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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    dead, and the contraction not absolute, delivery can be effected by craniotomy. It is in that class of pelves, however, which are just on the border line between the other two, in which the conjugata diagonalis measures lo cm., or thereabout, that cause the greatest amount of anxiety and are the most difficult to treat. From what we have observed in such cases, we think that the following is the proper method of treatment: The patient, be- ing allowed to go to term, is put to bed as soon as definite labor pains begin, and kept there throughout the labor. This lessens the liability to prolapse of the umbilical cord and pre- mature rupture of the membranes, which accidents should always be looked out for. At the close of the first stage, after spontaneous rupture of the membranes, if the head applies itself to the pelvic brim in one of the typical presentations, and there is no reason for immediate delivery, she is allowed to have several hours of good second stage pains, in order to bring about as much moulding of the head as possible. The condition of both mother and child being, of course, carefully watched during this time. In the meantime, everything having been made ready for a possible Caesarean section, the patient is anaesthetized and placed upon the operating table. Tarnier axis traction forceps should now be carefully applied over the sides of the head, if possible, and, by a few well applied tractions in the axis of the superior strait, an attempt is made to make the head enter the pelvis. If the blades have been well fitted to a head of ordi- nary dimensions, this manoeuvre will be successful, and the child will be delivered without injury. But in the event of the head not coming into the pelvis, (unless we have reason to believe that the child is very small, when it can be delivered by version) an immediate Caesarean section should be done. I do not wish to be misunderstood in making this state- ment, and thought to believe that pelves of such dimensions are indications per se for the Caesarean operation; for, as has just been said, the great majority of such cases will be deliv- ered by forceps; nor do I mean that such can be our method of procedure in private practice, for here we have to make the best of the conditions in which we are placed. But with pa- tients in a well-appointed lying-in hospital, where we believe our methods approach the ideal, I think that in Caesarean sec-