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PELVIS DESDE EL PUNTO DE VISTA OBSTETRICO Alumno: Giovany Paolo Gaytan Amezcua Sección: 25 Obstetricia teórica
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INTRODUCCION
Vesalio y Arancio (1700).- sostenían que la pelvis ósea no sufría modificación modificación alguna durante el trabajo de parto.
Deventer (Hol.1701).- demostró que durante el parto se desviaban el sacro y el cóccix hacia atrás y con ello disponía el feto de mayor espacio.
Smille (Esc.1754).- aporta la valoración del conjugado diagonal
Baudelocque (Fran. 1775).- reduce el conjugado externo a 9 cm. obteniendo así el conjugado diagonal.
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Thomson ( 1899).- demuestra el papel que juegan los factores genéticos en el desarrollo morfológico de la pelvis en el feto describe las diferencias sexuales de la pelvis del R.N.
Kirchhoff y Thoms.- demuestran que la pelvis del recién nacido es recta y relativamente larga, con pelvis en embudo y diámetros sagitales cortos
Kasser y cols..- demuestran la presencia de promontorio con paredes laterales paralelas, paralelas, composición composición cartilaginosa cartilaginosa de los huesos huesos pélvicos, osificación isquio - pubica a los 8 años y del acetábulo hasta los 15-20 años
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PELVIMETRIA CLINICA La pelvis ósea
En la mujeres esta estructura ósea tiene una forma especial que la adapta al parto.
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La pelvis ósea
La pelvis esta compuesta de cuatro huesos:
El sacro
El cóccix
Dos iliacos
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articulaciones
Articulación sacroiliaca
Sacrococcígea
Sínfisis del pubis
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coxal Está formado por la unión de otros tres huesos: ílion,, ísquion y pubis. ílion
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La pelvis ósea
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Pelvimetria externa Los diámetros mas relevantes de la superficie externa son los siguientes:
Diámetro biespinoso:
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Estrecho superior de la pelvis Esta limitado por atrás por:
Promontorio La alas del sacro
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Diámetros internos del estrecho superior
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Diámetros del estrecho inferior
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Diámetros de la excavación
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Pelvimetria interna
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Diagonal conjugada
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Morfología de la pelvis
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Tipo II sacralización sacralización de L5 pelvis larga ( sacro 6v) cóncava Tipo III sacralización de L5 pelvis larga (sacro 6 v) recta
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Pelvis uniformemente estrecha
Pelvis de forma ginecoide pero p ero uniformemente reducida.
Se observa en mujeres de estatura o poco p oco desarrolladas.
En la pelvis infantil / pelvis juvenil tiende a ser oval o alargada en embudo de pared lateral estrecha.
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Grados de estreches pelviana Según las dimensiones de los diámetros pelvianos, se distinguen distintos grados de estrechez pelviana:
1º. Pelvis relativamente relativamente estrecha, con una conjugada entre 9 y 10.5 cm.
2º. Pelvis moderadamente estrecha, con una conjugada
