Severe contracted pelvis appearing after normal deliveries

Bedouin women constitute a rather important fraction of the obstetric population admitted to the hospital, the only one in the Negev area. Almost 15 per cent of the deliveries in the Obstetrics Department belong to Bedouin women. 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. The sudden appearance of 3 consecutive cases prompted an investigation to be carried out. A roentgenray 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', and 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 vagival delivery is not granted from a pelvic point of view for multiparous women who have delivered normally in the past.