Анатомически узкий таз - тактика родоразрешения

[silver]

Читаю записи некоторых коллег и страшно становится ,очень хочется согласиться с Аннабелой
вот какая классификация принята в американском учебнике по акушерству Вильямса, в этом же учебнике приведены минимальные значения входа ,широкой части и выхода ,
никаких 4ех степеней сужения там нет ,
никакой корреляции с данными наружного тазоизмерения и ислледования также нет
стандартом исследования исключительно с теоретической точки зрения являются рентгеновская пельвиметрия и ямр
если я при проверке действительно нахожу узкий таз - приглашаю женщину на плановую операцию и на этом все ведение и заканчивается
Если есть ситуация когда пациенка уже вродах - если есть критерии установления CPD -тактика зависит от клинической ситуации.

Pelvic Shapes

In the past, x-ray pelvimetry was used frequently in women with suspected cephalopelvic disproportion or fetal malpresentation. Caldwell and Moloy (1933, 1934) developed a classification of the pelvis that is still used. The classification is based on the shape of the pelvis, and its familiarity helps the clinician understand better the mechanisms of labor.

The Caldwell–Moloy classification is based on measurement of the greatest transverse diameter of the inlet and its division into anterior and posterior segments. The shapes of these are used to classify the pelvis as gynecoid, anthropoid, android, or platypelloid (Fig. 2–24). The character of the posterior segment determines the type of pelvis, and the character of the anterior segment determines the tendency. These are both determined because many pelves are not pure but are mixed types; for example, a gynecoid pelvis with an android tendency means that the posterior pelvis is gynecoid and the anterior pelvis is android in shape.

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Figure 2–24. Add to 'My Saved Images'

The four parent pelvic types of the Caldwell–Moloy classification. A line passing through the widest transverse diameter divides the inlets into posterior (P) and anterior (A) segments.



From viewing the four basic types in Figure 2–24, the configuration of the gynecoid pelvis would intuitively seem suited for delivery of most fetuses. Indeed, Caldwell and co-workers (1939) reported that the gynecoid pelvis was found in almost 50 percent of women. In contrast, in the android pelvis, the posterior sagittal diameter at the inlet is much shorter than the anterior sagittal diameter, limiting the use of the posterior space by the fetal head. Moreover, the anterior portion is narrow and triangular. The extreme android pelvis presages a poor prognosis for vaginal delivery. In the anthropoid pelvis, the anteroposterior diameter of the inlet is greater than the transverse. This results in an oval anteroposteriorly, with the anterior segment somewhat narrow and pointed. Variations of anthropoid-type pelves are found in about one third of women. The platypelloid pelvis has a flattened gynecoid shape with short anteroposterior and wide transverse diameters. Pure varieties are found in fewer than 3 percent of women.