Frequency, etiology and practical significance of contractions of the pelvic outlet / by J. Whitridge Williams.

  • Williams, J. Whitridge (John Whitridge), 1866-1931.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Frequency, etiology and practical significance of contractions of the pelvic outlet / by J. Whitridge Williams. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the pelvimeter may be moved in any direction, while that of the straight one remains in rela- tion with the axis of the horizontal bar (Fig. 5). When it is desired to use the instrument the patient lies upon her back with the leg flexed and the buttocks protruding sufficiently far beyond the edge of the table to render the lower end of the sacrum readily accessible. By palpation the operator then determines the location of the transverse diameter, upon which the assistant places the horizontal bar of the pelvimeter and maintains it in position with two fingers, at the same time making sufficient pressure to keep its axis in accurate correspondence with the transverse diameter. Naturally the amount of pressure will vary considerably according to the thickness and elasticity of the perineal region. In thin women with a flabby pelvic floor practically no force is required, while in stout women with a thick and resistant perineum deep and firm pressure will' be necessary. After the hori- zontal bar has been placed in position the operator palpates the lower portion of the sacrum, and after having determined the lo- cation of tis tip, and depresses the pelvimeter so as to bring the tip of the curved blade in close relation with its posterior surface. The distance is then read off upon the scale, and the measurement obtained represents the length of the posterior sagittal diameter, plus the thickness of the lower part of the last sacral vertebra and the skin covering it. A deduction of one centimeter is usually sufficient to give the actual length of the diameter, although when the bone is unusually thick it may be necessary to deduct ij cm. More- over, in the exceptional cases in which the coccyx is anchylosed, the measurement must be made to the tip of the coccyx, instead of the tip of the sacrum. In order to measure the anterior sagittal diameter, the entire pelvimeter is rotated about the horizontal bar so as to bring the curved blade anteriority, after which the lower margin of the symphysis pubis is palpated, the tip of the curved blade brought into relation with it, and the measurement read off upon the scale of the pelvimeter. In this case the layer of tissue covering the lower margin of the symphysis is so thin that no deduction is neces- sary. It will be remembered that my inves- tigations show that the normal length of the anterior and posterior sagittal diameters aver- age 5.5 to 6, and 7.5 cm. respectively. From the description just given it will be seen that the patient may remain in the same position for the palpation of the pubic arch, the determination of the transverse diameter and the mensuration of the anterior and posterior sagittal diameters. Accordingly it is my prac- tice to make the usual pelvic examination, to determine the mobility of the coccyx and to measure the length of the diagonal conjugate with the patient in the usual obstetrical posi- tion, and afterwards to draw her down upon the table to such an extent that the buttocks project sufficiently beyond the edge to render the lower portion of the sacrum easily palpable. Then the pubic arch is palpated, the trans- verse diameter measured, and while the thumbs are still in position, the outlet pelvimeter is adjusted and the length of the anterior and pos- terior sagittal diameters determined, while the mensuration of the antero-posterior diameter of the outlet concludes the examination. Prognosis. Upon reading the statement in most text-books one would be inclined to be- lieve that the usual types of funnel pelvis rarely gives rise to serious dystocia, and consequently have but little influence upon the prognosis for either the mother or child. On the other hand, many of the mongraphs upon the sub- ject convey a very different impression, and to judge from several of them one would be forced to conclude that the condition is fraught with very serious danger. Thus, Mansbach, in a dissertation which appeared in 1891, collected from the literature the histories of 35 labors complicated by fun- nel pelvis and estimated that the maternal and foetal mortality was 34 and 60 per cent re- spectively. Likewise, Walther, after studying the results in 117 cases described in the litera- ture, stated that labor ended spontaneously in but 22 instances; 13.6 per cent of the mothers were lost, and that 25.7 per cent of the children were born dead, not including an additional 4.5 per cent which died within a few days after delivery as the result of fracture of the skull. Such an appalling mortality is susceptible of two explanations. In the first place, par-