Dystocia due to deformed pelvis

　　Many women believe that childbirth is the main culprit. According to experts, an enlarged pelvis before childbirth is a natural phenomenon, but after childbirth, the hormone 'relaxin' is no longer secreted, so there is no problem of joint and ligament relaxation. Therefore, as long as the mother engages in more pelvic-related exercises during the postpartum period to strengthen muscles and bones, the size of the pelvis can return to the pre-childbirth state. However, if it is ignored, the pelvis will become larger, leading to changes in body shape.

　　However, many unmarried and childless women also have problems with a larger or deformed pelvis. In fact, this is mainly caused by their poor posture and habits in daily life, which accumulate over time and lead to a crisis of pelvic deformation. This includes crossing legs, wearing high heels for long periods, sleeping on too hard or too soft a mattress, and wearing tight clothing, among other things. The specific introduction is as follows:

　　1. Wearing high heels

　　Wearing high heels can make a woman's back straight, the arch of the foot raised, and the legs look more slender. However, experts have found that high heels can increase the burden on the ankle and knee bones, making the muscles in the legs and pelvis prone to fatigue.

　　2. Crossing legs

　　Many women like to cross their legs, but when they do, due to the long-term pressure on the pelvis and hip joints, they are prone to soreness. Over time, the pelvis may subtly misalign without notice, and there may also be skeletal deformities or muscle injuries. Experts suggest that people who sit for long periods should maintain a correct sitting posture, keep the waist straight, the knees naturally bent, and keep the feet on the ground.

　　3. Too soft or too hard mattress

　　Too soft of a mattress can cause the body to sink during sleep, while too hard a mattress can exert pressure on the heavier pelvic area, both of which can lead to pelvic misalignment. The ideal bedding should be moderately soft and hard, allowing the body's curves to fully fit into the mattress when lying on the back, with the head, chest, and pelvis together providing horizontal support for the spine.

　　Pelvic deformation is prone to cause curvature of the spine, compressing the nerves, causing dysfunction of the muscles, joints, and organs. Many people's troubles such as back pain, shoulder ache, and other visceral diseases are rooted in pelvic deformation.

　　Pelvic deformation will make the blood circulation and metabolism of the lower body worse, making it easy for the lower body to accumulate excess fat, the waist to become loose, and the buttocks to become larger.

　　Pelvic deformation can cause muscle imbalance on both sides of the lower abdomen, making one side of the lower abdomen明显突出, and this protrusion cannot be restored by any diet or exercise.

　　Pelvic deformation can also lead to various gynecological diseases, and in severe cases, it can even increase the difficulty of childbirth.

　　1. Narrowness of the pelvis entrance plane is more common in Chinese women. The measurement of the sacroiliac diameter commonly shows the following two types:

　　(1) Simple flat pelvis.

　　The pelvis entrance is round and flat, with the sacral promontory protruding forward, shortening the anteroposterior diameter of the pelvis entrance while keeping the transverse diameter normal.

　　(2) Rickets-type flat pelvis: Due to the softening of the bones caused by rickets in childhood, the pelvis deforms, the sacral promontory is pressed forward, and the anteroposterior diameter of the pelvis entrance is significantly shortened. Due to the outward expansion of the ilium, the intertrochanteric diameter is equal to or greater than the interspinal diameter; due to the outward flip of the ischial tuberosity, the angle of the pubic arch increases, and the transverse diameter of the pelvic outlet becomes wider.

　　2. Narrowness of the middle pelvis and pelvic outlet plane

　　(1) Funnel-shaped pelvis: The values of the pelvis entrance are normal. Due to the inward inclination of the two sides of the pelvis wall, it resembles a funnel, hence the name funnel-shaped pelvis.

　　1. Change bad habits and avoid pelvic deformation

　　Don't underestimate these bad habits in daily life. Only by starting from the smallest things can you build your perfect pelvis.

　　2. Wear fewer high heels

　　High heels can make our feet arch elegantly, making our legs look longer. However, due to the certain height of the heels of high heels, they cause the body to tilt, increasing the burden on the legs and pelvis, causing the pelvis to tilt as well. Over time, it may even cause the pelvis to shift, making it easy to cause anteversion of the uterus, leading to irregular menstruation and increasing the chance of infertility. If you have to wear high heels, the time you walk in high heels every day should not exceed two hours, and the heel height should be about 3 centimeters, preferably not more than 5 centimeters.

　　3. Do not sit cross-legged

　　When crossing your legs, the pelvis and hip joints are prone to pain due to long-term pressure, and the pelvis may subconsciously tilt over time. It is best to avoid sitting for a long time and to get up and move around every hour. People who sit for a long time should also maintain correct posture, keep the waist straight, the knees naturally bent, and keep both feet on the ground.

　　4. Do not sit cross-legged on the floor

　　Sitting on the floor is more likely to cause distortion of the body's bones than sitting on a chair. Especially the kneeling posture with both legs bending outward is particularly bad, as it is easy to deform the pelvis.

　　5. Do not sleep on a too soft or too hard mattress

　　Sitting on a too soft bed will cause the waist to sink, and sitting on a too hard bed will exert pressure on the pelvis, both of which can cause pelvic deformation. The ideal bed should be moderately soft and hard, and our body curve should be completely embedded in the mattress when we lie on our back, providing horizontal support force for the spine together with the head and face, chest, and pelvis.

　　6. Do not entrust the correction task to the corset

　　Corset can correct pelvic deformation to a certain extent, but do not entrust the correction task entirely to it, because wearing tight-fitting corrective underwear frequently can cause gynecological inflammation due to tight binding of the lower body.

　　7. The pelvis has two diameters in structure, the anteroposterior diameter is short and the transverse diameter is wide, which is conducive to the passage of the fetus and can be naturally delivered. If the pelvis is narrow by nature, the anteroposterior diameter is long and the transverse diameter is narrow, it will be difficult for the fetus to be delivered in the future, and cesarean section can be chosen. The composition of the pelvis is nothing more than bone, and strong bones make the pelvis less likely to be damaged, so some foods that increase bone density are listed as healthy for the pelvis. Calcium-rich milk, AD calcium milk, fish, shrimp, oysters, egg yolks, walnuts, hazelnuts, etc. are rich in calcium and trace elements such as selenium, magnesium, zinc, and iron. It is not bad to eat more of them in daily life.

　　First, five-step self-test for pelvis deformation

　　1. Feel your lower waist with your hands, whether one side is fat and the other side is thin.

　　2. Lie on your back with your face up on the bed, relax your lower limbs, and see if the angle of inclination of the ankles on the left and right sides is inconsistent.

　　3. Lie flat on the bed on your back, see if the waist is floating. The distance from the waist to the middle of the bed is whether an object the size of an egg can be placed.

　　4. Look at your lower waist in front of the mirror, do the two sides have asymmetry, such as whether the knee joints are prominent, and whether the two buttocks are the same size.

　　5. Look from the side to see if the curve of the waist and buttocks is too large (the buttocks look particularly prominent from the side, and the waist curve is particularly large at the back).

　　Second, professional detection of pelvis deformation and dystocia

　　1. Medical history: Inquire about the history of rickets, poliomyelitis, tuberculosis of the spine and hip joints, and trauma in childhood. If she is a multipara, it should be understood whether there is a history of difficult labor and its cause, and whether the newborn has birth injuries, etc.

　　2. General examination: Measure height, if the pregnant woman's height is below 145cm, be alert to the possibility of a small pelvis. Pay attention to observe the pregnant woman's body shape, whether there is a limp, whether there are deformities of the spine and hip joints, whether the Misch's diamond fossa is symmetrical, and whether there are sharp abdomen or pendulous abdomen, etc.

　　3. Abdominal examination

　　(1) Abdominal shape: Pay attention to observe the abdominal shape, measure the length of the uterus above the pubic symphysis and the abdominal circumference, use B-ultrasound to observe the relationship between the presenting part of the fetus and the pelvis, and also measure the biparietal diameter, chest diameter, abdominal diameter, and femur length of the fetal head to predict the fetal weight and judge whether it can pass through the birth canal smoothly.

　　(2) Abnormal fetal position: Narrow pelvis entrance often leads to malpresentation due to mismatch between the pelvis and the fetal head, making it difficult for the fetal head to enter the pelvis, resulting in abnormal fetal position, such as breech presentation or shoulder presentation. Narrow middle pelvis affects the internal rotation of the fetal head that has entered the pelvis, leading to persistent occipitotransverse position or occipitoposterior position.

　　(3) Estimating the maternal-fetal relationship: Normally, some primigravid women should have the fetal head enter the pelvis 2 weeks before the expected delivery date, and multiparous women should have the fetal head enter the pelvis during labor. If labor has started but the fetal head has not entered the pelvis, the maternal-fetal relationship should be fully estimated. The specific method of checking whether the maternal-fetal relationship is appropriate is: the pregnant woman should empty her bladder, lie on her back, and stretch her legs. The examiner places their hands above the symphysis pubis and pushes the floating fetal head towards the pelvic cavity. If the fetal head is below the level of the symphysis pubis, it indicates that the fetal head can enter the pelvis, the maternal-fetal relationship is appropriate, and it is called a negative Cephalopelvic Index (CPI); if the fetal head is at the same level as the symphysis pubis, it indicates a suspicious CPI, called a可疑positive CPI; if the fetal head is above the level of the symphysis pubis, it indicates a明显inappropriate CPI, called a positive CPI. For pregnant women with a positive CPI, they should be asked to assume a semi-recumbent position with their legs bent, and the CPI should be checked again. If it turns negative, it suggests an abnormal pelvic tilt rather than an inappropriate maternal-fetal relationship.

　　4. Pelvic measurement

　　(1) External pelvis measurement: The pelvis is oblique when any of the external measurements deviate by 1 cm.

　　(2) Intra-pelvic measurement: If abnormalities are found in the measurement of the lateral pelvis, intra-pelvic measurement should be performed. Diagonal diameter

　　　Food to be eaten: Calcium-rich foods such as calcium milk, AD calcium milk, fish, shrimp, oysters, egg yolks, walnuts, hazelnuts, etc., which are rich in trace elements such as selenium, magnesium, zinc, and iron.

     Management of difficult labor due to abnormal pelvis: For those with severe narrow pelvis or deformity, it is difficult for a full-term live fetus to pass through, and cesarean section should be performed in a timely manner. For those with mild or critical narrow pelvis at the pelvis entrance, whether to try labor should be decided according to the size and position of the fetus. Generally, labor should be tried for 6-8 hours. If the amniotic membrane breaks prematurely or the fetal head does not descend, or there is no obvious progress in labor, waiting should not be continued. Narrowness in the middle pelvis and outlet plane often coexist. When there is mild or critical narrowness in the middle pelvis, labor should be approached with caution, and the second stage of labor should not exceed 2 hours, otherwise, it will pose great harm to both the mother and the child. Significant narrowing of the transverse diameter of the outlet, or the sum of the transverse diameter of the outlet and the posterior sagittal diameter is less than 15 cm, cesarean section should be performed for full-term fetus. If the sum of the transverse diameter of the outlet and the posterior sagittal diameter is greater than 15 cm, the majority of the fetus's presenting part is posteriorly shifted, and it can be delivered through the triangular space behind the outlet, and a larger perineal lateral incision should be made to prevent severe perineal laceration.