Volume 1

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

  • Playfair, W. S. (William Smoult), 1836-1903.
Date:
1893
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 King’s College London. The original may be consulted at King’s College London.

    448/462 (page 420)
    Causes. Circum- stances in- tei'fering with the adapta- tion of the presenting part to the pelvis. Pelvic deformity. Diagnosis. Import ance of de- termining the pulsa- tions of the cord. Amount of cord prolapsed. of the soft parts, and tlie consequent prolongation of the labour. The causes of prolapse of the funis are an} circum- stances 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- tions than in any other. Amongst occasional accidental predisposing causes may be mentioned early rupture of the membranes, especially if the amount of liquor amnii be excessive, as the sudden escape of the fluid washes down the cord; undue length of the cord itself; or an unusually low placental attachment. Engelman attaches great importance to slight contraction of the pelvis, and states that in the Berlin Lying-in Hospital, where accurate measurements of the pelvis were taken in all cases, it was almost invariably found to exist. The explanation is evident, since one of the first results of pelvic contraction is to prevent the ready engagement of the presenting part in the pelvic brim. The diagnosis of cord presentation is generally devoid of difficnlty; but if the membranes are still unruptured, it may not always be quite easy to determine the precise nature of the soft structures felt through them, as they recede from the touch. If the pulsations of the cord can be felt through the membranes, all difiiculty is removed. After the mem- branes are ruptured, there is nothing for which it can well be mistaken. The important point to determine in such a case is whether the cord be pulsating or not; for if pulsations have entirely ceased, the inference is that the child is dead, and the case may then be left to nature without further inter- ference. It is of importance, however, to be careful; for, if the examination be made during a pain, the circulation might be only temporarily arrested. The examination, therefore, should be made during an interval, and a loo]-) of the cord pulled down, if necessary, to make ourselves absolutely certain on this point. The amount of the prolapse varies much. Sometimes only a knuckle of the cord, so small as to escape observation, is engaged between the pelvis and presenting part. Under such circumstances the child may be sacrificed without any