Cesarean section . ugh they willafford some help. Fortunately the degree of contraction is seldom ex-treme, but serious interference with labor may occur. The deformityinvolves the inferior as well as the superior strait, and the position of OTHER PELVIC INDICATIONS 45 the ankylosed leg may interfere seriously with operative procedures un-dertaken to deliver the patient. If examination under anesthesia demonstrates the fact that engage-ment is improbable, an elective cesarean is indicated, as it is also inmultiparae with a history of previous dystocia. If there seems to beno serious obstructio
Cesarean section . ugh they willafford some help. Fortunately the degree of contraction is seldom ex-treme, but serious interference with labor may occur. The deformityinvolves the inferior as well as the superior strait, and the position of OTHER PELVIC INDICATIONS 45 the ankylosed leg may interfere seriously with operative procedures un-dertaken to deliver the patient. If examination under anesthesia demonstrates the fact that engage-ment is improbable, an elective cesarean is indicated, as it is also inmultiparae with a history of previous dystocia. If there seems to beno serious obstruction to engagement, if the child is not larger than theaverage, and if the outlet is not seriously contracted, it is probable thatdelivery through the pelvis will occur and the case should be left to nature,under careful observation. In these cases a modified test of labor, con-ducted under careful asepsis, will often determine the proper treatmentof the case. If after four or five hours of good first stage labor, the. Fig. 21.—Pelvis Obliquely Contracted from Tension of Dis-located Femur. head shows no sign of entering the pelvis, the conservative policy shouldbe abandoned and the patient delivered by the abdominal route. Obliquely Contracted, or Nagele Pelvis.—This form of contractedpelvis is of very rare occurrence, but causes serious dystocia in the ma-jority of instances, when found. The main characteristics are an obliquecontraction, involving both the brim and outlet, combined in most caseswith ankylosis of the sacro-iliac joint on the affected side. The causeof the pelvic deformity is a lack of development, or even practicalabsence, of the sacral alae on one side, which results in an oblique con-traction. The patients do not limp, and the ordinary pelvic measure-ments do not show the degree of contraction. The attendants attention 46 CESAREAN SECTION should be called to the presence of some abnormality by the fact that oneiliac crest is higher than the other, and that
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