Pelvic Assessment During Labor

A mother who is pregnant for the second time (Gravida 2, Para 1+0) reports with labor pains. Your task is to perform an internal pelvic assessment and create a plan for the mode of delivery.

Pelvic Assessment

Pelvic assessment is a process to determine whether a mother’s pelvis is wide enough for a baby to pass through safely during delivery.

Methods of Pelvic Assessment

1. External Pelvic Assessment: This is a non-invasive assessment that can be performed by a midwife or healthcare provider. It involves observing the woman’s physical characteristics and taking a detailed history.
2. Internal Pelvic Assessment: This is a more invasive assessment that requires a vaginal examination. It is typically performed by a doctor, especially during labor.

External Pelvic Assessment

The woman is observed/as she moves towards the HCW/ midwife, note the stature, gait and shape of the abdomen. Any mother with a pendulous abdomen is suspected of having a contracted pelvis.

1. Observation:
Observe the woman as she approaches. Pay attention to her;

• Stature: Observe the woman’s height and build. A woman with a shorter stature might have a smaller pelvis.
• Gait: Observe how the woman walks. A waddling gait can indicate a wider pelvis.
• Abdomen: Observe the shape of the abdomen. A pendulous abdomen (protruding belly) can suggest a contracted pelvis

2. History Taking:

• Social History:

  • • Age:

• Under 18 years may indicate an immature pelvis with smaller diameters.
• Over 30 years may suggest that the pelvic joints are less flexible due to ossification, making labor more difficult.

  • • Tribe: Some tribes are known to have smaller or larger pelvises, which can influence delivery outcomes.

• Medical History:
  Ask if the mother has had diseases like poliomyelitis or rickets, which can affect the pelvis’s shape and size.
• Surgical History:
  Inquire about any accidents or surgeries involving the spine, pelvis, or lower limbs, as these may lead to a contracted pelvis. 
• Past Obstetrical History:

1. This is especially important for mothers who have been pregnant before (multigravida).
2. Ask about previous deliveries: Were they normal or assisted?
3. Ask about the condition of babies at birth: This can help rule out obstructed labor.
4. Ask about the baby’s health: This can help rule out mental retardation, which could be a result of abnormal labor.
5. Ask about the baby’s birth weight: This gives an idea of the size of baby that can pass through the pelvis without complications.

3. General Examination:

• Shoe Size: A woman wearing a smaller shoe size (size 4 or less) might have a smaller pelvis.
• Size of Hands and Feet: Smaller hands and feet can indicate a smaller pelvis.
• Height: A woman shorter than 152 cm might have a smaller pelvis that may not allow an average-sized baby to pass through.