Uniformly contracted, non-rachitic pelvis. Three successive pregnancies terminated respectively by premature delivery, version and forceps. Fracture of the coccyx.

Boston Medical and Surgical Journal

1856 Volume 113 number 21 page 485-487

Lombard, FH.

Abstract

[Taken from a description of the third pregnancy and childbirth of a woman with an abnormally small pelvis]

The outlet of the pelvis was felt on examination to be narrowed both in the transverse and the anteroposterior diameters, the tubera ischii being abnormally near together, and the finger impinging at once upon the coccyx as soon as it entered the vagina.

It was agreed that ether should be given and the forceps applied at once without awaiting complete dilatation of the os. This was done, and as much traction as possible employed. The head, which was small, advanced slowly until it reached the outlet. At this point, the projecting coccyx could be felt grasping the head like a claw, and indenting the scalp. To drag the head by this without fracturing the coccyx was impossible. It snapped with a dull sort of click that was distinctly felt and heard. [....]

Vaginal examination, while the patient was still under ether, showed that separation of the coccyx had taken place at its junction with the sacrum. No crepitus could be detected, and although the detached fragment was freely movable, there was little displacement. [....]

The fracture of the coccyx was unavoidable, and it would have been as serious an obstacle to the aftercoming head as to the head in advance. It was attended by no ill results to the mother, who would not have known of its occurrence had she not been told of it a month after delivery. On examination yesterday (five weeks after delivery), the coccyx was found to have re-united with the sacrum, though with a slight lateral deviation, which will be favorable rather than otherwise in the event of a subsequent pregnancy.

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