. Obstetrics for nurses. ors: (1) theactual size of the pelvis, (2) the size andcompressibility of the fetal head, and (3)the effectiveness of the expulsive forces. The Size of the Pelvis.—Spontaneousdelivery occurs less frequently as the sizeof the pelvis diminishes, so that when thediagonal conjugate is reduced to to centimeters (true conjugate of to centimeters) its chancesare reduced by one-half, and, when it falls to centimeters (true con-jugate of centimeters), less than one-fifth of the children are bornspontaneously. Moreover, when it measures below centime
. Obstetrics for nurses. ors: (1) theactual size of the pelvis, (2) the size andcompressibility of the fetal head, and (3)the effectiveness of the expulsive forces. The Size of the Pelvis.—Spontaneousdelivery occurs less frequently as the sizeof the pelvis diminishes, so that when thediagonal conjugate is reduced to to centimeters (true conjugate of to centimeters) its chancesare reduced by one-half, and, when it falls to centimeters (true con-jugate of centimeters), less than one-fifth of the children are bornspontaneously. Moreover, when it measures below centimeters (trueconjugate of centimeters) vaginal delivery is impossible even aftercraniotomy; whereas, between this limit and centimeters, the deliveryof a dead child can be effected with difficulty, while the extraction of alive child through the vagina is not to be expected. The size and compressibility of the fetal head are subject to consider-able variations and cannot be easily determined before birth, although. Fig. 121.—Patient with markedkyphosis—nine months preg-nant. Pelvis normal. Spon-taneous labor at term. 290 TEXTBOOK OF OBSTETRICS FOR NURSES it is generally recognized that women in the upper walks of life aremore likely to have large, hard-headed babies than those who apply tothe charity clinics. In any given case, the course of labor dependsnot so much upon the absolute, as upon the relative, size of the head,which can be determined with considerable accuracy by pressing thehead down into the superior strait and estimating, by palpation, theextent to which it projects beyond, or over-rides, the symphysis. Inwhite women living under good surroundings, the existence of evenmoderate disproportion probably meansthat the dystocia will be of a seriousnature, whereas, in colored patients, thesame amount of over-riding may generallybe viewed without alarm, because, in thelatter, the fetal head will almost certainlybe smaller and less perfectly ossified, sothat,
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