PELVIMETRI

 PENGERTIAN
Pemeriksaan dengan menggunakan sinar-X
sebagai salah satu metode yang tepat untuk
menaksir hubungan antara panggul ibu dengan
kepala fetus
 TUJUAN
– Menentukan Ukuran panggul ibu
– Menentukan proporsi ukuran panggul ibu
thd kepala janin
 DASAR ANATOMIS
– Pintu Masuk panggul
– Pintu tengah panggul
– Pintu keluar/bawah panggul
Pelvic Type
 Gynecoid

 Android

 Antropoid

 Platypelloid
 UKURAN PANGGUL

 PINTU MASUK PINTU

PANGGUL TENGAH
– Diameter AP PANGGUL
• Jarak  Diameter AP
promontorium & – Jarak tepi
tepi dalam atas bwh
simpisis pubis simp.pubis
– Diameter Oblik dengan tepi
• Jarak
bwhs
sakrum
art.sakroiliaka &
eminensia  Diameter
iliopektina Oblik
– Diameter  Diameter
Transversa Transversa
• Jarak terpanjang
– Jarak kedua
antara 2 titik
tuberiskium
masuk
– Diameter  Diameter
Sakrokolitloidea sagitalis
• Jarak posterior
promontorium dg – Antara
salah satu tuberum &
eminentia ujung
ileopektina sakrum
 PINTU KELUAR/BAWAH
PANGGUL

 DIAMETER AP
– Jarak antara tepi bawah simpisis
& tepi bawah sakrum

 DIAMETER OBLIK
– Sejajar dg pintu masuk panggul
 DIAMETER TRANSVERSA
– Jarak antara kedua tuberiskiadium
& kedua spina iskiadika
 DIAMETER SAGITALIS
POSTRIOR
– Jarak antara tuberum & ujung
tulang sakrum
UKURAN PANGGUL YANG
ADEKUAT

 Collea dkk :
– PAP : Ø transversal 11,5cm & Ø AP
10,5 cm.
– PTP : Ø bispinosus 10,5 cm & Ø
AP ≥ 11 cm.

 Russel & Richards

- PAP: Ø AP > 11 cm, Ø Transversal >11,5cm
- PBP: Ø AP > 10 cm, Ø Interspinosus > 9 cm

 Ø Intertuberositas (bituberal) > 10,4 cm

INDIKASI Pelvimetri

 Disproporsi Kepala janin dan

lebar panggul
 Distocia : kesulitan persalinan
karena :
– Kelainan jalan lahir
– Panggul semit
– Tumor-tumor yg mempersempit
jalan lahir.
KESEMPITAN PANGGUL ADA
3:
– Sempit pintu atas
– Sempit pintu tengah
– Sempit pintu bawah
PERSIAPAN Pelvimetri

 ALAT:
– Pesawat Sinar-X kemampuan
cukup
– Kaset & Film
– Bucky
– Marker
– Alat Fiksasi
– Pelvic Caviter
– Water pass
– Penggaris
 PASIEN:
– Bila mungkin, dilakukan
pembersihan perut
– Minimal Buang air kecil
 TEKNIK RADIOGRAFI
Pelvimateri
METHODE THOMS
 PROYEKSI INLET
– Posisi Pasien :
• Duduk dg kmiringan sandaran kursi 50 derajat
• Palpasi untuk menentukan titik Lumbl IV & V
(marker)
• Pasien diatur diatas platform

– Posisi Obyek
• MSP pada pertengahan platform
• Posisi pasien setengah duduk
• Pelvic inlet diatur sehingga paralel bidang film
• Kaki pasien diregangkan dengan genu untuk
imobilisasi
• Rongga panggul dipusatkan pada 2,5 inci
posterior pubis
• Atur lengan pelvic caviter belakang pd Lumbal
IV & V, Lengan Pelvic caviter depan pada titik 1
cm di tepi atas simpisis pubis.

– Film : 24 x 30 cm
– Arah Sinar : vertikal
– CP : pada MSP tepat pada titik 2,5 inchi
posterior simpisis pubis
– Eksposi : Inspirasi & Tahan nafas
Thoms tools
Ap Thoms projection
PROYEKSI LATERAL Thoms
 Posisi Pasien :
– Berdiri posisi lateral kanan
– Kedua kaki lurus, semua berat badan sama pada kedua kaki
– Kedua lengan disilangkan keatas

 Posisi Obyek:
– Dengan palpasi, tentukan titik yang berada pada L –V
sebagai tiitk bidik penyinaran
– Hip yang dekat film menempel bucky stand. Bucky Stand
diatur sehingga titik tengah film pada titik yang telah
ditentukan.
– Atur hingga garis antara titik L-V dengan film dan
pertengahan labi dan film sama
 Arah Sinar
– Horisontal tegak lurus

 Titik Bidik
– Titik yang beraa pada sepertiga jarak antara simpisis pubis
dengan lekukan di bawah vertebta Lumbal V yang dihitung
mulai dari arah posterior yang beraa pada pertengahan
daerah lekukan panggul.

 FFD: 90 cm
 Eksposi : Ekspirasi dan tahan nafa
 Kriteria :
– Sakrum, lekukan sakroiliaka
– Spina iski dan tuberositas isiadika
– Asetabulum
– Batas depan dan belakang simpisis pubis
– Gambaran lubang skala cm yang berupa titik hitam yang
terlihat di belakang sakrum
Lateral Thoms
Projection
COLER SUSMAN
PROJECTION
Prinsip :
•Metal ruler perforated at centimeter
interval
•Mounted on a small stand in such a
way that is paralele with plan film
•Ruler can be rotated in a complate
circle ang can be adjusted for high
AP Colcher Susman
 Patient :
– Supine position
– MSP of the body to the midline of table
– Flex the knees to elevate the forepelvis
& separate the thigh enough to permit
corrrect placement of the pelvimeter
 Object :
– Turn the ruler transverly and center in
to gluteal fold at the level of the ischial
tuberosity
– The tuberosity are easily palpated
through the median of the buttock,and
placing the ruler 10 cm below the supor
border simpisis pubis
 AP Colcher con’t
– After determining that the fetus is quiet,
instruct the patien to suspend respiration at
the end inhalation for the exposure
 Central Ray :
– Direct the & perpendicular to the mid point
of the film 1,5 inci supor simp.pubis
 Center Point :
– Center the film 1,5 inci (3,7 cm) supor to the
sip.pubis
LATERAL COLCHER
•Patient :
•Patient turn to lateral position
•Center midaxxilary line of
patient’s body to midline of table
•Partially extend the thigh so they
will not obscure the pubic bones
•Object :
•Place sandbag under & between
the knees & ankles to immobilize
the legs
•Place a folded shet or other
suitable support under the lower
thorax & adjust the support so
long axis of the lumbar vert is
paralel with tabletop.
•Adjust the body in true lateral
position
• Turn the ruler lengthwise and
adjust is height to coincide with
midsagital plae of the patrient’s
body.
• Place the pelvimeter so metal
ruler lies within the upper of the
gluteal fold and against the
midsacrum
CENTRAL RAY :
Direct , perpendicular to the most
prominent point of the greater
trochanter
CENTER POINT :
• Center the casseteat the level of
most prominent point of the
greater trochanter.
• Respiration is suspended at the
end inhalation
Methode BALLS
 Requires no special apparatus or
accessories in exposing the films.
 The examintaion normally consist two
images :
– AP
– Lateral
With the film centered at the level of tip of xipjoid
process
 For radiographic measurement of the fetal
head and maternal pelvis, the degree of
image magnification is composated for
sinply by adjusting the movable arm of the
calculator to the correct pointon the anode
film distance
 Utilizies the effect Gravity on the fetus
 The erect positions discloses any
displacement of the fetus
AP PROJECTION
 Patient :
– Erect , center the MSP plane the body to the
midline of the vertical grid device
– The cassete is placed crosswise to include the
greater trochanter.
 Object :
– Adjust the height of the device so the lower
boder of the cassete will be about 1 inci (2,5
cm) below thec level the ischial tuberositas
(gluteofemoral fold is a convenient landmark)
– Have the patstand straight, with the weight of
the body equaldistributed on the feet
– CENTRAL RAY :
• Exposed the film , perpethrough the midsagital
plae at the level superior margin of the simpisis
pubis
• Respiration : suspended at the end of inhalation
after determining that fetus is queit
AP Balls
LATERAL BALLS
 Patient :
– Have patient turn from AP to true lateral postion
– Place The cassete lengthwise to include the fundus
uterus’The height of the vertical grid device is not
changed
 Object :
– Adjust position of the body so the postor margin the
gluteus is barely incleded on the lateral border the
film
– This Position places the hip joint slightly to one side
of the midline of the vertical grid device.
– Instruct the patient to stand stright with the weight of
the body equally distributed on the feet
 Central Ray
– Shift the tube laterally so the central ray passes
through the upper margin of the hip joint.

 Center Point :
– It enter the body about 1 inci above margin the supor
margin of the greather trokanter
– Respiration : suspended at the end of inhalation after
determining that the fetus is queit
Lateral Balls
Normogram Holmquist u/ Metode
Ball
Pelvimetri Measurement
SID

 X = FOD
U FFD
X = FOD x U
FFD
FOD = SID – OFD
X = ukuran sebenarnya bidang
panggul yg diukur
U = ukuran bidang panggul
radiograf