Transiting Uranus square natal Venus. Transits of Uranus to personal planets

Examination of the pelvis is important in obstetrics because its structure and size have a decisive influence on the course and outcome of childbirth. A normal pelvis is one of the main conditions for the correct course of labor. Deviations in the structure of the pelvis, especially a decrease in its size, complicate the course of labor or present insurmountable obstacles to it. The pelvis is examined by inspection, palpation and measurement of its size. When examining, pay attention to the entire pelvic area, but special meaning attached to the lumbosacral rhombus (Michaelis rhombus). The Michaelis rhombus is a shape in the sacral area that has the contours of a diamond-shaped area. The upper corner of the rhombus corresponds to the spinous process of the V lumbar vertebra, the lower - to the apex of the sacrum (the origin of the gluteus maximus muscles), the lateral angles - to the superoposterior spine of the iliac bones. Based on the shape and size of the rhombus, you can evaluate the structure of the bone pelvis, detect its narrowing or deformation, which has great value in the management of childbirth. With a normal pelvis, the rhombus corresponds to the shape of a square. Its dimensions: the horizontal diagonal of the rhombus is 10-11 cm, the vertical - 11 cm. With various narrowings of the pelvis, the horizontal and vertical diagonals will be of different sizes, as a result of which the shape of the rhombus will be changed.

During an external obstetric examination, measurements are made with a centimeter tape (circumference of the wrist joint, dimensions of the Michaelis rhombus, abdominal circumference and height of the uterine fundus above the womb) and an obstetric compass (pelvis gauge) in order to determine the size of the pelvis and its shape.

Using a centimeter tape, measure the largest circumference of the abdomen at the level of the navel (at the end of pregnancy it is 90-100 cm) and the height of the uterine fundus - the distance between the upper edge of the pubic symphysis and the fundus of the uterus. At the end of pregnancy, the height of the uterine fundus is 32-34 cm. Measuring the abdomen and the height of the uterine fundus above the womb allows the obstetrician to determine the duration of pregnancy, the expected weight of the fetus, and identify disorders of fat metabolism, polyhydramnios, and multiple births. By the external dimensions of the large pelvis one can judge the size and shape of the small pelvis. The pelvis is measured using a pelvic meter. Only some measurements (pelvic outlet and additional measurements) can be made with a measuring tape. Usually four sizes of the pelvis are measured - three transverse and one straight. The subject is in a supine position, the obstetrician sits to the side of her and faces her. Distantia spinarum - the distance between the most distant points of the anterior superior iliac spines (spina iliaca anterior superior) is 25-26 cm. Distantia cristarum - the distance between the most distant points of the iliac crests (crista ossis ilei) is 28-29 cm. Distantia trochanterica - the distance between the greater trochanters of the femurs (trochanter major) is 31-32 cm. Conjugata externa (external conjugate) - the distance between the spinous process of the V lumbar vertebra and the upper edge of the symphysis pubis is 20-21 cm. To measure the external conjugate, the subject turns around on the side, bends the underlying leg at the hip and knee joints, and extends the overlying leg. The pelvic meter button is placed between the spinous process of the V lumbar and I sacral vertebrae (suprasacral fossa) at the back and in the middle of the upper edge of the symphysis pubis at the front. By the size of the outer conjugate one can judge the size of the true conjugate. The difference between the external and true conjugate depends on the thickness of the sacrum, symphysis and soft tissues. The thickness of bones and soft tissues in women is different, so the difference between the size of the external and true conjugate does not always exactly correspond to 9 cm. To characterize the thickness of the bones, they use the measurement of the circumference of the wrist joint and the Solovyov index (1/10 of the circumference of the wrist joint). Bones are considered thin if the circumference of the wrist joint is up to 14 cm and thick if the circumference of the wrist joint is more than 14 cm. Depending on the thickness of the bones, with the same external dimensions of the pelvis, its internal dimensions may be different. For example, with an external conjugate of 20 cm and a Solovyov’s circumference of 12 cm (Solovyov’s index is 1.2), we must subtract 8 cm from 20 cm and obtain the value of the true conjugate of 12 cm. With a Solovyov circumference of 14 cm, it is necessary to subtract 9 cm from 20 cm, and with 16 cm, subtract 10 cm - the true conjugate will be equal to 9 and 10 cm, respectively. The size of the true conjugate can be judged by the vertical size of the sacral rhombus and the Frank size. The true conjugate can be more accurately determined by the diagonal conjugate. The diagonal conjugate (conjugata diagonalis) is the distance from the lower edge of the symphysis to the most prominent point of the sacral promontory (13 cm). The diagonal conjugate is determined during a vaginal examination of a woman, which is performed with one hand. The direct size of the pelvic outlet is the distance between the middle of the lower edge of the pubic symphysis and the tip of the coccyx. During the examination, the pregnant woman lies on her back with her legs apart and half-bent at the hip and knee joints. The measurement is carried out with a pelvis meter. This size, equal to 11 cm, is 1.5 cm larger than the true one due to the thickness of the soft tissues. Therefore, it is necessary to subtract 1.5 cm from the resulting figure of 11 cm, and we obtain the direct size of the outlet from the pelvic cavity, which is equal to 9.5 cm. The transverse size of the pelvic outlet is the distance between the inner surfaces of the ischial tuberosities. The measurement is carried out with a special pelvis or measuring tape, which is applied not directly to the ischial tuberosities, but to the tissues covering them; therefore, to the resulting dimensions of 9-9.5 cm, it is necessary to add 1.5-2 cm (thickness of soft tissues). Normally, the transverse size is 11 cm. It is determined in the position of the pregnant woman on her back, with her legs pressed as close as possible to her stomach. The oblique dimensions of the pelvis have to be measured with oblique pelvises. To identify pelvic asymmetry, the following oblique dimensions are measured: the distance from the anterosuperior spine of one side to the posterosuperior spine of the other side (21 cm); from the middle of the upper edge of the symphysis to the right and left posterosuperior spines (17.5 cm) and from the supracruciate fossa to the right and left anterosuperior spines (18 cm). The oblique dimensions of one side are compared with the corresponding oblique dimensions of the other. With a normal pelvic structure, the paired oblique dimensions are the same. A difference greater than 1 cm indicates pelvic asymmetry. The lateral dimensions of the pelvis are the distance between the anterosuperior and posterosuperior iliac spines of the same side (14 cm), measured with a pelvic meter. The lateral dimensions must be symmetrical and at least 14 cm. With a lateral conjugate of 12.5 cm, childbirth is impossible. The pelvic inclination angle is the angle between the plane of the entrance to the pelvis and the horizontal plane. In the standing position of a pregnant woman, it is 45-50. Determined using a special device - a pelvis angle meter.

Measuring the size of the pelvis. Transverse dimensions of the pelvis. Distantia spinarum. Distantia cristarum. Distantia trochanterica.

Usually measured four pelvis sizes: three transverse and one straight.

1. Distantia spinarum- the distance between the anterosuperior iliac spines. The buttons of the pelvis are pressed to the outer edges of the feathers and non-upper spines. This size is usually 25-26 cm (Fig. 4.11, a).

2. Distantia cristarum- the distance between the most distant points of the iliac crests. After measuring distantia spinarum, the pelvis meter buttons are moved from the spines along the outer edge of the iliac crest until the greatest distance; this distance is distantia cristarum; it averages 28-29 cm (Fig. 4.11, b)

3. Distantia trochanterica- the distance between the greater trochanters of the femurs. Find the most prominent points of the greater trochanters and press the buttons of the pelvis gauge to them. This size is 31-32 cm (Fig. 4 11, c)

It also matters ratio between transverse dimensions. For example, normally the difference between them is 3 cm; a difference of less than 3 cm indicates a deviation from the norm in the structure of the pelvis.

The bony pelvis consists of a large and small pelvis. The border between them: behind is the sacral promontory; on the sides - innominate lines, in front - the upper part of the pubic symphysis.

The bony basis of the pelvis is made up of two pelvic bones: the sacrum and the coccyx.

The female pelvis is different from the male pelvis.

Large pelvis in obstetric practice important does not have, but it is available for measurement. The shape and size of the small pelvis are judged by its size. An obstetric pelvisometer is used to measure the large pelvis.

Basic female pelvis sizes:

In obstetric practice, a fundamental role is played by the small pelvis, which consists of 4 planes:

1. The plane of entry into the pelvis.
2. The plane of the wide part of the small pelvis.
3. The plane of the narrow part of the pelvic cavity.
4. The plane of exit from the pelvis.

The plane of entry into the pelvis

Borders: behind - the sacral promontory, in front - the upper edge of the pubic symphysis, on the sides - innominate lines.

Direct size is the distance from the sacral promontory to the upper edge of the false articulation 11 cm. The main size in obstetrics is coniugata vera.

The transverse size is 13 cm - the distance between the most distant points of the nameless lines.

Oblique dimensions are the distance from the sacroiliac joint on the left to the false protrusion on the right and vice versa - 12 cm.

The plane of the wide part of the pelvis

Borders: in front - the middle of the false articulation, in the back - the junction of the 2nd and 3rd sacral vertebrae, on the sides - the middle of the acetabulum.

It has 2 sizes: straight and transverse, which are equal to each other - 12.5 cm.

Straight size is the distance between the gray area of ​​the pubic symphysis and the junction of the 2nd and 3rd sacral vertebrae.

The transverse dimension is the distance between the middles of the acetabulum.

The plane of the narrow part of the pelvic cavity

Borders: in front - the lower edge of the pubic symphysis, behind - the sacrococcygeal joint, on the sides - the ischial spines.

Direct size is the distance between the lower edge of the pubic joint and the sacrococcygeal joint - 11 cm.

The transverse dimension is the distance between the ischial spines - 10.5 cm.

Plane of exit from the pelvis

Borders: in front - the lower edge of the symphysis pubis, in the back - the apex of the coccyx, on the sides - the inner surface of the ischial tuberosities.

Direct size is the distance between the lower edge of the symphysis and the tip of the coccyx. During childbirth, the fetal head deviates the coccyx by 1.5-2 cm, increasing the size to 11.5 cm.

Transverse size - the distance between the ischial tuberosities - 11 cm.

The pelvic inclination angle is the angle formed between the horizontal plane and the plane of the entrance to the pelvis, and is 55-60 degrees.

The wire axis of the pelvis is a line connecting the vertices of all straight dimensions of the 4 planes. It is not shaped like a straight line, but concave and open at the front. This is the line along which the fetus passes when it is born through the birth canal.

Pelvic conjugates

External conjugate – 20 cm. Measured with a pelvic meter during an external obstetric examination.

Diagonal conjugate – 13 cm. Measured by hand during internal obstetric examination. This is the distance from the lower edge of the symphysis (inner surface) to the sacral promontory.

The true conjugate is 11 cm. This is the distance from the upper edge of the symphysis to the sacral promontory. Not measurable. It is calculated by the size of the outer and diagonal conjugate.

According to the external conjugate:

9 is a constant number.

20 – external conjugate.

Along the diagonal conjugate:

1.5-2 cm is the Solovyov index.

The thickness of the bone is determined around the circumference of the wrist joint. If it is 14-16 cm, then 1.5 cm is subtracted.

If 17-18 cm, 2 cm is subtracted.

Michaelis's rhombus is a diamond-shaped formation located on the back.

It has dimensions: vertical – 11 cm and horizontal – 9 cm. In total (20 cm), giving the size of the external conjugate. Normally, the vertical size corresponds to the size of the true conjugate. The shape of the diamond and its size are used to judge the condition of the small pelvis.

Accurate determination of the size of the pelvis in obstetrics before the onset of labor can save the life of the mother and child. Every woman goes through this procedure, since with its help you can understand in advance whether a caesarean section is required. In gynecology, the sizes of the large and small pelvis are measured; each distance has its own name and standards. To carry out the procedure, a special instrument is used - a medical metal compass - a tazometer.

Basic parameters of the large pelvis

The female pelvis differs significantly in size from the male one. It is important for a girl to know several parameters and their meanings to make sure that doctors act correctly:

1. The spinarum distance is normally 25-26 cm - this is the distance between the anterosuperior spines of the bones of the iliac zone.
2. The cristarum distance – normally 28-29 cm – is the position of the distant promontories of the iliac crests, located above the attachment of the hip joint.
3. External conjugate - from 20 to 21 cm - the distance from the middle of the top of the symphysis to the upper corner of the Michaelis rhombus.

An awn is an acute formation on the bones, which is diagnosed both normally and in various diseases. Osteophytes and osteoporosis are derivatives of this word.

Narrowing of the female pelvis is a common problem in obstetrics. This indicator matters:

• at grade 1 - the mildest - the true conjugate retains a size greater than 9, but less than 11 cm;
• with degree 2 narrowing of the pelvis, this figure is 7 and 9 cm, respectively;
• at grade 3 – 5 and 7 cm;
• at grade 4, the true conjugate barely reaches 5 cm.

The true pelvic conjugate is the distance from the protruding part of the sacrum to the superior promontory of the pubic symphysis at the exit. The easiest way to determine the parameter is by the dimensions of the conjugates on the outside.

The true conjugate is the smallest distance inside through which the fetus emerges during childbirth. If the indicator is less than 10.5 cm, then doctors prohibit natural childbirth. The true conjugate parameter is established by subtracting 9 cm from the external indicator.

The diagonal conjugate is the distance from the bottom of the symphysis pubis to the prominent point of the sacrum. It is determined using vaginal diagnostics. With a normal pelvis, the figure does not exceed 13 cm, sometimes it is at least 12 cm. To clarify the true conjugate, 1.5-2 cm is subtracted from the resulting figure.

When examining the diagonal indicator, the doctor in rare cases reaches the promontory of the sacrum with his fingers. Usually, if the bone is not felt when you place your fingers inside the vagina, the size of the pelvis is considered normal.

The shape of the pelvis can affect normal indicators. With a platipeloid constitution, which occurs in 3% of women, the pelvis is elongated and slightly flattened. In this case, the gap between the bones narrows, as a result of which the birth process can be complicated.

Pelvic planes

To understand the exact characteristics of the female skeleton, it is necessary to measure the plane before giving birth:

1. Entrance plane. In front, it starts from the top of the symphysis and reaches behind the promontory, and the lateral distance borders on the innominate line. The direct size of the entrance corresponds to the true conjugate - 11 cm. The transverse size of 1 plane is between distant points of the boundary lines, not less than 13 cm. The oblique sizes start from the sacroiliac joint and continue to the pubic tubercle - from 12 to 12.5 cm normally. The entrance plane usually has a transverse oval shape.
2. Plane of the wide part. It runs through the inner surface of the pubis strictly in the middle, passes along the sacrum and the projection of the acetabulum. It has a round shape. The straight size is measured, which is normally 12.5 cm. It starts from the middle of the pubic symphysis and extends to the 2nd and 3rd vertebrae of the sacrum above the buttocks. The transverse size of the zone is 12.5 cm, measured from the middle of one plate to the other.
3. Plane of the narrow part. It starts from the bottom of the symphysis and reaches behind the sacrococcygeal joint. On the sides the plane is limited by the ischial spines. The straight size is 11 cm, the transverse size is 10 cm.
4. Exit plane. It connects the lower edge of the symphysis with the edge of the coccyx at an angle, along the edges it goes into the ischiums located in the buttocks area. The direct size is 9.5 cm (if the tailbone is deviated, then 11.5 cm), and the transverse size is 10.5 cm.

In order not to get confused in all the indicators, you can only pay attention to the measurement of the large pelvis. The table shows an additional parameter - the distance between the trochanters of the femurs.

The trochanters of the femurs are located at the point where girls usually measure the volume of their hips.

Determining the size of the pelvis: narrow or wide

By comparing the obtained indicators, it is easy to determine whether a woman has wide or narrow hips. After consulting with a gynecologist and determining whether the size of the female pelvis is normal, you can decide whether to have a caesarean section or give birth on your own.

Indicators are higher than normal

In most cases, a wide female pelvis is a good factor for pregnancy. Girls should understand that if a woman loses weight, the pelvis cannot become narrower because of this - everything is inherent in the structure of the bones. Wide hips are most often found in large women, and this cannot be considered a pathology. If the dimensions exceed the norm by 2-3 centimeters, this is considered a wide pelvis.

The main danger of too wide hips is rapid labor. In such a situation, the child passes much faster through the birth canal, which can lead to female injuries: rupture of the cervix, vagina and perineum.

Anatomically narrow pelvis

The definition of an anatomically narrow pelvis in obstetrics is closely related to normal indicators. A deviation of 1.5 cm from the minimum limit indicates that the woman has small hips. In this case, the conjugate should be less than 11 cm. Natural birth in this case is possible only when the child is small.

When diagnosing, the doctor identifies the type of pelvis: transversely narrowed, uniformly narrowed, flat, simple or rachitic. Less common are pathological forms in which the pelvis has begun to narrow due to pathological changes in the bone structure: kyphotic, deformed, obliquely displaced or spondylolisthetic pelvis. Causes of anatomically narrow pelvis:

• bone injuries;
• rickets;
• elevated physical activity and lack proper nutrition in childhood;
• neoplasms in the study area;
• hyperandrogenism, leading to male type formation;
• accelerated growth during adolescence;
• psycho-emotional stress that caused compensatory development in childhood;
• general physiological or sexual infantilism;
• Cerebral palsy, birth injuries, polio;
• professional sports;
• metabolic problems;
• dislocations of the hip joints;
• inflammatory or infectious diseases of the skeletal system;
• curvature of the spine.

Factors such as hormonal imbalance, constant colds and problems with the menstrual cycle provoke improper formation of the pelvis.

Clinically narrow pelvis

Clinically, a narrow pelvis can be identified only before childbirth, or during the process of delivery. This is due to the discrepancy between the size of the fetus and the woman’s birth canal. For example, if the child’s weight is more than 4 kg, even a girl with normal indicators can be diagnosed with a “clinically narrow pelvis”. There is no single answer to the question of why this condition is formed. The doctor identifies a whole range of reasons:

• large fruit;
• post-term for more than 40 weeks;
• malposition;
• tumors of the uterus or ovaries;
• fetal hydrocephalus (enlarged head);
• fusion of the vaginal walls;
• breech presentation of the fetus (the baby is turned with the pelvis instead of the head).

In obstetric practice, there are more and more cases of clinically narrow birth canal, because large children are born.

Every woman should know her pelvic parameters before giving birth. A responsible gynecologist never ignores these indicators and carefully conducts the examination using an obstetric caliper.

During pregnancy, the size of the pelvis plays a role important role. Sometimes the course of labor depends on this. If the pelvic bones are narrow, complications may arise during childbirth or result in a caesarean section. A narrow pelvis is observed in approximately 3% of women during pregnancy, but it is not always an indicator for cesarean section.

When registering for pregnancy, the female pelvis is given special attention. After measuring it, the gynecologist will be able to predict at the very beginning of pregnancy how the birth will proceed.

Distinguish anatomical And clinical narrow pelvis during pregnancy.

Anatomical narrow pelvis- discrepancy of at least one parameter by 1.5-2 cm or more from normal. It is a consequence of the impact of certain factors on the body in childhood: poor nutrition, frequent infectious diseases, lack of vitamins, hormonal disorders during puberty, congenital anomalies, injuries and fractures. Also, deformation of the pelvic bones can occur as a result of tuberculosis, rickets, and polio.

If a pregnant woman is diagnosed with 1 degree of narrowing out of 4, then giving birth naturally is quite possible. It is also possible to give birth independently with 2 degrees of contraction, but taking into account certain conditions, for example, if the fetus is not large. The remaining degrees (3 and 4) are always an indication for cesarean section.

Clinical narrow pelvis- discrepancy between the fetal head and the parameters of the mother’s pelvis, diagnosed during childbirth. IN in this case the pelvis has normal physiological parameters and shape. It is considered narrow because the fetus is quite large or is not presented correctly on the forehead or face. For this reason, the child cannot be born naturally.

Normal pelvic sizes

The pelvis is measured with a special instrument, a pelvis meter, which measures:

Additionally, it is possible to obtain data on the parameters of the pelvic bones using the following studies:

• X-ray pelviometry. This study is allowed at the end of the third trimester, when all the tissues and organs of the fetus are already formed. Thanks to the procedure, you can find out the shape of the bones and sacrum, determine the direct and transverse dimensions of the pelvis, measure the fetal head and determine whether it corresponds to its parameters.
• Ultrasound examination. An ultrasound can determine the correspondence of the size of the fetal head with the size of the pelvic bones. The procedure also allows you to find out the location of the fetal head, since in cases of frontal or facial presentation during childbirth, it will need more space.
• Solovyov index- measuring the circumference of a woman’s wrist joint, thanks to which you can determine the thickness of the bones and determine the direct size of the cavity of the entrance to the pelvis. Normally, the circumference of the wrist joint is 14 cm. If it is larger, then the bones are massive; if smaller, then the bones are thin. For example, with insufficient external dimensions of the pelvic bones and with a normal Solovyov index, the dimensions of the pelvic ring are sufficient for a child to pass through it.

Childbirth with a narrow pelvis and possible complications

In the antenatal clinic, all pregnant women with a narrow pelvis are specially registered. It is very important, in this case, to determine the date of birth, since post-term pregnancy is extremely undesirable. The woman will be admitted to the maternity hospital in 1-2 weeks. Closer to the due date, doctors will decide on the method of delivery.

During natural childbirth with a narrow pelvis, there is a high risk of developing complications in the fetus (breathing disorders, oxygen starvation, birth trauma, impaired blood circulation in the brain, clavicle fracture, damage to the skull bones and, worst of all, intrauterine death) and the mother (weak labor, premature rupture of amniotic fluid, postpartum infection, threat of uterine rupture).