A textbook of obstetrics . t) 8^ Cm; minisned. it, as is tne rule tr (outlet) 1yz cm- in extreme degrees of this (specimen in the authors collection). deformity, the inlet and cavity are contracted, the outlet is still smaller in proportion. Acareful palpation of the pelvic canal is an important aid to acorrect diagnosis. The pelvic walls are felt to converge as theyapproach the outlet; the narrowness of the pelvic arch is appre-ciated, and the approxima-tion of the tuberosities andspines of the ischiatic bonesis noticeable. Influence upon Labor.—The peculiarities of mech-anism in labor are ma
A textbook of obstetrics . t) 8^ Cm; minisned. it, as is tne rule tr (outlet) 1yz cm- in extreme degrees of this (specimen in the authors collection). deformity, the inlet and cavity are contracted, the outlet is still smaller in proportion. Acareful palpation of the pelvic canal is an important aid to acorrect diagnosis. The pelvic walls are felt to converge as theyapproach the outlet; the narrowness of the pelvic arch is appre-ciated, and the approxima-tion of the tuberosities andspines of the ischiatic bonesis noticeable. Influence upon Labor.—The peculiarities of mech-anism in labor are malpo-sitions of the head at theoutlet (as backward rota-tion of the occiput), obliqueand transverse position ofthe head, and imperfectflexion. There is also aninsufficiency of the expul-sive forces, the greater partof the fetal body being con-tained in the lower uterinesegment, cervix, and vagina, while the upper muscular segmentof the uterus is in great part emptied and therefore Fig. 28^.— Minor grade of narrow, funnel-shaped pelvis with contracted pubic arch (froma plaster cast in the authors collection). 28 ! ? Prager Zeitschrift f Heilkunde, Bd. ix, 11. 4 and 5. 434 THE 1 \l THOLOGY OF LABOR. \\y the approximation of the pubic rami the presenting part isforced backward, and serious lacerations of the perineum areto be feared. The pressure of the head upon the lower birth-canal may result in necrosis of s ft structures or in lacerationsalong the descending rami of the pubis and the ascendingbranches of the ischium. The tissues over the projectingspines ^t the ischiatic 1. nes are also the seat of tears or ofnecroses. The narrowing of the pubic arch may lead to seriousinjuries if the forceps be applied. I have seen long, cleancuts in the anterior vaginal walls and profuse hemorrhage fol-lowing the use of instruments. In well-marked examples ofthe narrow, funnel-shaped pelvis, with a transverse diameter atthe outlet not much below three inches, symphysiot
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Keywords: ., bookcentury1800, bookdecade1890, bookidtex, booksubjectobstetrics
