A review of 610 cases of primiparous labors in the obstetric service at the Brooklyn Hospital in the last fifteen months, and an intensive study of sixty-one cases in which the vertex was not engaged at the onset of labor, demonstrates that:
Failure of vertex engagement cannot be accepted as an indication of disproportion without other direct confirmatory evidence.
Persistence of nonengagement after a few hours of labor does not constitute such confirmatory evidence, nor is a so-called "test of labor" significant as demonstrating the feasibility of vaginal delivery. Our study further affirms that, in managing such cases, instead of avoiding vaginal examinations in anticipation of abdominal delivery, a thorough vaginal examination under an anesthetic should be made, at which time the ability of the pelvis to accommodate the infant may be determined and all adjuvant conditions that should govern the management may be studied.
Nonengagement per se should not
CARY WH, CASAGRANDE J. NONENGAGEMENT OF VERTEX IN PRIMIPARAS AT ONSET OF LABOR: DOES IT INDICATE DISPROPORTION OR DIFFICULT LABOR? JAMA. 1925;84(12):888–889. doi:10.1001/jama.1925.02660380024008
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