A textbook of obstetrics (1898) (14778506934)

Identifier: textbobstet00hirs (find matches)

Title: A textbook of obstetrics

Year: 1898 (1890s)

Authors: Hirst, Barton Cooke, 1861-1935

Subjects: Obstetrics

Publisher: Philadelphia : Saunders

Contributing Library: Yale University, Cushing/Whitney Medical Library

Digitizing Sponsor: Open Knowledge Commons and Yale University, Cushing/Whitney Medical Library

Text Appearing Before Image:

on succeed, as they always have in my hands, a large-sized pessary or a tampon in the posterior vaginal vault shouldbe applied until the growth of the organ maintains it in the ab-dominal cavity, and its increased size prevents its slipping backunder the promontory. The artificial support should be removedmidway between the third and fourth months. If the uterus isbound down by strong inflammatory bands, steady and long-continued pressure should be applied by means of large tamponsin the posterior vaginalvault, inserted while thepatient is in the knee-chest posture, by the aidof a Sims speculum, andrenewed daily. Failingto secure reposition insuch a case by this planabortion should be in-duced, before the symp-toms of incarcerationappear. Treatment of Retro-displacement when theUterus is Incarcerated.—The physicians attentionmust first be directedto the overfilled bladder.Catheterization is usu-ally easy if a prostaticcatheter is employedand if the physicianrecollects that the lower

Text Appearing After Image:

Fig. 149.—Frozen section of retroverteduterus of three and a half to four months. Deathfrom rupture of bladder. segment of the bladderas well as the urethra ispressed upon, making of the latter a canal perhaps more than five inches long (Fig. 149).It might be of advantage, in case of difficulty in reachingthe accumulation of urine, to catch the cervix with a tenaculumand to pull it backward, as suggested by Cohnstein, so asto relieve the pressure upon the urethra. If catheterization isimpossible, suprapubic puncture of the bladder with an aspiratingneedle is always practicable and perfectly safe if done in an asepticmanner. After the bladder is emptied attempts at repositionshould be made as previously described. If these attempts should 214 PREGNANCY. prove unavailing, abortion must be induced. If it is impossibleto effect an entrance into the cervix for this purpose, it is justifi-able to puncture the uterine wall through the vaginal vault, andthus draw off the liquor amnii. The o

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1898

Whitney Medical Library

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