1889 American Journal of the Medical Sciences  
VTMTINR OBSTETRICIAN TO TUB PHILADELPHIA HOSPITAL. Version in Contracted Pelves. Nagel (Arehiv fiir Gynakologie, Band 34, Heft 1) reviews the literature of this subject, and reports 59 cases of version and extraction, which he com¬ pares with 2(1 eases of forceps delivery in contracted pelves. His conclusions favor version and extraction as a mode of treatment; and are based upon the following practical considerations: The varieties of contracted pelves most commonly encountered arc the
more » ... red arc the symmetrically contracted (justo minor), the flat pelvis, and the flat-rachitic pelvis. Nagel is convinced that podalic version iB equally indicated in these pelves. He considers the measurement of the diagonal conjugate of little practical value, and measures the true conjugate only; the shortest true con¬ jugate in hid cases measured three and one-eighth inches. His record is 60 versions in contracted pelves, without a maternal death; 61 children were delivered, 46 of whom lived. Version should be performed early; mortality and morbidity increase with the duration of labor. The obstetrician must not delay until the os is fully dilated, but should perform version as soon as the hand can be introduced and the breech brought into the cervix, when uterine contractions generally dilate the os sufficiently to permit birth. Bo long as the membranes have not ruptured, the case should be left to nature, but in transverse positions, when the membranes rupture, version should be performed at once; extraction should follow as soon as the os is sufficiently dilated. Nagel considers the use of forceps after version unjustifiable. In cases where children had been loBt in previous labors, version lessened greatly foetal mortality. Nagel found no malposition of the head a contra-indication to version. He performed version in all grades of pelvic contraction, as it affords the foetus a chance for life, and perforation of the after-coming head has been no more difficult than when the head presents, in his experience, when craniotomy becomes necessary. In delivering these cases Nagel relies chiefly upon external pressure upon the head through the abominal walls; traction should not be made upon the trunk until flexion is well established. At the moment when the head emerges undue haste is to be avoided, as children may survive after a delay of five or ten minutes. Nagel closes by urging the critical importance of the early stages of labor for the choice of a mode of treatment. In primiparse, with contracted pelves, when the membranes have not ruptured and the head does not enter the pelvis, version should be performed as soon as the os is dilated; if the head partially enters the pelvis, or inclines to enter, the complete dilatation of the
doi:10.1097/00000441-188905000-00071 fatcat:2g7gpz4oeffrhikmardpzdv4ai