A pelvimeter for the direct measurement of the true obstetric conjugate

A PELVIMETER

FOR THE DIRECT MEASUREMENT TRUE OBSTETRIC CONJUGATE T.

BY JOSEPH (From

the

Clinic

of Cleveland

SMITH,

JR., M.D.,

Hater&y

CLEVELAND,

Hospital

and

Western

OF THE

OHIO Reserve

University)

ITH the desire of developing an instrument which would measure the true conjugate directly, the device illustrated in the accompanying pictures is suggested for trial. w

Fig.

Fig.

I.-Pelvimeter

Z.-Pelvimeter

folded

arm

raised

for

introduction.

for

measurement.

This instrument consists of a small but rigid square steel bar, carrying a saddleshaped piece (1) at one end. (Fig. 1.) At (a) is a thimble for the middle finger. On this bar, a sliding sleeve (3-7) is controlled by the handle (4). Back of this handle, a button (5) actuates a rod which raises an arm (8) at right angles to the bar (1-6) when the button is pushed in as far as it will go. Centimeter calibration marks on the upper side of the bar are read at the point 7, where the end of the sliding sleeve (3-7) cuts the bar. The pelvimeter is made as slim as possible, and when the arm (8) is folded Thus, it may be down, the whole device is about the diameter of a man’s linger. carried into the vagina without causing pain. In use, the middle finger of the examining hand is slipped into the thimble at 2. The instrument, well lubricated, is carried into the vagina by the middle and index fingers. The examiner then locates the promontory of the sacrum with the middle finger, which may be slipped out of the thimble temporarily for this purpose. The procedure is exactly the came as that described in standard textbooks for the measurement of the diagonal conjugate. With the middle finger in the thimble (d), the saddle 1 is now seated over the sacral promontory. The other hand,

SMITH

:

MEASUREMENT

OF

THE

TRUE

OBSTETRIC

CONJUGATE

551

grasping the handle (4), slides the sleeve within the vagina, with the arm (8) folded down. The handle (4) does not enter the vagina. Pressure on the button (5) with the thumb raises the arm (8) to a right angle. Holding it firmly in this position, and with the bar firm against the under surface of the pubic arch, the handle (4) is drawn outward until the arm (8) is pressed firmly against the posterior surface of the OS pubis. (Fig. 2.) The instrument is then read directly at the last figure showing under the sleeve at the point (7). This calibration is not calculated straight along the bar (1-6).

Fig.

3. Introducing

Fig.

4 .-Arm

folded

raised,

pelvimeter.

measuring.

The figures represent the distances from the point (1) in the curve i.e., from the point where that touches the sacral promontory, to the up the arm (8), i.e., the point where numerous measurements teach arm generally touches the most posterior point of the OS pubis. In the scale gives the length of the imaginary hypotenuse (8-1) of (2-3-8). That hypotenuse, when the instrument is in place, is the conjugate, and its length may be read directly, on the scale at 7.

of the saddle, point 2.5 cm. us that the other words, the triangle true obstetric

558 may

THE

AMERICAN

A slight pull be removed

on the easily

JOURNAL

OF

button (5) now and painlessly.

ORSTETRICS folds

down

I wish to thank Dr. Arthur H. Bill permission to test out the instrument of the Cleveland Maternity Hospital. interest and intelligent, cooperation of the instrument, following a model. 2429

PROSPECT

the

arm

GYNECOLOGY (8),

and

the in$rument

for his encouragement. and for on many patients in the clinic I also wish t.o acknowledge the 3Zr. George Guilford, who made

AVENUE.

REPORT BY E. C.

ASD

OF A CASE

OF BICORNUATE M.D.!

STEINIIARTER,

CINCINNATI,

AND

SAMGEL

UTERUS BROWN,

M.D.

OHIO

F

ULL-TERM pregnancy in a bicornuate uterus is probably not so uncommon as the paucity of the literature on the subject and the experience of the busy obstetrician would lead one to believe. The reason for this is that the condition can occur without being recognized, since gestation, labor, and puerptrium may all be unevent,ful. In rare cases, however, according to Williams,l the nonpregnant horn may part,ially fill up the pelvic cavity and give rise to a serious dystocia similar to that produced by tumors of other origin. The following report is that of a patient who had a series of fullterm normal confinements before it was discovered that she had a bicornuate septate uterus. In this particular case the positive diagnosis was made by x-ray, aided by lipiodol and later confirmed by exploration of the uterus from below and inspection of it intraabdominally. I. F., aged thirty-three years, housewife. Her chief complaints were : skipping a period from time to time and pain in the lower abdomen. Past history was negative, except for general debility during past year. First pregnancy was a miscarriage at t,hree months, followed by three normal full-term pregnancies and then an incomplete abortion at four months, for which she was curetted. The gynecologist ot this time apparently failed to observe a uterine septum. Catamenia at seventeen years. Dysmenorrhea the first day. Periods regular until recently, lasting five days with profuse flow. In the past year the menstruation has become irregular, the periods oeeurring at intervals of from 4 to 8 weeks. For a few months prior to being referred to one of us (E. C. S.) for gynecologic examination, the patient had been under the cart of an internist because of general debility, poor appetite, and pain in lower :~bdomq especially on the right side. She stated that she had skipped a period dur twenty days before, but did not consider herself pregnant. Bimanual examination revealed a slightly enlarged irregular uterus. In the right vault, low down, there was a tender sausage-shaped mass about the size of a nulliparous uterus, ;tnd it moved with the rervix and the uterus. ‘Williams:

Textbook

on Obstetrics,

New

York.

1900, D. Appleton

& Co..

p. 110.