File:Operative gynecology - (1906) (14596943360).jpg

Identifier: operativegynecol001kell (find matches)
Title: Operative gynecology :
Year: 1906 (1900s)
Authors: Kelly, Howard A. (Howard Atwood), 1858-1943
Subjects: Gynecology Gynecology Gynecologic Surgical Procedures
Publisher: New York and London : D. Appleton and company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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ese authors disagree, however,in the method by which the lesionis produced, Beekmann claimingfrom an analysis of 100 cases,that in the majority of instancesthe accident occurs spontaneous-ly, while Vogel, in a similar re-view, holds that most cases aredue to violence. As the major-ity of cases reported have oc-curred in private practice andfrequently in the care of mid-wives, the idea of violence cannot be disregarded. Any condi-tion that favors relaxation of themusculature of the uterus andpatulousness of the cervix willpredispose to a uterine inversion.The exciting cause is usuallysome direct mechanical pressure,exerted from above by efforts ofexpulsion on the part of the pa-tient, attempts at Crede, etc.,or even the pressure caused bythe post-mortem development ofgas in the abdominal cavity.Taylor and Kaltenbach (citedby Beekmann, loc. cit.). The pressure may also come from below by traction upon an abnormallyshort cord or one which has been reduced in length by coils about the ex-
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Fig. 362.—Inversion of the Uterus, showing theInverted Uterine Body filling the Upper Va-gina, and the Cervical Ring through whichthe Inversion has taken Place. The ovaries and the uterine tubes lie at the entranceto the inversion funnel. 636 INVERSION OF THE UTERUS. tremities of the child. Beckmann calls attention to the importance of thesituation of the placenta as a predisposing factor, claiming that a centrallyimplanted one may predispose to inversion. Increased weight of the placenta,as in syphilis, infarcts, etc., has also been mentioned by these authors, andRokitansky speaks of a paralysis or a failure to retract on the part of theplacental site. The commonest cause of pathological inversion is a submucousfibroid attached to the fundus of the uterus. The mechanism of the formationunder these circumstances, is relaxation of the uterine cavity below the tumor,produced by expulsive efforts like those of labor, through which the tumoris finally forced into the vagina, dragging wi

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