File:The American text-book of obstetrics for practitioners and students (1903) (14775397554).jpg

Identifier: americantextbook02came (find matches)
Title: The American text-book of obstetrics for practitioners and students
Year: 1903 (1900s)
Authors: Cameron, James C. (James Chalmers) Norris, Richard C. (Richard Cooper), 1863-1937 Dickinson, Robert Latou, 1861-1950
Subjects: Obstetrics
Publisher: Philadelphia : W.B. Saunders & Co.
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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ic hones from springing too widely apart. The separa-tion must not he permitted to exceed 7 cm. (2; inches). The wound i- pro-tected with sterile gauze, and the child extracted. Forceps arc employed 440 AMERICAN TEXT-BOOK OF OBSTETRICS. if the head presents. Care is needed to prevent too great strain upon theanterior soft parts, and consequent laceration of these structures duringdelivery. The liability to this accident is especially great in breech extrac-tion, since the delivery must be completed rapidly. When anterior lacera-tion seems imminent, it should be prevented by double episiotomy incisions.Rarely the woman may be permitted to deliver herself with the aid ofexpressio foetus. As a rule, it is better to terminate the labor at once. Thepatient is thus spared a prolonged exposure of the operation wound and theattendant risk of infection. After extraction of the child and placenta the pubic bones are broughtfirmly together, the bladder and urethra meantime being held backward to
Text Appearing After Image:
Fig. 224.—Symphysiotomy: subcutaneous operation; the left index-finger within the vagina and behind the symphysis (side view). prevent injury by pinching between the bones. The prepubic fibrous struct-ures are sutured with three or four interrupted stitches of catgut, and theremaining portion of the wound closed with silkworm-gut, passed fromwithin outward. If preferred, the catgut sutures may be dispensed with,the silkworm-gut sutures being made to include the ligamentary structuresin front of the pubic bones. Or the deeper portion of the wound may beclosed with buried catgut and the skin with the subcuticular suture. Thewound is dressed as in other celiotomies. While the technic just detailed, it is believed, will be found most satis-factory, other methods are by some operators preferred. The symphysismay be divided with the blunt-pointed bistoury, the finger behind the jointserving in place of the director as a guard. Bleeding, which is sometimes OBSTETRIC SURGER ) HI profuse, is

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