A handbook of obstetric and gynaecological nursing / by the late Fleetwood Churchill.

  • Fleetwood Churchill
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: A handbook of obstetric and gynaecological nursing / by the late Fleetwood Churchill. Source: Wellcome Collection.

    119/240 (page 99)
    completed, they virtually delay the second stage, and the effects are the same. The following are the princi- pal causes of difficult labor:— 1. Minute or imperforate os uteri. In some few cases, it may be found impossible to detect any open- ing into the womb ; in others, disease has evidently closed the uterine orifice abnormally after conception, whilst in others the opening is congenitally so small as not to admit the necessary expansion. This is obviously of great consequence, as if during the pro- gress of labor the orifice remains closed, or dilates too little, the patient will suffer the consequences of a prolonged second stage, until the case eventuates. If, however, you find it difficult to discern the os uteri on making an examination, you must not hastily con- clude, either that there is none or a very minute one, because it is sometimes pushed so far back as to be nearly out of reach. In such cases you should wait a while, until the patient has had some pains, and then examine carefully again. If, after all your endeavours you really cannot detect any uterine opening, you had better obtain additional help. On the other hand, if you discern it, and it is very small, you may safely wait a few hours, to see the effect of continued pains, from which it may ultimately yield, but if not, and tin* pains apparently change their character into those of the second stage without effect, you should at once pro- pose that further assistance should be obtained. If you are careful, you will be quite capable of ascertaining the existence of this obstacle, but its further manage- ment is too great a responsibility. 2. Cancer of the uterus. Pregnancy may occur not- withstanding the existence of cancer. We do not ex- pect that you will be able to recognise this disease, nor is it necessary, for if you find the cervix unusually large, hard, and cartillagenous, the os uteri well marked by ulceration, and no dilatation produced by the pains, the case is clearly beyond you, and requires special assistance.