Difficult labour : a guide to its management for students and practitioners / by G. Ernest Herman.

  • Herman, G. Ernest (George Ernest), 1849-1914.
Date:
1906
Catalogue details

Licence: In copyright

Credit: Difficult labour : a guide to its management for students and practitioners / by G. Ernest Herman. 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.

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    uterus either before or after uterine contraction has become tonic. The mode of production of this accident I shall describe in a subsequent chapter. Importance of diagnosis between uterine inertia and tonic contraction of the uterus. —One of the greatest practical blunders that can be made is in the mistaking tonic contraction of the utei'us for secondary uterine inertia, otherwise called temporary passiveness, and the reverse. Therefore pay careful attention to the diagnosis between tonic contraction of the uterus and secondary ttteriiie iner- tia. Tonic contraction of the uterus and secondary uterine inertia present certain superficial resemblances. In both, regular pains have ceased. In both, the jjatient and her friends may think the labour has lasted too long, and be clamorous for delivery. But yet the diagnosis between them is of extreme import- ance, for the treatment is diametrically opposite. In tonic contraction of the uterus immediate delivery is absolutely necessary : in secondary uterine inertia it is the worst possible practice, for it ensures post- partum hemorrhage. Therefore, I give the difleren- tial diagnosis in a tabular form. The points of difference are as follows :— Secondary uterine inertia, otherwise called Tonic contraction temporary passiveness, of uterus, and uterine exhaustion. A. As to the patient's general condition. Expression placid: at most Expression of face tired and showing signs of fatigue : anxious, not anxious. Pulse not over 100. Pulse small and quick ; gener- . ally 120 or over. Breathing not hurried. Breathing hurried in proiwr- tion to pulse. B. Abdominal examination. Uterus not tender. Uterus tender if condition haa n ... lasted long. Ortline and limbs of child can Outline of child cannot be felt, be distinctly felt, and child ' but only that of hard and moved about. immovable uterus : irregular in shape because moulded to the shape of the child.