File:The science and art of midwifery (1891) (14786082783).jpg

Identifier: scienceamidw00lusk (find matches)
Title: The science and art of midwifery
Year: 1891 (1890s)
Authors: Lusk, William Thompson, 1838-1897
Subjects: Obstetrics
Publisher: New York, D. Appleton and Co.
Contributing Library: Yale University, Cushing/Whitney Medical Library
Digitizing Sponsor: Open Knowledge Commons and Yale University, Cushing/Whitney Medical Library

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close retraction ofthe uterus upon the foetus. The first cause may lead to retarded heart-action and intra-cranial extravasations of blood ; while the second is afruitful source of asphyxia, owing to the diminution of the maternalblood-currents which circulate through the placenta. In view of the foregoing, it will be seen that forceps is not alone FORCEPS. 361 indicated in the presence of perils fully developed, but is of stillgreater service as a prophylactic against the dangers of an undulylengthened second stage. It is in vain to lay down well-defined rules as to the precise timeat which the forceps should be applied. Formerly it was advised towait for the advent of a thin, reddish-brown discharge. As the lattersimply consists of serum commingled with blood from overstrainedcapillaries, it furnishes a sign that delivery has been delayed too long.Some counsel applying forceps two hours after the completion of thefirst stage of labor, and proclaim longer waiting a useless barbarity.
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Fig. 162.—Introduction of blades. Clearly, however, it is not so much the length of the second stage oflabor which furnishes the indication for forceps as the degree of thereciprocal pressure exercised between the head and the pelvis. A val-uable index to this pressure is furnished by the caput succedaneum.In the second stage, a scalp tumor of large circumference can only beproduced by the circle of the bony pelvis. Such a tumor, increasingin size, without any evidence of progress in the delivery, is a signifi- 362 OBSTETRIC SURGERY. cant evidence of pressure, and furnishes, therefore, the most reliableindication for forceps. ■ Whether the case with which forceps can be applied at the outletand the safety which attends its employment justify its use as ameans of saving the physicians time, or the patient from an addi-tional half-hour of suffering, are questions which are at least de-batable. I can only say that, with increasing experience, my ownpractice has grown more and more co

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