On the management of labour in contracted pelvis : an inaugural thesis, for which a first prize was awarded by the Minister of Public Instruction of France / by William H. Jones.

  • Jones, William H.
Date:
1867
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Licence: Public Domain Mark

Credit: On the management of labour in contracted pelvis : an inaugural thesis, for which a first prize was awarded by the Minister of Public Instruction of France / by William H. Jones. Source: Wellcome Collection.

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    of the forceps which saved so many children in the first category, and that of the cephalotribe which saved so many mothers in the third, have quite opposite results, when we consider them inversely in the third or in the first category. In the fourth category, where the narrowing was extreme, the utter impotence of obstetrical therapeutics is manifested ; for, out of 9 children, 1 only was saved, and that at the expense of the life of the mother, upon whom the Caesarian 'section was performed, an operation almost inevitably mortal in the great centres of population. It has been so at least for many years. In the five transverse presentations, not one mother lost her life. In the breech presentations there was a mortality of 2 in 6 among the mothers. Of the two women who died, the first (pelvis narrowed to 2 inches) is the one who succumbed after the Caesarian opera- tion. The labour had lasted 48 hours, and the os uteri was not completely dilated. As for the second, whose pelvis was narrowed to the same degree, and who was seven months enceinte, she died after undergoing five utero-vaginal douches, which were administered for the purpose of inducing labour. At the autopsy, a rupture of the uterus was discovered. With these and other statistics before me, I shall now proceed to consider what practical conclusions can be deduced from them. SECTION I. What ought to be the conduct of the Accoucheur when the conjugate diameter of the Pelvis is narrowed, but not under 3\ inches ? The accoucheur's conduct would evidently vary according to the kind of presentation. A. Cephalic presentation.—The number of spontaneous accouche- ments (6 in 16, Table I.), proves that the intervention of medical art is often not necessary. The first period of labour is prolonged on account of the elevation of the head. But, if the membranes remain intact, and if the pains be strong and regular, the prognosis is not unfavourable. A rigorous surveillance should be exercised over the state of the child after the membranes are ruptured ; and if he is warned by auscultation, or by a discharge of meconium, that