T HE prediction of the probability of the safe passage of the fetus through the birth canal is the primary function of the attendant at the start of labor. The means of determining the relative size of the fetal head and the internal diameters of the pelvis have therefore been the objects of deep concern down through the centuries. Manual techniques of clinical evaluation of cephalo-pelvic relations reached their peak a generation or two ago. A massive nomenclature existed with respect to pelvic planes and diamยญ eters. To these were related various positions, attitudes, stations, and synclitisms of the fetal head. Measurements depended on digital efforts to explore the interior and on dubious implications drawn from external pelvimetry. The mechanisms of labor, as it might occur under the innumerable possible pelvic measureยญ ments and fetal orientations, were the subject of hours of stuยญ dent drilling and remained a lifelong preoccupation of the most seasoned specialist. The increasing safety of cesarean section somewhat mitiยญ gated the consequences of error. When a borderline internal conjugate was digitally determined, a trial labor might be perยญ mitted with the assurance that an ultimate solution was in reserve. Mistakes of two kinds persisted, however. On the one hand, trial labor might be permitted to continue too long and, with penicillin not yet discovered, a delayed cesarean section v vi Foreword could be perilous. Alternately, to be on the safe side, many unยญ necessary elective sections might be carried out
CONTENT
Section I General Morphology of the Pelvis -- Analysis of Pelvic Shape -- Sexual Differences in Pelves -- Classification of Pelves -- The Pure Types -- Mixed Types -- The Mid and Lower Pelvis -- Frequency of Occurrence of Pelvic Types -- Section II Clinical Examination of the Pelvis -- Technic of Examination -- Section III Mechanism of Labor -- The Fetus -- The Mechanism of Labor -- Relationship of Head Position to Pelvic Type at the Inlet -- Section IV Significance of Pelvic Shape in the Treatment of Pelvic Arrest -- Treatment of Arrest in the Transverse Position -- Treatment of Arrest in the Posterior Position -- Treatment of Arrest in the Anterior Position -- The Pelvic Outlet as Influenced by Lower Sacral Variations -- Section V Recognition of Disproportion -- X-ray Pelvimetry -- Disproportion at the Inlet -- Disproportion at the Midpelvis -- Miscellaneous Types of Disproportion -- Breech Presentation -- Value of the X-ray Data -- References
