Operative midwifery / by J.M. Munro Kerr.

  • John Martin Munro Kerr
Date:
1908
Catalogue details

Licence: In copyright

Credit: Operative midwifery / by J.M. Munro Kerr. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    657/732 (page 639)
    wonderful is one recorded by Leopold/ in which rupture occurred at the fourth month, and yet pregnancy Continued to term, when the child died. On opening the aljdomen three months later the child was removed. Its umbilical cord was found to run through an open- ing in the posterior wall of the uterus. But it is profitless to consider such rarities. Various estimates have been given of the mortality from the ex- pectant treatment, but it appears to have been 90 per cent, at least amongst recognized cases of complete rupture. Naturally, it was much lower in the incomplete variety. In recent years, with a more exact understanding of the condition and with the adoption of active treatment, the mortality has fallen fully a third. It is still, however, 50 to 60 per cent., being a little higher than that figure for complete, and a little lower for incomplete, rupture. This question, however, will be more carefully considered when the different methods of treatment are being discussed. Treatment. As rupture of the uterus is so often a preventable accident, it is necessary that I should say a word or two about its prophylaxis. As regards those cases where the uterus has been previously injured, either ])y tears, incisions, curettage, or disease, subsequent pregnancies should be watched, and especially should the patient be under careful observation during the later weeks, so that, should rupture occur, an operation could be immediately undertaken. The same applies to cases in which previous lal)Ours have been difficult and protracted, owing to malformations of the pelvis, or undue size of the children, for, as we have seen, previous lacerations are often passed unrecog- nized, and a lower segment which has once been overstretched yields and tears more readily. As the danger of rupture during the first stage is practically nil, excepting in cases where there have been previous lacerations or injuries to the uterus, there is nothing to be done. In the second stage, however, if any of the premonitory symptoms of rupture arise, delivery must be carefully completed. In contracted pelvis the degree of deformity and the relative size of fa3tal head and pelvis must be carefully calculated, and the safest treatment adopted. As rupture of the uterus occurs so commonly in neglected transverse presentations, it is of the greatest importance that such a malposition of the child should be early recognized and corrected. Again, if, for any reason, the presentation has not been ' Archiv f. Gyn., 1896, Ld. lii., p. 376.