When necessary to effect Miscarriage or Artificial Delivery.
During pregnancy, deformities of the pelvis become objects of solicitude to the accoucheur, when they are of such a character as to render delivery at full term impossible without the interference of cutting operations. At this period only can he guard against the deplorable consequences of these deformities.
Pelvic Deformities.
The accoucheur may be consulted by a mother anxious to know whether the pelvis of her daughter is such as to justify marriage. His opinion may also be desired by a female pregnant for the first time, in whose mind there may exist fears as to the formation of her pelvis. In this case, he will have to reply to the following questions:
Is delivery at full term compatible with the safety of the child? What influence will the deformity have on pregnancy? What precautions are necessary to guard against accident until the completion of gestation, and to facilitate delivery?
When the accoucheur states that delivery will not be possible without the interference of art, he will then be asked whether this interference will compromise the life of the mother or child; and whether this operation cannot be avoided by some process during pregnancy, either saving the life of mother and child, or sacrificing the child for the benefit of the mother?
In order to answer these questions satisfactorily, and to furnish himself with a rule of conduct in advance, it will be necessary for the accoucheur to know precisely the condition of the pelvis, and the dimensions of the diameters, &c.
However, it must not be supposed that this mensuration can be made with mathematical accuracy; our means will not enable us to obtain this precision; but even if we could, the object we have in view would not be completely accomplished, for, in order to arrive at a rigorous appreciation of the consequences of the deformity and the operations it might require, it would be necessary also to know the exact size of the fœtus, which is not possible.
Happily, in practice, an approximation as to the absolute condition of the pelvis will suffice, and it is easy to arrive at this result. With this view, the accoucheur should, in the first place, learn the previous history of the patient in infancy and youth, and afterward proceed to an external and internal examination.
When the accoucheur is called upon to pass an opinion as to the natural or unnatural conformation of a female, he should, says M. P. Dubois, inquire minutely into the antecedent condition of this woman during her infancy and youth. The history of early life will often, of itself, cause him to suspect the state of the pelvis. He should address the following questions to the parent: