Outlet Contraction of the Pelvis *
OUTLET CONTRACTION OF THE PELVIS * By W. I. C. MORRIS, M.B., F.R.C.S.E., M.R.C.O.G. There is no great unanimity in regard to the incidence or even the existence of outlet contraction. Stander (1946) states that contractions of the pelvic outlet occur in about 6 per cent, of all women. De Lee (1938) quoted figures as high as 26 per cent. (Stocker), but others, including Bourne and Williams (1939), are sceptical of the importance of outlet contraction, and emphasise that the head which passes the pelvic brim is unlikely to meet grave difficulty at the outlet. All of us, however, are familiar with the occasional unexpectedly stiff forceps operation, as a result of which we deliver with much soft tissue damage a still-born baby, or, perhaps worse, one which survives to develop signs of grave intra-cranial damage. A tentative diagnosis of outlet contraction in such a case may enable us to lay a flattering unction to our souls, but outlet contraction is a subtle condition which may result from a variety of deformities and abnormalities, and its detection before the occurrence of a disaster is often difficult. I propose to devote the major portion of this lecture to an examination of various diagnostic criteria which may give such forewarning, and to deal but briefly with other aspects of outlet contraction. The Shape and Dimensions of the Fcetal Head in Labour The first approach to this problem should be to obtain an accurate picture of the fcetal head in that stage of labour when it first meets the outlet resistance.
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