. Obstetrics for nurses. the spontaneous completion ofthe second stage, even though the disproportion is not extreme. The Course of Labor in Contracted Pelves.—Labor is usually pro-longed either by reason of imperfect dilatation of the cervix, or becauseof the length of time required to mold the head so that it may descendthrough the pelvis. Moreover, the occurrence of an unusually largepercentage of abnormal presentations tends to more difficult labors. When the head presents, it finds difficulty in engaging in an obliquediameter of the pelvic inlet, and frequently descends with the sagittals
. Obstetrics for nurses. the spontaneous completion ofthe second stage, even though the disproportion is not extreme. The Course of Labor in Contracted Pelves.—Labor is usually pro-longed either by reason of imperfect dilatation of the cervix, or becauseof the length of time required to mold the head so that it may descendthrough the pelvis. Moreover, the occurrence of an unusually largepercentage of abnormal presentations tends to more difficult labors. When the head presents, it finds difficulty in engaging in an obliquediameter of the pelvic inlet, and frequently descends with the sagittalsuture directly transverse—R. 0. T. or L. 0. T.—a condition whichrarely occurs in normal pelves. In such circumstances, the head fitsonly loosely into the superior strait, and, as a result, premature ruptureof the membranes and prolapse of the cord are rather frequent complica-tions. The former results in delay in the dilatation of the cervix, inthat it must now be accomplished by direct pressure of the head, which. Fig. 122.—Showing dispropor-tion between the head and thepelvis. (Williams.) ABNORMAL LABOR 291 is impossible until descent has taken place or until a marked caputsuccedaneum has been formed. Prolapse of the cord, on the other hand,is a very serious accident for the child, since it may be compressedbetween the head and the pelvic wall, with the result that its circulationwill be cut off and lead to asphyxiation of the child. When the disproportion is marked and the head is arrested at thesuperior strait, a prolonged but ineffectual second stage frequently leadsto tetanic contraction of the uterus and to extreme thinning of thelower uterine segment, with its danger of uterine rupture. In thisevent, operative delivery is essential if the latter possibility is to beavoided. The unusual length of the labor in patients with contracted pelvespredisposes to greater danger from intra-partum infection and to actualphysical exhaustion, both of which aiford an indicatio
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectobstetrics, bookyear1
