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A critical survey of the questionable pelvis

1948; Elsevier BV; Volume: 56; Issue: 6 Linguagem: Inglês

10.1016/s0002-9378(48)90354-8

1097-6868

H. HOFFMAN GROSKLOSS, Owen F. Robbins, John T. Moehn,

Maternal and Perinatal Health Interventions

Abstract Precision obstetrics is within the scope of practicability. A careful survey of the female pelvis allows for recognition of absolute or relative cephalo-pelvic disproportion, and should serve to stimulate more precise evaluation of the classification, essential diameters, and areas in square centimeters, of each plane of the pelvis. Midpelvic contractions, if present, should be suspected, even in the presence of normal inlet and outlet measurements; and these cases should merit the advantages offered by stereo- and isometric roentgenpelvimetry. If clinical measurements of this plane are found to be critical, significant midpelvic disproportion is highly possible. Election of the proper procedure for the termination of the full-term pregnancy, and prediction of the course of labor may be made with a reasonable degree of accuracy. With an average size baby, in the absence of unequivocal cephalopelvic disproportion, and under the “permissive” conditions outlined above in respect to the degree and nature of contraction, the patient may, under careful supervision, be allowed to go into labor spontaneously. No single diameter, except possibly the conjugate vera, should be employed alone for the prognosis of labor. In considering the sums of any two diameters, that of the widest possible transverse diameter and the anteroposterior diameter might well be combined with the area computation for the fullest measure of efficiency. The latter consideration, emphasizing the presence or limitation of compensatory space, proves the importance of stereo-perspective and classimetric knowledge of the particular pelvis; and appears more significant than a study of the sum of the interspinous and posterior sagittal diameters. The proper clinical roentgenometric approach to the suspect pelvis promises a favorable advance in lessening maternal morbidity and mortality, a greater fetal salvage, and a lesser incidence of elective cesarean section.