Obstetrics for NursesReed, Charles B. (Charles Bert)
Science
Obstetrics for Nurses
Reed, Charles B. (Charles Bert)
Maternity nursing
The brim or inlet has four important diameters to be remembered;
important because the hard, round head of the child must pass through
them by accommodating its diameters as favorably as possible to those of
this opening. These diameters are named respectively the anteroposterior
or conjugate diameter, the transverse, and the right and left oblique
diameters. The two oblique diameters attain their greatest importance
when the pelvis is irregularly distorted, but the others are essential
in every case where labor impends. It is to secure an estimate of these
latter diameters that the bony prominences are measured. This upper
opening lies not horizontally, but in oblique relation to the body in
standing position, and the weight of the abdominal viscera rests largely
upon the bones and in consequence does not crowd into the inlet unless
forced in by corsets or faulty habits.
[Illustration: Fig. 2.—The planes of (_a_) the brim, (_b_) the cavity
and (_c_) the outlet. (Eden.)]
Passing through the brim, a cavity is found below it, midway between the
inlet and outlet, which is nearly round in shape. This is the
“excavation,” or the _true pelvis_. Then comes the _outlet_, bounded in
front by the pubic arch and soft parts, and behind by the coccyx pushed
back as far as it can go. It is ovoid in shape, but the long axis of
this ovoid lies at right angles with the axis of the ovoid inlet.
We find, therefore, a succession of three geometric figures or planes
through which the head must pass by means of a spiral motion called
rotation. These figures are inclined to one another so markedly in front
that a line drawn through the center of each will curve forward at both
ends, one end passing out near the umbilicus, the other through the
vulva. This is known as the axis of the pelvis or the curve of Carus.
[Illustration: Fig. 3.—Visceral relations. (Redrawn from Gray.)]
THE SOFT PARTS
Inside the pelvis are the organs of generation with their accessory
structures and supporting tissues.
Of first importance are the ovaries, tubes and uterus, together with the
vagina. These special structures are the true genital organs. They are
bounded in front by the bladder, behind by the rectum, above by the
abdominal viscera, and surrounded everywhere by muscular, mucous and
fatty tissues, which support them and aid their function.
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