File:The practice of obstetrics, designed for the use of students and practitioners of medicine (1910) (14590419498).jpg

Identifier: practiceofobstet00edga (find matches)
Title: The practice of obstetrics, designed for the use of students and practitioners of medicine
Year: 1910 (1910s)
Authors: Edgar, J. Clifton (James Clifton), 1859-1939
Subjects: Obstetrics
Publisher: 3rd ed., rev
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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on, but the liability to septicaccidents is a contraindication save when intervention is absolutely necessary.When a rupture at the vulval outlet is threatened, episiotomy may be performedunder strict asepsis. XVllI. DISTENDED BLADDER AND RECTUM. CYSTOCELE, RECTO-CELE, VESICAL CALCULUS. Distended Bladder.—The subject of retention during pregnancy is consideredon page 318. The condition is often encountered during labor, because thepresenting part may, during its descent, press upon the neck of the bladder.As the cervix dilates, the summit of the bladder ascends into the abdomen.Abdominal palpation will therefore readily reveal the presence of the fluctuatingmass in front of the uterus. The urine collects in the upper part of the bladder 614 PATHOLOGICAL LABOR, and impairs the efficacy of uterine contractions. An elastic male catheterwill probably be required to reach the urine. Owing to the displacement ofthe meatus and urethra, considerable difficulty may be encountered in entering
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Fig. 808.—Distended Bladder DuringLabor. Fig. 809.—Abdomen Seen in Fig. 808,after the Use of the Catheter. the bladder. It may even be necessary to push back the advancing head inorder to make way for the passage of the instrument (Figs. 808 and 809). Fecal Accumulations.—The extreme type of retention of feces known ascoprostasis, in which ordinary resources are insufficient for the evacuation of the bowel, constitutes a serious mechanical obstacleto delivery and may lead to grave consequences (Fig.810). Such a condition is of very rare occurrence, forTarnier* saw but one case. One would expect copro-stasis to depend, in these cases, upon some malforma-tion of the rectum, and such a coincidence is knownto have occurred. These fecal accumulations obstruct-ing a portion of the pelvic cavity must have the samedystocic effect upon labor as a contracted pelvis; theyprevent engagement of the head and lead to faultypositions. Owing to the degree of hardness of thefeces, removal dan har

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