File:A textbook of obstetrics (1899) (14778287815).jpg

Identifier: textbt00hirs (find matches)
Title: A textbook of obstetrics
Year: 1899 (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

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gt; internum;c, uterovesical reflection of peritoneum ; if, bladder; e, symphysis pubis; j\ urethra;;■, promontory of sacrum ; //, pouch of Douglas ; /. posterior fornix ; /, os externum. and their removal should be attempted unless some other con-dition is clearly seen to be the cause of the bleeding. To reachthe uterine cavity after involution and retraction have made someprogress, it is often necessary to dilate the cervical canal.I legars bougies will be found the safest and most convenientinstruments for the purpose. Branched dilators, unless used PUERPKRA I. ffEMORRH. 1GES. 595 with the greatest care, are dangerous in the puerperal womb.Not rarely, however, the cervical canal remains patulous in con-sequence of a foreign body in utero ; in this case access to theretained mass and its removal are easy. Displacements of the Uterus.—The dislocation of the puer-peral uterus often manifests itself in puerperal hemorrhage.Inversion, prolapse, displacements forward and backward and
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Fig. 454.—Section of a primipara who died from sepsis rive and a half days-after delivery (Barbour). upward by a distended bladder, are all likely to be followed byprofuse bloody lochia, if not by an active hemorrhage. In-version and prolapse have already been considered ; retroversion,retroflexion, and anteflexion are noticed here. Hemorrhage is likely to occur in these displacements as aresult of the passive congestion always associated with them,due to interference with the venous circulation ; or the bleeding /,/ THOLOGY OF 7 HE 1»t /■ RI *£ R11 M. may be the consequence of the retention o\ blood within theuterine cavity, due to the mechanical interference with its escape ;in the latter eases clots are formed, increasing gradually in size,often undergoing putrefaction, and acting not only as a foreignbody, preventing uterine contraction, and attracting by their irri-tating action an extra amount of blood to the uterus, but consti-tuting as well a favorable nidus for the deve

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