Contracted Pelvis Research Articles

A statistical study of the incidence and treatment of labor complicated by contracted pelvis in the obstetric service of the Johns Hopkins hospital from 1896 to 1924

E in his career the senior author became interested in the study of contracted pelvis, as shown by the fact that one of his earliest publications was entitled "Pelvimetry for the General Practitioner." When the obstetric department of Johns Hopkins was organized in October, 1896, opportunity was afforded for developing that interest, with the result that the pelvis of every patient has been carefully and accurately measured, and the rule was laid down that the final measurements recorded in the histories must be made either by the chief or his substitute, or by the resident obstetrician (who has had three years of practical training before assuming the post). Consequently, the pelvic diagnoses are reasonably accurate. It was soon found that our material was especially suitable for the study of the question on account of the large negro population of Baltimore, with its unusual incidence of abnormal pelves; and as the service continued to increase in size the number of negro patients became disproportionate to their share of the population, and latterly we have deliberately allowed it to exceed that of the white patients. For this reason, we have been able to study the conditions in the two races concurrently and to establish certain important and fundamental differ-

Trial labor in the treatment of 477 cases of contracted pelves: Conducted under one plan of treatment during the last four years

Trial labor in the treatment of 477 cases of contracted pelves: Conducted under one plan of treatment during the last four years

A clinical consideration of the contracted pelvis

A clinical consideration of the contracted pelvis

Clinical consideration of the contracted pelvis: Dr. H. C. Burgess, Montreal, Que., (by invitation) presented a (For original article see page 739)

Clinical consideration of the contracted pelvis: Dr. H. C. Burgess, Montreal, Que., (by invitation) presented a (For original article see page 739)

Three Lectures ON CONTRACTED PELVIS: Delivered in the University of London, for Advanced Students

Three Lectures ON CONTRACTED PELVIS: Delivered in the University of London, for Advanced Students

Three Lectures ON CONTRACTED PELVIS: Delivered in the University of London, for Advanced Students

Three Lectures ON CONTRACTED PELVIS: Delivered in the University of London, for Advanced Students

Three Lectures ON CONTRACTED PELVIS: Delivered in the University of London, for Advanced Students

Three Lectures ON CONTRACTED PELVIS: Delivered in the University of London, for Advanced Students

CESAREAN SECTION

The indications for cesarean section can be divided into two classes: (1) the absolute, in which there is no question of choice, and (2) the relative, in which a choice of methods of delivery exists, but cesarean section seems to give the best chance of safety for both mother and child. The absolute indications are comparatively simple: (1) a contracted pelvis, with a conjugate at the brim of less than 7 cm., or with other measurements so small that delivery could be accomplished in no other way; (2) complete obstruction of the pelvic canal by a fibroid tumor, ovarian cyst or tumor of the sacrum; (3) a gigantic child, whose head will not engage in the pelvic inlet and whose anterior parietal eminence projects well beyond the symphysis. In all these' cases, safe delivery by methods other than cesarean section is out of the question. It must be remembered, however,

The conduct of labor in contracted pelves: Schmitt: Zeitschrift fu¨r Geburtshilfe und Gyna¨kologie, 1921, lxxxiii, 366

The conduct of labor in contracted pelves: Schmitt: Zeitschrift fu¨r Geburtshilfe und Gyna¨kologie, 1921, lxxxiii, 366

Cæsarean Section performed for a slightly contracted Pelvis combined with a Recto‐Vaginal Fistula

BJOG: An International Journal of Obstetrics & GynaecologyVolume 28, Issue 3-4 p. 546-547 Cæsarean Section performed for a slightly contracted Pelvis combined with a Recto-Vaginal Fistula William Fletcher Shaw M.D., Ch.B. (Vict.), William Fletcher Shaw M.D., Ch.B. (Vict.) Lecturer in Gynæcology and Obstetrics, Manchester University; Hon. Assist. Gynæcologist, Manchester Royal Infirmary; Senior Hon. Assist. Surgeon for Women, St. Mary's Hospital, ManchesterSearch for more papers by this author William Fletcher Shaw M.D., Ch.B. (Vict.), William Fletcher Shaw M.D., Ch.B. (Vict.) Lecturer in Gynæcology and Obstetrics, Manchester University; Hon. Assist. Gynæcologist, Manchester Royal Infirmary; Senior Hon. Assist. Surgeon for Women, St. Mary's Hospital, ManchesterSearch for more papers by this author First published: September 1921 https://doi.org/10.1111/j.1471-0528.1921.tb16155.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume28, Issue3-4September 1921Pages 546-547 RelatedInformation

The treatment of contracted pelves

The treatment of contracted pelves

CERVICAL IMPLANTATION OF THE PLACENTA WITH RUPTURE OF THE UTERUS

Any investigations which throw light on the causation or treatment of that greatest of obstetrical calamities, rupture of the uterus, are of importance to the obstetrician, the surgeon and the general practitioner. The most frequent causes of this condition are obstructions to the descent of the fetus, with neglect of the procedures necessary for delivery of the child, as in patients treated by midwives or by the laity. Such obstructions are often in the form of contracted pelves, or tumors of the pelvis encroaching on the parturient canal. A normal fetal head of large measurements or a hydrocephalic head may cause obstruction by failure to enter a normal pelvis. Malpositions of the fetus, as a transverse position with a shoulder presentation, lead invariably to obstruction unless properly cared for. Rupture of the uterus has been the direct result of manipulations, as attempted versions or the use of the hand or

THE INDICATIONS FOR, AND TECHNIQUE OF, CÆSAREAN SECTION: AND ITS ALTERNATIVES, IN WOMEN WITH CONTRACTED PELVES, WHO HAVE BEEN LONG IN LABOUR AND EXPOSED TO SEPTIC INFECTION. 1

THE INDICATIONS FOR, AND TECHNIQUE OF, CÆSAREAN SECTION: AND ITS ALTERNATIVES, IN WOMEN WITH CONTRACTED PELVES, WHO HAVE BEEN LONG IN LABOUR AND EXPOSED TO SEPTIC INFECTION. 1

THE DELIVERY OF DEBILITATED WOMEN, WITH ESPECIAL REFERENCE TO THE INTEREST OF THE CHILD.

No statement is more true than the old remark that natural labor is a spontaneous and successful process which prohibits interference. The universal application of this remark to obstetric practice without discrimination has cost the lives of many mothers and children. If there had been added to the foregoing sentence the phrase anatomically and physiologically perfect individuals, the statement would have remained unchallenged. Pathologic conditions, inherited or acquired, and largely the products of modern life, have made a perfectly natural labor a rare occurrence, because anatomically and physiologically perfect individuals seldom exist. We recognize in obstetric pathology certain abnormalities easily diagnosticated, and therefore not especially dangerous for the patient; such, for example, is a highly contracted pelvis, especially if accompanied by manifest deformity in other portions of the skeleton. The presence of a large abdominal or pelvic tumor complicating pregnancy draws attention to the impossibility of spontaneous labor. A

MANUAL AND INSTRUMENTAL DILATATION OF THE PREGNANT AND PARTURIENT CERVIX.

Most of the graver obstetric operations find their necessity in the difficulty or impossibility of overcoming two barriers to delivery by the natural passages. The first of these is the resistance offered by the bony pelvic inlet and the second the obstruction of the cervix. Leaving out of consideration for the moment the causes of fetal dystocia, I believe that, broadly speaking, the most important factor in maternal dystocia is in the large proportion of instances of this second barrier to the progress of delivery, namely, the barrier of the cervix. Unlike the barrier presented by a contracted pelvis, this barrier of the cervix is always present; and although it is true that in physiologic labor it is readily and safely removed by the natural efforts, it is, I firmly believe, equally true that unfortunate results for both mother and child are far oftener the consequence of non-dilatation or unsatisfactory

CESAREAN SECTION FOR PLACENTA PRÆVIA AN IMPROPER PROCEDURE.THE STATISTICAL STUDY OF 25 REPORTED CASES WITH THE COMPARATIVE MORTALITIES OF 1,257 CASES OF CESAREAN SECTION AND 4,731 CASES OF PLACENTA PRÆVIA TREATED OBSTETRICALLY.

On account of the marvelous results obtained by asepsis and antisepsis, and by the safe administration of anesthetics, obstetrics is becoming an inviting field for surgical intervention. Indeed, operative obstetrics has so broadened in the past decade that now the care of parturient women is a distinct surgical specialty, and its wealth of literature vies with that of other specialties. In fact, in certain directions, it almost seems as if the<i>furor operativus</i>which swayed the ovariotomist one and two decades ago, has seized those who come in contact with pregnant and parturient women. Operations which are safe and expedient when performed for one type of indications are applied erroneously to complications of a very different sort; deductions made from one class of cases are fallaciously made to fit another without due consideration of the consequences. The application of the Cesarean section to placenta prævia comes within this category. It is folly to compare the results of Cesarean section for a contracted pelvis with those of placenta

THE MAJOR OBSTETRICAL OPERATIONS.

<h3>GENERAL PRINCIPLES.</h3> The recent advances in the study of the contracted pelvis, and the possibility of saving fetal life in such cases, by the extension of the major operations to a wider field, have as yet been confined too exclusively to the practice of professed obstetricians, and too little popularized among the great mass of the profession; perhaps because it has been thought by manv that the technicalities involved in the detection of contraction are too great for the general practitioner's use, and probably because there is still too much credence for the former erroneous idea of the comparative scarcity of contraction in America. This belief must, however, now be given up. The results of all those who have recently investigated the subject having vielded about the same percentages of contraction, namely, about 11 per cent., if we except the negroes, in whom it rises to nearly 20 per cent.

Art. XXXVII.—What is the best Treatment in Contracted Pelves?

Art. XXXVII.—What is the best Treatment in Contracted Pelves?

Version in contracted pelvis

Version in contracted pelvis

Case of Turning, instead of Craniotomy, in a contracted Pelvis

Case of Turning, instead of Craniotomy, in a contracted Pelvis