|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Re: +3/5 (Long)From: RModugno@aol.comSat Jun 27 21:52:46 1998
In a message dated 98-06-27 19:32:00 EDT, you write: << Robert or Peter or Malcolm, Can you please give more details about abdominal assessment of engagement? What exactly did Professor Philpott tell the midwives to do in their exam? I find the statement that engagement doesn't occur in African patients until labor very interesting. Patients here are >50% African-American. Some c/s here are done because the presenting part is "high" and progress has been unsatisfactory, with indication for c/s "CPD". Often these babies are small, <3000g. While I know from recent experience that even a little baby can be a struggle to deliver vaginally, abdominal assessment of progress might be a useful adjunct. Does engagement not occur in African patients (and perhaps in some African-American patients) before labor because of pelvis shape--molding produced by labor is necessary for engagement? Please tell us more.
Jane
>> For more detail on the assessment of CPD in African women,Philpott wrote a chapter in Clinics in Obstetrics and Gynecology of North America - the title of that issue was Obstetrics in the Developing World and was published in the late 70s or early 80s. Philpott's view was that in most African primigravidae, the head did not engage until active labor had begun, and in many, late in the first stage. The reason for this was thought to be 1) A high angle of inclination of the pelvis and 2) A relatively contracted pelvis, which was thought to be due possibly to poor nutrition. The relationship of the presenting part to the ischial spines was thought by Philpott to be a poor indicator of descent due to molding and caput. In fact he had a grading system whereby one would judge the amount of caput and molding which ranged from + to +++. The system of fifths was an abdominal assessment of the head through the pelvic brim.The average fetal head was thought to be about five fingersbreadths in diameter( by Leopold's ?fourth manouvre).For example: 5/5 to4/5 "above" (the brim) would indicate a high or floating presenting part,2- 3/5 would represent engagement, and 1-0/5 would mean that the head was virtually all in the pelvis. ( This system applied to fetuses presenting by the vertex only, and not to face or brow presentations). Therefore if a patient was assessed with the head at 4/5 and ++ to +++ caput and molding, together with secondary arrest of cervical dilatation or arrest of descent in the second stage, she had CPD. This was also used as a guide to the feasibility of operative vaginal delivery vs cesarean section ( and also, yes, symphysiotomy!). I hope this answers your question. Robert Modugno MD Premier Medical OB/GYN Roswell, Ga ( ex Philpott Resident, Durban, South Africa 1996-1977)
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Mon Nov 2 05:28:03 2009 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.