Volume 3

A system of gynecology and obstetrics / by American authors ; edited by Matthew D. Man and Barton Cooke Hirst.

Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: A system of gynecology and obstetrics / by American authors ; edited by Matthew D. Man and Barton Cooke Hirst. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    the jiressure of the head of the child, forcing tiiese tist)Ue.s against the sharp promontory of a rachitic pelvis. Rupture of the Body of the Uterus.—Ruptures limited to the body of‘ the uterus have resulted from the giving way of cicatrices consequent upon a rupture in a previous labor or of a Caesarean section. Barnes admits that in some cases of this accident excessive fatty degeneration of the muscular tissue of the organ was present. He adds, however, that to prove that a particular cause existed in a limited number of cases is very different from establishing it as a general or universal law; and there is abundant evidence to prove that in a considerable num- ber of cases no such excess did exist. But of course cases belong- ing to these categories are very few, and we may assume, with Zwei- fel, that in some instances spontaneous rupture of the uterus results from a change, a displacement of the individual muscle-layei's of the uterus. Rupture of the Neck and of the Body of the Icterus.—By far the great majority of grave ruptures of the uterus involve the neck and the body, and the explanation of their occurrence given by Bandl is generally aceepted. In normal labor the first stage is regarded as ending when the os uteri is so dilated that it offers no resistance to the presenting ])art, and this, therefore, under the influence of uterine contractions, descends and is exjx'lled from the uterus, but with de.scent of the head, for example, ascent <A' the os uteri occurs. The activity of the uterus is exerted during that stage in a retraction of the os, drawing it upward over the ])resenting part. But if there be a marked disproportion between the ju-esenting part and the canal it must pass through—as, for exani])lc, that caustxl by a shoulder presentation or a hydrocephalic head or bv .a narrow jiclvis—advance is impossible; meantime, the uterine force struggling against an invincible obstacle, the effort at retraction of the (;ervix still continues, and the tissues of the cervix and of the lower jiortion of the body of the uterus arc greatly stretched and attenuated. In consequence of the right obliquity of the uterus—this being the fact in the great majority of cases—the retraction as a rule is greater upon the left side than upon the right. “ This ex])lanation makes clear the reason for these ruptures always involving the cervical portion, and thence extending uinvard to the contraction-ring and down- ward into the cul-de-sac, and why they are in only rare instances directly longitudinal, but have an oblique or transverse c'ourse ; theii greater frequency upon the left side is not to be attributed to the gieater frequency of the pressure of the head upon that side, but to the usually occurring right obliquity of the uterus and to the greater retiaction ot the left uterine wall.”^ To the question as to Avhy the vagina is not made tense, drawn up by this retraction of the cervix, the answer is ’ Zweifel.