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Re: +3/5From: Malcolm Griffiths (Malcolm@MGRIFF22.demon.co.uk)Sat Jun 27 09:53:25 1998
In message <bee658a1.359419cd@aol.com>, RModugno@aol.com writes >In a message dated 98-06-26 07:56:32 EDT, you write: > >> >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?" > This is a pet hate of mine. Philpot devised his scheme of fifths for his original partogram, where he asked non-midwife carers in labour to assess abdominally the descent of the head in labour. Remeber that he was dealing with an african population where engagement typically occured in labour and not before. He got the lay carers to recognise obstructed labour by lack of descent in this way and they then trasnferred the labouring woman to a hospital with facilities for interventions such as CS. Philpot never said fifths measured engagement! This is a curruption of an excellent clinical method. Engagement is defined as the entry of the widest denominator of the presenting part into the pelvic inlet. It is therefore recognised clinically by whether the presenting part seems wider or narrower above the pelvic brim. It is quite possible for a head to be >3/5 palpable and engaged. Next time you encounter a face presentation you'll see what I mean. In a plea for sanity - please talk about engagement and descent separately - they're not the same thing. Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK. Tel: 01582-497459 (office) Fax: 01582-497376 01525-222849 (home) email: Malcolm@mgriff22.demon.co.uk http://www.obgyn.net/board/griffith.htm "CLINICAL FREEDOM IS THE LAST REFUGE OF THE CLINICALLY INCOMPETENT!" (Someone [1997])
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