Volume 1

A treatise on the science and practice of midwifery / by W.S. Playfair.

  • William Smoult Playfair
Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the science and practice of midwifery / by W.S. Playfair. Source: Wellcome Collection.

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

    161/432 (page 137)
    y^VLRSlTY OF I^^DS. Chap. III.] TREGN, and so much so that at this time those unaccustomed to vaginal examination experience some difficulty in distinguish- ing it from the vaginal walls. It is this softening, then, Valuo of which gives rise to the apparent shortening of the cervix so «f generally described, and it is an. invariable concomitant of of prog- pregnancy, except in some rare cases in which there has been '^''y- antecedent morbid indiu-ation and hypei-trophic elongation of the cervix. If, therefore, on examining a woman supposed to be advanced in pregnancy, we find the cervix to be hard and projecting into the vaginal canal, we may safely conclude that pregnancy does not exist. The existence of softening, however, it must be remembered, will not of itself justify an opposite conclusion, as it may be produced, to a very considerable extent, by various pathological conditions of the uterus. . At the same time that the tissue of the cei-vix is softened. The os its cavity is widened, and the external os becomes patulous. genj._^],y This change varies considerably in primiparse and multiparas, patulous. In the former the external os often remains closed until the end of pregnancy; but even in them it generally becomes more or less patulous after the seventh month, and admits the tip of the examining finger. In women who have borne children this change is mxich more marked. The lips of the external os are in them generally fissured and irregular, from slight lacerations of its tissue in former labours. It is also sufficiently open to admit the tip of the finger, so that in the latter months of pregnancy it is often quite possible to touch the membranes, and through them to feel the presenting part of the child. The remarkable increase in size of the uterus dm-ing preg- Cliargcs nancy is, as we have seen, chiefly to be explained by the [^^^^.g^f growth of its structures, all of which are modified during the uterine gestation. The peritoneal covering is considerably increased, l^j^^'^^^;.; so as still to form a complete covering to the uterus when at toneai its largest size. William Hunter supposed that its exten- sion was affected rather by the unfolding of the layers of the broad ligament than by growth. That the layers of the broad ligament do unfold during gestation, especially in the early months, is probable; but this is not sufficient to account for the complete investment of the uterus, and it is certain that the peritoneum grows pa7'i 'passu with the