Volume 1

A treatise on the science and practice of midwifery / by W.S. Playfair.

  • Playfair, W. S. (William Smoult), 1836-1903.
Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the science and practice of midwifery / by W.S. Playfair. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    422/432 (page 398)
    LABOUR. [Part III. Prognosis. ]{cl;itivo I'letal iiior- tiility in different presenta- tions. The fcetal mortality is greater in first labours. Causes. Circum- stances in- terfering with the adapt ation of the In France, where, although the patient is laid on her bac-k, the pelvis is kept elevated, the complication occurs least frequently; in England, where she lies on her side, more often; and in Gfermany, where she is placed on her back with her shoulders raised, most often. The special frequency of prolapsed funis in certain districts, as in Kiel, is supposed by Engelman • to depend on the prevalence of rickets, and consequently of deformed pelvis, which we shall presently see is probably one of the most frequent and important causes of the accident. With regard to the danger attending prolapsed funis, as far as the mother is concerned, it may be said to be altogether unimportant; but the universal experience of obstetricians points to the great risk to which the child is subjected. Scanzoni calculates that 45 per cent, only of the children were saved; Churchill estimated the number at 47 per cent.; thus, under the most favourable circumstances, this com- plication leads to the death of more than half the children. Engelman found that out of 202 vertex presentations only 36 per cent, of the children survived. The mortality was not nearly so great in other presentations; 68 per cent, of the cases in which the child presented with the feet were saved, and 50 per cent, in original shoulder presentations. The reason of this remarkable difference is, doubtless, that in vertex presentations the head fits the pelvis much more completely, and subjects the cord to much greater pressure; while in other presentations the pelvis is less completely filled, and the interference with the circulation in the cord is not so great. Besides, in the latter case, the complication is detected early, and the necessary treatment sooner adopted. The foetal mortality is considerably greater in first labours ; a result to be expected on account of the greater resistance of the soft parts, and the consequent prolongation of the labour. The causes of prolapse of the funis are any circumstances which prevent the presenting part accurately fitting the pelvic brim. Hence it is much more frequent in face, breech, or shoulder than in vertex presentations, and is relatively more common in footling and shoulder presenta- ' Amcr. Journ. of Obst. vol. vi.