Aids to obstetrics : double part / by Samuel Nall.

  • Nall, Samuel.
Date:
[1885?]
Catalogue details

Licence: Public Domain Mark

Credit: Aids to obstetrics : double part / by Samuel Nall. Source: Wellcome Collection.

    118/150 (page 114)
    J14 The spine is then divided internally by the scissors, and the breech is drawn down by traction with the blunt hook externally, or by the crotchet applied internally to the lower part of the spine. XLV.—CJESARIAN SECTION. Definition.—Division of the abdominal and uterine walls, and extraction of the child through the openings thus made, when delivery by the natural passages is impossible. The Operation is Indicated as a last resource in cases of extreme pelvic contraction. If the pelvis measures 1^ inches or less in the conjugate, the passage of a mutilated child is generally impossible, and Ceesarian section becomes necessary. These cases of great contraction may be produced by osteo-malacia, rickets, uterine, pelvic and other tumours encroaching on the pelvic space. When the mother dies in labour it is indicated to save the life of the child* Prognosis.—As regards the mother it is extremely bad. The mortality is about 60—70 per cent., due in a great measure to the fact that it is rarely performed till the mother is moribund. As regards the child, if it is alive before the operation, the risks are no greater than in ordinary labour. Time and Preparation for the Operation.—It should be per- formed during the first stage of labour, before the membranes are ruptured, so that the lochia may have a free escape through the dilated cervix. If the condition is known before labour the patient should be prepared by a course of good food, tonics, etc. The operation should be performed under the carbolic spray, and, if possible, not in a hospital. Ether should be used as an anaesthetic, The bladder should be catheterized before the operation. The Operation.—An incision is made along the linea alba from an inch above the umbilicus to three inches below it; when the peritoneum is reached it is laid open over the whole length of the incision. The uterus is then pushed by an assist- ant against the opening, and an incision four inches long is made into it till the membranes are reached, carefully avoiding