No subject in medicine presents greater difficulties in all its aspects than this one, (treatment of contracted pelves) and none demands such art or practical skill. Science aids little here. P. 709.
Outside factors must also be considered: 1—The environment, whether the parturient is in a squalid tenement, in the country, in a home where every appliance is attainable, or in a well equipped maternity. 2—Whether in the hands of a general practitioner or a trained specialist. 3—If the patient is a Catholic, all medically indicated procedures not being permitted. 4—The age of the parturient, and the probability of her having more children. Even with these enumerations, the possible factors which might influence a labor, or our decision regarding the course to pursue have not all been mentioned. P. 709.
THE PRACTICE OF OBSTETRICS. Designed for the use of Practitioners and Students of Medicine. J. Clifton Edgar, Professor of Obstetrics and Clinical Midwifery in the Cornell University Medical College. Visiting Obstetrician to Bellevue Hospital, New York City; Surgeon to the Manhattan Maternity Dispensary; Consulting obstetrician to the New York Maternity and Jewish Maternity Hospitals. 5th Edition, Revised. P. Blakiston’s & Co., Phila.
A knowledge of the female bony pelvis is the very alphabet of obstetrical science, and the foundation of obstetrical art. This structure is most important since it is from the disproportion between its size and that of the fetus, or from its abnormal shape that many of the difficulties of labor arise.
PRACTICAL OBSTETRICS. Thos. Watts Eden. Obstetrician; Physician and Lecturer on Midwifery and Gynecology, Charing Cross Hospital; Consulting Physician to Queen Charlotte’s Lying-in-Hospital; Surgeon to In-Patient Chelsea Hospital for Women. 4th Edition. C. V. Mosby Co. 1915.
The general course of labor is modified by pelvic contractions in various ways. 1—Abnormal presentations are three or four times commoner in contracted than in normal pelves. 2—Prolapse of the cord is much commoner than in normal pelves. 3—When natural delivery occurs labor is prolonged and the mechanism is modified. 4—Unless the true conjugate is at least 3¼ inches, even with artificial aid the survival of the child is seriously jeopardized. 5—The maternal risks are increased by the greater length and difficulty of the labor and by the frequent necessity of employing artificial methods of delivery. 6—The fetal risks are increased in natural delivery by severe compression of the head during its passage through the narrow pelvis, and other circumstances by the operations required to effect delivery, some of which involve the destruction of the fetus. P. 409.
THE PRACTICE OF OBSTETRICS. In Original Contributions by American authors. Edited by Reuben Peterson, A.B., M.D. Lea Bros. & Co., Phil. and New York. 1907.
Labor complicated by anomalies of the Bony Pelvis. John F. Moran, M.D.
The frequency with which pelvic contraction occurs can only be determined with relative accuracy. There is in existence a comparatively large amount of statistical data on this subject, but the reports of different investigators vary within wide limits, and these variations are naturally not to be explained entirely on the assumption of racial conditions, or geographic distribution. Between these wide limits are arrayed the figures of about 20 modern observers in different parts of the civilized world who have reported statistics of cases. The combined figures of 19 observers include a total of over 150,000 cases examined for pelvic contraction. In these cases the average of contraction is found to be about 10%. Williams concludes that contracted pelves occur in from 7% to 8% of the white women of this country. P. 658–659.