SEVERE CONTRACTED PELVIS APPEARING AFTER NORMAL DELIVERIES

Abstract

Three cases of contracted pelvis in Bedouin women, appearing after two and three previous normal vaginal deliveries, are presented. In these three cases cesarean section had to be performed to deliver the babies. A roentgen‐ray screening revealed osteomalacic pelves in all cases with typical pseudo‐fractures (Milkman) and Looser zones. Pelvic deformities of the osteomalacic type are considered rare medical curiosities, and elective cesarean section is usually indicated.It has been found that Bedouins consume large quantities of “raghif”, an unleavened bread with high content of phytic acid, very similar to Indian “chapati”. Phytic acid impairs the absorption of calcium from the intestine by the precipitation of an amorphous calcium phytate and causes probably some interference with the action of vitamin D. Withdrawal of this alimentation improves the illness. There is emphasis on the fact that vaginal delivery is not granted from a pelvic point of view for multiparous women who have delivered normally in the past.Bedouin women constitute a rather important fraction of the obstetric population admitted to our hospital, the only one in the Negev area. Almost 15 per cent of the deliveries in our Obstetrics Department belong to Bedouin women. The sudden appearance of three consecutive cases of contracted pelvis in which we had to perform cesarean section on women who had previously delivered vaginally at least twice, produced this investigation, whose interesting results we describe herewith.