The operative treatment of labor, complicated by pelvic deformities : based upon a critical review of the first thousand patients delivered in the obstetrical department of the Johns Hopkins Hospital / by George W. Dobbin.

Date:
[1899]
Catalogue details

Licence: Public Domain Mark

Credit: The operative treatment of labor, complicated by pelvic deformities : based upon a critical review of the first thousand patients delivered in the obstetrical department of the Johns Hopkins Hospital / by George W. Dobbin. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    It is of the greatest importance to note the effect of the degree of pelvic deformity on the fetal mortality, and to show this we have divided onr pelves in three classes, according to the size of the antero-posterior diameter. In doing this we have taken the conjugata diagonalis as our standard diameter, for this is the only antero-posterior diameter which can be directly meas- ured with accuracy, and the conjugata vera, being estimated from this, is subject to variation with the pelves and the oper- ator making the measurement. In the first class of cases we have put those pelves the diagonalis of which is between 11.5 and 10.5 cm., in the second class those between 10.5 and 10 cm., and in the third all in which this diameter falls below 10 cm. In Class I., there were 28 cases with 7 fetal deaths—a mortality of 25 per cent.; in Class II., 10 cases with 6 fetal deaths—mortality 60 per cent.; and in Class III., 5 cases with I fetal death or 20 per cent, mortality. (table VII.). MORTALITY, FETAL AND MATERNAL, IN ITS RELATION TO THE DEGREE OF PELVIC CONTRACTURE. Conjugata diagonalis. Total cases. Forceps. Version. Extraction. Symphysi- otomy* Destructive operations. Deatji, maternal. Death, fetal. Mortality, maternal. Mortality, fetal. 20% 50% 23.81% Fetal - mortality. Class I. 25% Class I. ■ II .25 cm 21 10 6 4.76% 10.75 cm Class^ II. 10.50 cm 25% 50% 100% 50% Fetal 10.25 cm 1- mortality, Class II. 60% 9.75 cm Class III. ■ 50% 50% 9.25 cm ■ mortality. Class 111.20% 9.00 cm ( not taken Totals 46 21 IS 8.69% 30-43% This definitely shows that in the lesser and more marked degrees of pelvic deformity where the indications for opera- tions are comparatively simple, and there is little doubt in the mind of the operator as to which operation is the most suitable for the case, the results are good, while, on the other hand, in the medium grades of contraction, those pelves which occur just in the border line, and where there is greater necessity for