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.

    660/732 (page 642)
    With the great improvement in technique and the results of abdominal surgery, it is not surprising that good results were expected from opening the abdomen and removing the uterus or stitching the tear. But I fancy most of us who have adopted such a course have been not a little disappointed with the results. Without doubt, a large number of cases have been saved by such treatment. Three cases in my own list were successful, and all other operators of any ex]Derience have had occasional recoveries ; but the mortality is still extremely high, because of the collapsed condition of the patient at the time of operation and the sepsis that so frequently follows. Of my fatal cases, two died of shock very shortly after the operation, and four of sepsis. One is not disheartened by death from shock, for in this condition it is often impossible to prevent it; but it is very disappointing when a patient recovers from the shock and dies of septicaemia. In the cases which died of sepsis the patients died on the fourth, fifth, eleventh, and thirteenth days respectively. It is not to be wondered at that septicfemia so frequently follows. Many of the cases have been carelessly handled ; the tissues have been much bruised; micro-organisms have been introduced, and actually rubbed into the tissues during the various manipulations carried out; and the patients are exhausted by prolonged labour and loss of blood. Nothing could be more favourable for the occurrence of infection. Table of Authoe's Fourteen Cases. jSTumber of Cases. Maternal Deaths. Died unoperated upon (both complete) 2 2 Plugging (all incomplete) Hysterectomy (Porro's) (incomplete) 3 0 1 1 „ retroperitoneal treatment of stump (all complete) 5 3 Panhysterectomy (all complete) 3 2 Total maternal mortality in cases treated ... ... ... 50 per cent. Mortality for hysterectomy (9 cases, 3 deaths) ... ... 67 ,, When the abdomen has been opened for the purj^ose of extracting the child, or when abdominal section is decided upon after the child has been removed by the vagina, there are several modes of dealing with the uterus. (a) Complete removal of the organ—panhysterectomy. (b) Supravaginal amputation, with retroperitoneal treatment of the stump.