PubMed · 8260994
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M Ostyn. 1993. Sharing experiences.. https://pubmed.ncbi.nlm.nih.gov/8260994/
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Dystocia of labor has become one of the leading indications for operative delivery during the past few years. Dystocia of the first stage of labor complicates 8-11% of all vertex delivery, and in the second stage of delivery it is at least as common. Dystocia may result in part from three factors: uterine activity, the fetus, and the pelvis. In each case of abnormal labor, assessment should be made according to those criteria. Shoulder dystocia is an infrequent, unanticipated, and unpredictable nightmare for the obstetrician. Although it is difficult to predict shoulder dystocia, effort should be made to prevent it. Tight glucose control in the management of diabetic patients will reduce the incidence of macrosomic fetuses. Cesarean section should be considered for diabetic women carrying fetuses with estimated fetal weight of greater than 4250g and for non-diabetic women carrying fetuses with estimated fetal weight of greater than 4500g. In all cases good clinical judgement can reduce the rate of shoulder dystocia. However, in some cases it remains a problem for the obstetrician and because it occurs so rarely, the care provider may have limited skills to manage this condition.
The female pelvis is fundamental to life itself, but it took ages to grasp this truism. During Antiquity, physicians had no need for the concepts of pelvic dystocia and cephalopelvic disproportion. When Aranzo (16th century), a practising physician, stated that a disproportion between the size of the fetus and that of the bony pelvis was the main culprit of difficult labor, his suggestion was overlooked, so much so that it was Hendrik van Deventer (1701) who came to be coined "father of the pelvic theory". The need for an accurate knowledge of the dimensions of the maternal pelvis and of the fetal skull became imperative in the middle of the 18th century, when forceps extraction had become popular. Levret, but above all William Smellie, made valuable contributions to the pelvic theory, which, however, were weakened by Baudelocque's fallacies concerning the intrinsic value of external pelvimetry. After the first quarter of the 19th century, the epicenter of scientific obstetrics moved to Germany and Austria, and German-speaking practitioners, e.g. Michaelis, Litzmann, and the Naegele, deepened our insight in the mechanism of labor. After the discovery of the X-rays (1895), the use of instrumental pelvimetry declined, but the clinical breakthrough of radiopelvimetry was delayed until the twenties of this century. Radiopelvimetry, a very valuable technique indeed, dispensed a large number of mothers from undergoing abdominal delivery. However, awareness of the hazards of fetal-maternal exposure to ionizing radiation pushed ante- and intrapartum radiopelvimetry from the scene. Thanks to the progress of chemistry, pharmacology and electronics, "dynamic pelvimetry" became the fad, heralded by what is called "active management of labour". The fetus now assumed the role of "dynamic pelvimeter". The historical circle was closed.