muscles that push the baby forward;
• mobility of the bones of the fetal skull, which are not completely fused and are capable of shifting slightly and thereby adapting to the size of the passage;
• easy movement of the pelvic bones.

The dimensions of this part of the skeleton are different for each woman. Some people's pelvis may be normal, some may be narrow, and some may be wide. A narrow variety is a serious problem for pregnant women, since the process of giving birth to a child in this case is not easy.

Due to this anatomical feature, childbirth can be complicated. Women with a narrow pelvis most often give birth not naturally, but through a caesarean section.

Anatomically narrow pelvis during pregnancy

Anatomically, a narrow pelvis is considered to be that part of the skeleton, all dimensions of which (or one of them) differ from normal parameters by 1.5-2 cm. About 6.2% of pregnant women have this diagnosis. The peculiarity of the anatomical deviation is that the fetal head may not pass through the pelvic ring during childbirth. Natural childbirth is only possible if the child is very small.

A narrow pelvis may be a consequence of the influence of certain causes on the human body in childhood: frequent infectious diseases, malnutrition, lack of vitamins, hormonal disorders during puberty. The pelvis can be deformed due to bone damage due to polio, rickets, and tuberculosis.

There is a classification of the narrow pelvis by shape. The most common types are:

• flat pelvis (flat rachitic; simple flat; with a reduced direct dimension of the plane of the wide part of the pelvic cavity);
• transversely narrowed pelvis;
• generally uniformly narrowed pelvis.

Rarely occurring forms include:

• oblique and obliquely displaced pelvis;
• pelvis deformed due to fractures, tumors;
• other forms.

The classification based on the degree of narrowing of the pelvis is of great importance:

• true conjugate more than 9 cm, but less than 11 cm - 1 degree;
• true conjugate more than 7 cm, but less than 9 cm - 2nd degree;
• true conjugate more than 5 cm, but less than 7 cm - 3rd degree;
• true conjugate less than 5 cm - 4th degree.

If a woman is diagnosed with 1st degree of contraction, then natural childbirth is quite possible. They are allowed under certain conditions and with 2 degrees of pelvic narrowing. The remaining varieties are always an indication for a planned caesarean section. Attempts to give birth on your own are excluded.

Clinically narrow pelvis during pregnancy

Experts also distinguish a clinically narrow pelvis. Its size is not smaller than normal. It has absolutely normal physiological dimensions and shape. However, the pelvis is called narrow due to the fact that the fetus is large. For this reason, the baby cannot be born naturally.

This type of narrow pelvis is caused not only by the large size of the fetus, but also by incorrect insertion of the child’s head (the largest size). This also prevents the birth of the fetus.

Basically, this type of narrow pelvis is diagnosed during childbirth, but assumptions often arise in the last month of pregnancy. The doctor can predict the course of labor by analyzing the size of the fetus, which is detected during an ultrasound, and the size of the woman’s pelvis.

Complications that can arise during childbirth with a clinically narrow pelvis are quite difficult for both the mother and her unborn child. For example, the following consequences may occur: oxygen starvation, respiratory failure, intrauterine fetal death.

How to determine a narrow pelvis in a pregnant woman?

A narrow pelvis in a pregnant woman should be diagnosed long before birth. Women with severe narrowing 2 weeks before the expected date of birth are routinely hospitalized in the maternity ward to avoid possible complications.

How to determine a narrow pelvis? The parameters of this part of the skeleton are determined by the gynecologist during the first examination when registering at the antenatal clinic. He uses a special tool for this - pelvisometer. It looks like a compass and is equipped with a centimeter scale. The pelvis meter is designed to determine the external dimensions of the pelvis, the length of the fetus, and the size of its head.

Suspicion of a narrow pelvis may arise before examination. As a rule, in women with this anatomical feature one can notice a masculine build, short stature, small foot size, and short toes. Orthopedic diseases (scoliosis, lameness, etc.) may occur.

How is a woman examined by a gynecologist? First of all, the specialist pays attention to the Michaelis rhombus, located in the lumbosacral region. The pits above the coccyx and on the sides are its corners. The normal longitudinal size is about 11 cm, and the transverse size is 10 cm. The parameters of the rhombus, which are less than normal values, and its asymmetry indicate an abnormal structure of the female pelvis.

A gynecologist, using a tazometer, determines the following parameters:

• distance between the iliac crests. The normal value is more than 28 cm;
• the distance between the anterior iliac spines (interspinous size). The normal parameter is more than 25 cm;
• the distance between the greater trochanters of the femurs. Normal value is 30 cm;
• the distance between the upper edge of the pubic symphysis and the suprasacral fossa (external conjugate). The normal parameter is more than 20 cm;
• the distance between the symphysis pubis and the promontory of the sacrum. Obstetricians call this parameter a true conjugate. Its value is determined during a vaginal examination. Normally, a gynecologist cannot reach the promontory of the sacral bone.

Some women have massive bones. Because of this, the pelvis may appear narrow even though all its parameters do not deviate from normal values. To assess bone thickness, the Solovyov index is used - the circumference of the wrist is measured. Normally, it should be no more than 14 cm. The pelvis of a pregnant woman may be narrow if the circumference of the wrist is more than 14 cm.

The size of the narrow pelvis can also be assessed during an ultrasound examination (ultrasound). In very rare cases, X-ray pelviometry is performed. This study is undesirable for the fetus.

The doctor prescribes it only if there are strict indications, which include the following:

• the age of the pregnant woman is over 30 years (provided that this is her first pregnancy);
• high risk of perinatal pathology:
• unfavorable outcome of childbirth in the past (stillbirth, surgical delivery through the birth canal, weakness of labor);
• endocrine pathology (pituitary adenoma, hyperprolactinemia, hyperandrogenism);
• history of miscarriage and infertility;
• concomitant extragenital diseases;
• suspicions of anatomical changes in the pelvis - previous polio and rickets, congenital dislocations of the hip joints, narrowing of the external dimensions of the pelvis, a history of traumatic injuries;
• suspicion of disproportion between the fetal head and the woman’s pelvis.

X-ray pelviometry is carried out using a low-dose digital radiographic unit.

All of the above is relevant to diagnosing an anatomically narrow pelvis. How does a doctor identify the clinical variety? This diagnosis is made by a specialist during childbirth.

The obstetrician may notice that the baby's head does not descend into the pelvic cavity, despite the fact that contractions are strong, labor is good and the opening of the cervix is ​​complete.

Doctors know specific signs that help identify lack of advancement of the fetal head. When diagnosing a clinical type of narrow pelvis, an emergency caesarean section is performed.

The course of pregnancy with a narrow pelvis

A narrow pelvis during pregnancy leads to the formation of incorrect fetal positions. Breech presentation is quite common. Oblique and transverse presentations of the fetus can also be diagnosed.

In the last trimester, a pregnant woman may notice some features. For example, due to a narrow pelvis, the baby’s head is not pressed against the entrance to the pelvis. This leads to shortness of breath in the woman. In primigravidas with a narrow pelvis, the abdomen has a special shape - pointed. In multiparous women, the abdomen appears saggy because the anterior abdominal wall is weak.

Childbirth with a narrow pelvis

A pregnant woman, when a narrow pelvis is detected at the stage of registration at the antenatal clinic, is observed in a special way, because complications are possible. Timely detection of the baby’s incorrect position, prevention of post-maturity, and hospitalization in the maternity ward at 37-38 weeks play an important role in preventing complications during childbirth.

A narrow pelvis during childbirth is a serious problem for obstetricians and gynecologists, because it is not so easy to decide whether a pregnant woman can give birth naturally.

In resolving this issue, many factors are taken into account:

• pelvic dimensions;
• presence/absence of any pregnancy pathology;
• age of the fair sex;
• presence/absence of infertility in the past.

Doctors determine delivery tactics based on the degree of pelvic narrowing. For example, independent childbirth is possible if the fetus is small, its presentation is correct and the narrowing of the pelvis is insignificant.

With the anatomical variety of a narrow pelvis, premature rupture of amniotic fluid. Possible loss of the umbilical cord or parts of the fetal body (arms or legs). Due to the early rupture of amniotic fluid, the process of cervical dilatation slows down.

Infections can also enter the uterine cavity. They are the causes of endometritis (inflammation of the inner lining of the uterus), placentitis (inflammation of the placenta), and infection of the fetus. As a rule, contractions against this background are very painful. The first stage of labor is prolonged in duration.

With a narrow pelvis it is often observed anomaly of ancestral forces, contractile activity of the uterine muscles. During childbirth, rare and weak contractions are observed. The process of giving birth to a child is very delayed, and the mother in labor becomes tired.

The second stage of labor is characterized by the development secondary weakness of labor. There are difficulties in moving the fetal head. Against this background, intense pain and fatigue of the woman in labor are noted. Prolonged standing of the head in one plane leads to irritation of the receptors of the cervix, the lower segment of this organ.

The period of passage of a child through the birth canal is long. If there are significant obstacles to the birth of a baby, violent labor and excessive overstretching of the bladder, rectum, and urethra may occur.

On the part of the expectant mother, a clinically narrow pelvis is a relative condition for caesarean section, but on the part of the fetus it is considered an absolute condition, since there is a threat of severe consequences and death of the child.

Quite often, pregnant women diagnosed with a clinically narrow pelvis experience untimely release of amniotic fluid. The baby's head stands in one plane for a long time.

This leads to weakness of labor, the formation of entero-genital and genitourinary fistulas, and injury to the birth canal. Fetal traumatic brain injuries are common. The threat of complications leads to the completion of labor by surgery.

Caesarean section for a narrow pelvis: indications

Indications for surgery for a narrow pelvis can be divided into 2 groups: absolute and relative.

Absolute indications include:

• narrow pelvis grade 3 and 4;
• severe pelvic deformities;
• damage to the joints and bones of the pelvis in previous births;
• pelvic bone tumors.

In all of the above cases, natural childbirth is impossible. A child can be born exclusively through a caesarean section. It is carried out as planned until the onset of labor or with the onset of the first contractions.

Relative indications for cesarean section include:

• narrow pelvis 1st degree in combination with one or more additional factors:
• large fruit;
• breech presentation;
• post-term pregnancy;
• fetal hypoxia;
• a scar on the uterus that occurred in the past during a caesarean section;
• abnormalities of the genital organs, etc.
• narrow pelvis 2nd degree.

In the presence of relative factors, independent childbirth may be allowed. If during the birth process the condition of a pregnant woman worsens and the life of the mother and fetus is threatened, doctors will perform a caesarean section.

In conclusion, it is worth noting that a narrow pelvis and a caesarean section are not a necessary combination. Don't be alarmed if you have been diagnosed with a narrow pelvis. Find yourself a doctor whom you can trust, and then the birth will take place without problems.

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After registration, the doctor asks about previous diseases, injuries, sports activities - everything that could be the cause of skeletal pathology. It is important how previous pregnancies and births went, what complications there were. If there are indications, the woman is identified as a risk group.

Everyone who is at risk undergoes a full external and internal examination, and the pelvis is required to be measured. You can determine a narrow pelvis yourself, or, in any case, suspect a reduction in the cavity due to the wide bone. To do this, it is enough to measure the circumference of the wrist joint, which is on average 14 cm, and larger or smaller values ​​indicate the thickness of the bone.

2 weeks before giving birth, the expectant mother is given a referral to a hospital, where the most favorable method of delivery will be determined.

How to determine a narrow pelvis in a pregnant woman?

The examination is carried out in the supine position using an obstetric pelvis. The tool resembles a compass with a division scale, the rounded ends of which are applied to the protruding points of the pelvis.

There are the following sizes, which are determined for all women:

• in front between the upper protrusions of the pelvic bones (25-26 cm);
• the buttons of the pelvis are advanced along the crests of the iliac bones to the greatest distance between them (28-29 cm);
• on the sides, measure the distance between the femurs, namely the greater trochanters (31-32 cm);
• the size is very important and is called the external conjugate, from the upper edge of the pubis to the fossa above the sacrum (20-21 cm). This measurement is taken in a lateral position with the lower leg bent and the other leg remaining straight.

If there is a suspicion of pelvic narrowing, the doctor will additionally determine other dimensions of the pelvis, including during vaginal examination.

There are:

• Anatomically narrow pelvis - all sizes or at least one is 1.5-2 cm less than normal.
• Clinically narrow pelvis - the size of the pelvis is within normal limits, but it is impossible to give birth on your own.

Degrees of anatomically narrow pelvis during pregnancy

The degree of narrowing is determined by the indicators of the true conjugate.

The term "conjugate" is used to refer to the different linear dimensions of the female pelvis. The true conjugate is the distance between the middle of the upper-inner edge of the pubic arch and the most prominent point of the promontory (indicated in the figure by line No. 3).

It is impossible to determine this indicator directly (such devices do not exist), therefore the size of the true conjugate is calculated through the outer or diagonal conjugate.

In the first case, 9 cm is subtracted from the size of the external conjugate and the true size is obtained (normally about 11-12 cm).

In the second case, 1.5-2 cm is subtracted from the size of the diagonal conjugate (determined during vaginal examination). With this calculation method, the normal values ​​for the true conjugant are slightly larger - from 12.5 to 13 cm.

In addition to its degrees, a narrow pelvis differs in shape depending on the narrowing of the straight, transverse or oblique dimensions of the pelvis.

Clinically narrow pelvis during pregnancy

Clinically, a narrow pelvis is detected during childbirth, when, during pronounced labor, the fetus does not move along the birth canal. The reason may be:

• fetal weight;
• bone outgrowths;
• incorrect insertion of the head.

The following picture is typical for this pathology:

• Attempts appear, although the head stands high.
• The vagina and cervix swell;
• Urinary retention occurs.

To determine the method of birth, it is important to assess the correspondence between the pelvis and the fetal head, which is carried out by the doctor using the palm of the hand and a pelvis gauge - if the baby’s head is higher than the symphysis, then this is a direct indication for relieving labor and operative delivery; if below the symphysis, then natural childbirth cannot be ruled out.

Childbirth with a narrow pelvis

If a pregnant woman has a first degree of contraction, and the fetal weight is no more than 3,000 kg, then there are no contraindications for normal childbirth, but there is always a danger of complications:

• childbirth takes a longer time with the development of weakness of labor;
• rising infection due to early rupture of amniotic fluid;
• oxygen starvation of the fetus;
• fetal damage;
• loss of umbilical cord loops;
• divergence of the symphysis pubis;
• since the head moves slowly, compression of the soft tissue occurs, which leads to necrosis and the formation of fistulas.
• in the postpartum period there is a risk of bleeding and infectious diseases.

Caesarean section is planned in the following cases:

• narrowing of the III-IV degree, which is very rare;
• narrowing of the I-II degree in combination with a large fetus, hypoxia or abnormal position of the fetus, weakness of labor; uterine scar, infertility, first birth over 30 years of age; if the previous pregnancy ended in a stillbirth or a child with injuries.
• the presence of deformities and tumors, developmental anomalies.

The decision to perform an emergency operation is made when there is a threat of uterine rupture and acute fetal hypoxia.

Vladlena Razmeritsa, obstetrician-gynecologist, especially for the site

Useful video

Sometimes during pregnancy, upon examination, a woman is diagnosed with a narrow pelvis. After this, the woman asks the question: what is this, is it dangerous for the child? Is it possible to give birth with a narrow pelvis? How will such a diagnosis affect the course of pregnancy? We will try to reveal the answers to these questions in this article.

So, according to anatomy, the pelvis is considered narrow if one or more of its internal sections is reduced by 2 centimeters. There is a special method for measuring it, which is used by obstetricians around the world.

Diagnosis of a narrow pelvis

Knowing the size of the pelvis is necessary in order to understand in time whether a woman can give birth to a child herself or whether surgical intervention is necessary. Such a study is mandatory when a pregnant woman registers with the antenatal clinic, as well as before the birth itself.

You can more accurately determine the size using an x-ray. It is done at the end of pregnancy, after 34-36 weeks of pregnancy. At the same time, the sizes of the woman’s pelvis and the fetal head are compared and a conclusion is drawn about the possibility of normal labor.

You should not be afraid of this study, because at the end of pregnancy, X-rays can no longer harm the baby.

Narrow pelvis during pregnancy: what you need to know

If the baby is small and lies correctly, and the contractions are strong enough, then the birth takes place without complications. Problems arise when the baby is large. Then he tries to adapt and choose a comfortable position for himself inside the uterus. He can lie upside down, obliquely or even across. In the last two situations, the only way out is a caesarean section.

Pregnant women with a narrow pelvis are at risk and should be specially registered at the antenatal clinic.

It is necessary to detect fetal malposition and other complications in time. It is important to accurately determine the due date so that there is no post-term pregnancy, which creates problems with a narrow pelvis. One to two weeks before giving birth, such women are advised to go to the clinic to clarify the diagnosis and choose the most effective method of childbirth.

There are other nuances. The pelvis has a “soft” place where, instead of bone, there is elastic cartilage. Every woman can easily feel it. During pregnancy, especially in the last 2-3 months, when the belly is already large, the cartilage stretches. The bones in this place diverge, increasing the pelvis by 1.5-2 cm. This is a kind of natural mechanism that allows women to better endure childbirth. If the narrowing of the pelvis is insignificant, then these centimeters are quite enough, and childbirth proceeds naturally.

Causes of a narrow pelvis

Often the cause of a narrow pelvis is trauma and fractures. If the injury occurred in childhood, then it is very important to perform the operation in time, when the body is still growing and the bones are soft. Correct and timely correction will save such a girl from possible problems during pregnancy. Although few doctors, having learned about pelvic surgery, will take it upon themselves to allow a woman to give birth on her own. In such a situation, the risk that the bones will not withstand the load is very high.

If pregnancy has already begun, then it is no longer possible to change the shape and size of the pelvis. This increases the risk of miscarriage.

Indications for caesarean section with a narrow pelvis

In most cases, a woman with a narrow pelvis is allowed to give birth on her own. However, in certain cases, a woman will still be offered a caesarean section. These are the following reasons:

If the pelvis is narrowed to a certain extent or severely deformed.

If the child is large.

If you had a caesarean section in a previous birth.

If the child lies obliquely, across or with his legs down.

If during childbirth the condition of the child causes concern.

If a woman has been treated for infertility for a long time.

If the woman is over 30 years old and this is her first birth.

In all other cases, it is believed that you can give birth with a narrow pelvis on your own. In any case, consult your doctor so that he can choose the method of delivery that is suitable for you and give appropriate recommendations.

Increasingly, during gynecological examinations during pregnancy, doctors say that the sizes of the female pelvis and the fetus do not correspond to each other. This interferes with the normal course of labor. Often this situation is so dangerous that the woman in labor is offered a caesarean section to avoid unwanted consequences. What is a narrow pelvis during pregnancy and how can it harm the baby?

The pelvic bones are a dense ring through which the baby's head will have to pass during birth. The problem is that this bone formation is practically inextensible. Only a slight discrepancy is possible (only half a centimeter) due to the fact that the symphysis (cartilage) softens slightly before childbirth.

At its core, the pelvis is motionless. And if the circumference of the child’s skull is larger than this bone ring, gynecologists are forced to diagnose this anatomical feature of the female skeleton and recommend. What could be the reason for such an unusual pathology?

According to statistics. Recently, the frequency of diagnosis of narrow pelvis has dropped compared to previous years. It is only 7%.

Causes

Most women who were diagnosed with a narrow pelvis during pregnancy believe that this is an individual feature of the structure of their skeleton, with which they were born. In fact, in 90% of cases this problem turns out to be acquired.

The main causes of a narrow pelvis include:

• health problems in childhood: rickets, poor nutrition, excessive stress provoke deviations in physical development;
• injuries in the pelvic area: bone fractures lead to serious deformation and reduction in size;
• tumors in this area: osteomas narrow the gap between the bones;
• hormonal disorders leading to hyperandrogenism, which is characterized by broad shoulders and a masculine narrow pelvis;
• acceleration of girls during adolescence, which leads to a transversely narrowed pelvis;
• bone infections: tuberculosis, osteomyelitis, which destroy bone tissue and lead to pelvic deformities;
• orthopedic diseases (for example, scoliosis).

The same phenomenon is said to occur if the fetus is too large and risks not passing into the pelvic ring, even if it is of normal size.

The parameters for which pelvis is considered narrow for childbirth have long been developed in gynecology, so the doctor will answer this question after appropriate measurements and examinations. Depending on the type of this pathology, a decision will be made on how the baby will be born - by caesarean section or.

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

Classification

According to the classification, there are two types of pathology - anatomically or clinically narrow pelvis during childbirth, which differ in relation to normal values.

Anatomical

Gynecologists diagnose an anatomically narrow pelvis when there is a narrowing of the bones, which is a deviation from the average statistical norm. It is not always an indication for a cesarean section, because the fetus may refuse to be small and pass freely through the birth canal without injury. This type of pathology has its own special classification.

By type of narrowing:

1. Evenly tapered.
2. Flat.
3. Transversely tapered.

By degree of narrowing (Litzman classification):

• 1st degree

If a woman is diagnosed with a narrow pelvis of the 1st degree during pregnancy, she is allowed to give birth on her own. However, the young mother and the team of doctors must be prepared for various complications of labor. In such cases, the surgeon and anesthesiologist are usually notified to be on the safe side. Their intervention may be needed at any moment.

• 2nd degree

The situation is a little more complicated when a woman is diagnosed with a narrow pelvis of the 2nd degree during pregnancy: natural childbirth is allowed, but under certain conditions. Most often, you are allowed to give birth on your own if the pregnancy is premature and the fetus is not too large.

• 3rd degree

Natural childbirth is not possible. If a narrow pelvis of the 3rd degree is diagnosed, this is a medical indication for cesarean section. The woman is hospitalized in advance (2 weeks before the cherished date), assigning her bed rest and absolute rest.

• 4th degree

If during pregnancy it turns out that the expectant mother has a narrow pelvis of the 4th degree, her child can only be born by caesarean section.

Clinical

If a woman in labor is of normal size, but on the eve of birth it turns out that the fetus is too large and will not be able to pass through the pelvic ring without injury, they speak of a clinically narrow pelvis. However, in subsequent pregnancies, if the child turns out to be smaller, such a diagnosis will not be made. So if there are no other indications for a cesarean section, the birth will take place naturally.

Clinically, a narrow pelvis is diagnosed only during the last months of pregnancy or even immediately before childbirth, and its classification in obstetrics has not been developed. The most common causes of a clinically narrow pelvis:

• incorrect insertion of the head;
• large fruit size;
• various malformations of the child;
• incorrect presentation.

All these phenomena can be clarified immediately before the birth itself or already during its process. The decision must be made very quickly; the diagnosis of a clinically narrow pelvis is based on specific obstetric signs and symptoms. In this case, it is carried out.

Regardless of its type, a narrow pelvis in obstetrics is regarded as a serious complication that can lead to dangerous consequences if handled incorrectly. An experienced, professional doctor, at the first suspicion of this feature of the female skeleton, takes appropriate measures and controls the size of the pelvic bones throughout pregnancy so that no unforeseen situation arises during the birth of the baby. How is this pathology diagnosed?

For reference. Hydrocephalus is a dangerous and common disease, hydrocephalus in a baby, which is characterized by the huge size of its head. There is no way it will pass through the pelvic ring.

Diagnostics

Many business and most active mothers try to find out on their own how to determine whether the pelvis is narrow for childbirth, and whether they can give birth themselves at certain sizes. In fact, this cannot be done either at home or “by eye”. Diagnosis is possible only in a hospital; it is carried out exclusively by a professional doctor using a specific obstetric instrument called a pelvisometer. With its help, the following dimensions are determined:

• the interspinous distance is measured between the anterior iliac (connecting the pelvis to the spine) spines (processes), normally it should be more than 25 cm;
• the gap between the most distant points of the iliac bones is normally more than 28 cm;
• the distance between the trochanters (greater) of the femurs, 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 highest point (promontory) of the sacrum; it is considered normal when the obstetrician cannot reach this point;
• external conjugate - the gap between the suprasacral fossa, which is located in the lumbosacral region, and the upper corner of the pubic symphysis, a certain norm - more than 20 cm;
• Michaelis's diamond above the coccyx, in the area of ​​the sacrum, the boundaries of which are normally clearly visible, all sides are symmetrical: transverse are 10 cm, vertical - 11 cm;
• The Solovyov index allows you to evaluate the thickness of the bones, which can also interfere with normal childbirth - this is the circumference of the wrist, the maximum norm is no more than 14 cm.

To clarify the parameters, in rare cases, radiography is performed, but it can harm the fetus. An ultrasound examination can also help assess the size of the narrow pelvis during pregnancy. In clinical cases where this data cannot be obtained in advance, obstetricians are guided by specific signs and symptoms.

Through the pages of history. S. A. Michaelis is a German gynecologist of the 19th century, whose name is the famous sacral rhombus, which determines whether a woman can give birth on her own or not.

Signs of a clinically narrow pelvis

Immediately before birth, if a woman in labor exhibits signs of a clinically narrow pelvis, a cesarean section is recommended. These symptoms include the following pathologies and complications:

• the baby’s head does not press against the pelvic bones upon entry;
• the biomechanism of childbirth is disrupted;
• amniotic fluid is discharged untimely;
• contraction of the uterus is disrupted: weakening of its activity, incoordination, premature appearance of attempts;
• the cervix has already fully opened, and the advancement of the fetus has not yet begun;
• the head remains in the pelvic plane for too long;
• protracted labor;
• deformation of the head, birth tumor, hematomas, ;
• problems with the bladder: pressure, urinary retention, blood in the urine;
• threat of uterine rupture.

If a woman has a clinically narrow pelvis and a large fetus due to at least one of these signs, the team of doctors in 98% of cases performs an emergency cesarean section to avoid death or injury to the fetus during its movement through the birth canal. This is the only correct way out of this situation, medically completely justified and recommended.

Of course, such a birth with a narrow pelvis is much more difficult than with an anatomical one, since you can prepare for the latter in advance.

On a note. Intrauterine hypoxia is oxygen starvation of the child, which can be fatal if the fetus is not removed in time.

Signs of an anatomically narrow pelvis

The main sign of an anatomically narrow pelvis is the discrepancy between its size and the standards indicated above. But there are such impatient young mothers who cannot wait for laboratory measurements and want to know in advance whether they are predisposed to such a diagnosis. There are such signs, and they usually include:

• short arms (hand length - no more than 16 cm);
• short fingers: thumb length - no more than 6 cm, middle finger - no more than 8;
• small foot size: less than 36;
• small height: no more than 150 cm;
• curvature of the spine, limbs, lameness, orthopedic diseases;
• pelvic injuries;
• complications during previous births;
• irregular menstrual cycle;
• androgenic (male type) physique.

However, do not think that if one of the listed features applies to you, this means that you have an anatomically narrow pelvis. These are indicative signs that are observed in 98% of women who were diagnosed with this during pregnancy. You just need to keep these facts in mind in order to prepare in advance for all possible consequences. And there is no need to be afraid of them: an anatomically narrow pelvis has a huge advantage over a clinical one: it allows you to prepare for childbirth in advance.

Sometimes it happens. Often, small women turn out to be much tougher than those who have more impressive sizes in terms of childbirth. They give birth to even large babies on their own.

Course of labor

Most women who have had to deal with the problem of a narrow pelvis are interested in whether it is possible to give birth on their own with this diagnosis.

In a clinical case, no, cesarean cannot be avoided, otherwise the risk of death or injury to the fetus is too great. In the anatomical case, everything will depend on the degree of pathology. The first, for example, allows the baby to be born independently, without surgical intervention. But childbirth with a narrow pelvis of the 2nd degree (and higher) in most cases ends with a cesarean section.

Here it is very important to listen to your 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 even the slightest threat that the child will suffer when passing through the pelvic ring, it is better not to insist on a natural birth. Caesarean section is the only correct way out in such a dangerous situation.

If during pregnancy a woman is diagnosed with a narrow pelvis, doctors will have to decide whether she can give birth on her own or whether she will have to have a caesarean section. To do this, a large number of studies are carried out, all kinds of bone measurements are taken to eliminate the possibility of injury to the mother or child during childbirth. The safe birth of a baby will largely depend on the professionalism of doctors and the right decision made on time.