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Re: +3/5From: Peter Wein (p.wein@obsgyn-mercy.unimelb.EDU.AU)Sat Jun 27 04:25:03 1998
At 05:07 PM 26/06/98 -0500, you wrote: >In a message dated 98-06-26 07:56:32 EDT, you write: > ><< The +3/5 means that the head is 3 cm below the level of the spines. The > /5 means that I am really using cm. and that there are actually 5 cm > between the spine and the outlet. For years and actually still many > people in the US divide the distance into thirds and count + 3 as on the > perineum. > Dan > >> >Dan, may I submit another meaning of +3/5? In my residency in South Africa, we >talked about the number of "fifths" above the pelvic brim. Each 'fifth' being >equal to about one fingersbreadth. This was popularized by Prof Philpott, the >originator of the "Alert' and "Action" line on the partogram of labor. We did >not use the level of the ischial spines as a denominator of station, as caput >and molding influence that so >much. Therefore, if the head was 2-3/5 above the brim, it was engaged. If the >head was high or floating, it was 5/5, if it was deeply engaged, it was 0 >to1/5.We used these denominators to determine the safety for operative >vaginal delivery - either vacuum or forceps. Are any other non-US physicians >aware of this concept of "fifths?" > >Robert Modugno MD >Premier Medical OB/GYN >Roswell, Ga > Yes - it is the standard way of describing the abdominal station in Australia - which is more accurate than describing station by pelvic examination - if the head is very moulded or very large it is possible that the vertex is below the spines even though the widest diameter of the presenting part had not yet passed the pelvic inlet ( the definition of engagement) - and if the head is not engaged, you will have trouble with forceps/ vacuum! For this reason we always examine the patient abdominally as well as vaginally prior to embarking on a mid-cavity forceps delivery. TI: A comparison of abdominal and vaginal examinations for the diagnosis of engagement of the fetal head. AU: Knight-D; Newnham-JP; McKenna-M; Evans-S AD: University Department of Obstetrics and Gynaecology, King Edward Memorial Hospital for Women, Perth, Western Australia. SO: Aust-N-Z-J-Obstet-Gynaecol. 1993 May; 33(2): 154-8 *LHM: Journal is held in the Medical Library from *LHC: v.1- 1961- ISSN: 0004-8666 PY: 1993 LA: ENGLISH CP: AUSTRALIA AB: The diagnosis of engagement of the fetal head is mandatory before operative vaginal delivery is to be attempted. There is widespread belief that the fetal head is engaged in the maternal pelvis when vaginal examination reveals that the bony presenting part has reached the level of the ischial spines. However, it is also claimed that in the presence of moulding the vaginal findings may be misleading and that it may be preferable to make the diagnosis by abdominal examination of the level of the fetal head in relation to the pelvic brim. In order to evaluate the relative merits of each of these 2 systems of physical examination, a retrospective study was made of 104 cases which had been evaluated for possible operative vaginal delivery by both methods. Prediction of successful vaginal delivery was greater by abdominal criteria (94%) than by vaginal criteria (80%) (p < 0.01). When evaluated by maximum likelihood logistic regression analyses, the factor of greatest importance in determining the probability of allocation of a case to each of the engagement groups was moulding (odds ratio 2.17; 95% confidence intervals 0.75-6.27). We conclude that when these 2 methods of assessment produce different diagnoses, the major factor responsible is moulding of the fetal head. Clinical evaluation prior to operative vaginal delivery must include abdominal examination and reliance on vaginal findings alone may prove misleading when moulding is present. MESH: Adult-; Cesarean-Section; Delivery-; Head-; Logistic-Models; Palpation-; Pregnancy-; Pregnancy-Outcome; Retrospective-Studies MESH: *Extraction,-Obstetrical; *Fetus-; *Physical-Examination-methods
-- Peter Wein Senior Lecturer Department of Obstetrics and Gynaecology University of Melbourne, Mercy Hospital for Women Clarendon Street, East Melbourne 3002 Australia Tel: +61 3 9270 2556 Fax: +61 3 9417 5406 Mobile: 0414 691690
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