PREGNANCY IN PELVIC DEFORMITY.
At the outset, we would recall the fact of the frequency of miscarriage and of premature labor, in case of pelvic deformity, owing to the mechani cal interference with the development of the uterus and of the fcetus. When the uterus, in the course of its growth, endeavors to rise above the superior strait, it is evident how a projecting promontory will interfere, and how, furthermore, in case the uterus is a little tilted backwards, there will result retroversion, and, in case this displacement increases, we witness all the phenomena indicative of incarceration. (See Retrover sion of the Uterus.) Happily, in the large proportion of cases, the uterus is able to pass by the obstacle, and to rise above the brim, and pregnancy may continue. What strikes us at once, in such cases, is the elevation of the fundus out of proportion to the age of the pregnancy, and, in addi tion, the lower segment of the uterus, and if, in the latter months, it can be reached, the foetal parts are felt hut indistinctly, if at all. This, ob viously, is different from that which obtains in normal cases. Again, this elevation of the uterus is accompanied by greater mobility. The abdom inal walls hang forwards, constituting the venter propendulus. The fall ing forward of the uterus is further favored by tho inclination of the pelvis.
Pelvic deformities have a capital influence on the presentations and positions of the fcetus.' The fact of the frequency of mal-presentations has been noted by all accoucheurs, from the time of Mauriceau, and this is explained by the difficulty the fcetus has in accommodating itself to the uterus and to the pelvis. The following data deduced from Litzmann, Spiegelberg, Schroeder and Stanesco, will give an approximative idea of the frequency of different presentations in pelvic deformity: It is evident, then, that presentations of the face, and of the shoul der are much more frequent in case of pelvic deformity than in normal pelves.
Spiegelberg and Schroeder have further noted that changes in presen tation, both in pregnancy and at the beginning of labor, are very frequent. These changes may be explained by the greater motility of the fcetus. Litzmann, Hecker, Cred(, Schultze, all agree on this point. These mutations are infrequent in primiparte, since in them the uterus tends to retain its ovoid shape. They are met with, on the other hand, very fre quently in multiparte, owing to the laxity and diminished resistance of the uterine and abdominal walls.
It is particularly in premature labors that mal-presentations are met with. All authorities agree in the frequencY with which there occurs prolapse of the limbs and of the cord. According to Spiegelberg, this frequency is 4 to 5 times greater than under normal conditions.
In the cases collected by Rigaud and Stanesco, 810 in all, there was noted: that is to say, 90 cases of prolapse in 810 cases, or 11.11 per cent.
Aside from these local phenomena, women with pelvic deformity pre sent certain general characteristics.
When there exist coincidently spinal curvature and alteration of the thorax, there often result respiratory and circulatory troubles, as evi denced by edema of the lower limbs, dyspncea, gravido-cardiac disorders, pulmonary congestion, ec]ampsia, and these complications may of them selves induce labor, even if they do not call for the induction. Usually, however, the general disturbances resulting from pelvic deformity are relatively well borne, and without disturbing pregnancy very much, which usually goes to term; it is generally only at labor that serious complica tions supervene. Every variety of deformity, however, as we will see, does not portend the same gravity.