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.

    25/42 (page 21)
    tion we have an absolutely certain method of delivering a liv- ing child, which has not been injured by ineffectual attempts at forceps and version, standing out in strong contrast to the uncertain delivery by symphysiotomy or a difficult version through a small pelvis. It is impossible to conclude an article on the operative treatment of contracted pelves without referring to the much discussed question as to the relative merits of forceps and ver- sion. Being guided strictly by our figures, it would seem that forceps is decidedly the better procedure, as, after this opera- tion, we have had only 3 fetal deaths in 21 cases, while in 15 children delivered by version, 6 were bom dead. As we have said, however, it is evident that our fetal mortality with the I latter operation is decidedly too high, and that this is probably due to the fact that so many of our versions were done after ineffectual attempts at forceps. If version is decided upon, it should be done as a primary operation, and only in the minor grades of pelvic contraction, namely those which we have included in Class I., Table VII., and if done under these conditions, should undoubtedly give better results than a difficult forceps operation on a high or floating head. On the other hand, in those cases in which the contraction is so marked as to cause any doubt in the mind of the operator as to his ability to extract the child through the intact pelvis, version should never be attempted, for when begun it must be completed in a very short space of time, and we cannot, as in the case of forceps, make a tetative attempt and then change our tactics. We have shown that in certain forms of obliquely con- tracted pelves, particularly those due to an old coxalgia, where there is an accompanying ankylosis of the hip joint, version is a more suitable operation than forceps, for the inability to flex the stiff leg offers the greatest possible impediment to the proper introduction of the blades. It seems almost superfluous to add that it should be borne in mind that a large percentage of contracted pelves (in our series 65 per cent.) are delivered spontaneously, without artificial aid of any kind, and that the minor gprades of contraction are not necessarily indications for operative interference. In such cases nature should always be given