In those cases of funnel-shaped pelvis which we have had the opportunity of observing, perforation has been ultimately required, although the head had passed easily through the brim and entered the cavity; in one of these we have subsequently used the artificial premature labour with success.
We have already stated the doubtful utility of arranging cases of deformed pelvis according to their degree of contraction, and of classifying the different modes of treatment by such a scale; still, however, there must be certain limits beyond which it will be impossible to make the child pass, even when diminished by embryotomy. To draw the precise line of demarcation, however, will be nearly if not quite impossible; and, as in cases of slighter deformity, we must take many other circumstances into consideration which we have already mentioned. An inch and a half from pubes to sacrum has been mentioned by many as the extreme degree of contraction through which a full grown child can be delivered by embryulcia; generally, however, in these cases of unusually deformed pelvis, there is much more space on each of the sacrum; and on this, in great measure, will depend the possibility of effecting the delivery. The celebrated case of Elizabeth Sherwood, which Dr. Osborn has recorded, and where he succeeded in delivering the child, although the antero-posterior diameter “could not exceed three-quarters of an inch,” has been looked upon as being of doubtful accuracy, and that Dr. Osborn had unintentionally deceived himself. When, however, we learn that on the right side of the sacrum the antero-posterior diameter was an inch and three-quarters, the incredible nature of the case diminishes considerably, the more as the patient was examined by Dr. Denman and others who fully coincided with Dr. Osborn’s statements. To assert that in this case the antero-posterior diameter was only three-quarters of an inch, as many have done, is evidently incorrect, and tends to throw doubt upon it: the case was evidently the closest possible approach to the limits requiring the Cæsarean operation; its success was mainly attributable to the gradual manner in which it was performed; the child had become completely soft and flaccid from putrefaction, and was thus more capable of being moulded to the contracted passage.
CHAPTER V.
FIRST SPECIES OF DYSTOCIA.
Obstructed Labour from a Faulty Condition of the soft Passages.
Pendulous abdomen.—Rigidity of the os uteri.—Belladonna.—Edges of the os uteri adherent.—Cicatrices and collosities.—Agglutination of the os uteri.—Contracted vagina.—Rigidity from age.—Cicatrices in the vagina.—Hymen.—Fibrous bands.—Perineum.—Varicose and œdematous swellings of the labia and nymphæ.—Tumours.—Distended or prolapsed bladder.—Stone in the bladder.
In speaking of the uterus itself as a cause of this species of dystocia, we only mention it here as one of the soft passages, not as the organ by the contractions of which the child is expelled; we merely refer to those faulty conditions of the uterus which produce an impediment to the child’s progress, not to those which interfere with the natural condition of its expelling powers, as this will be considered under the next division of dystocia.
We have already stated our disbelief that an oblique position of the uterus can have any influence in producing malposition of the child. With the exception of extreme anterior obliquity, or pendulous belly, we equally doubt that it can have any effect in retarding the labour when the child presents naturally. The highest authorities in midwifery during the last hundred years unite in asserting that this celebrated opinion of Deventer, was a misconception.