102 



OBSTETRICS. 



CiESAREAN OPERATION. 



When from any cause the antero-posterior diameter of the superior 

 strait, or the transverse diameter of the lower, is not more than 1 J 

 inches, there is no possibility of delivery " per vias naturales," and 

 it becomes necessary to resort to the Cgesarean operation. 



The conclusions that have been derived by Dr. Churchill from a 

 careful examination of statistics are, " that in cases where we cannot 

 deliver the patient by any other means, and when, consequently, 

 both mother and child would inevitably die, we may afford each a 

 chance by performing the Casarean section.^'' 



The best j^eriod for operating is at the commencement of the labour, 

 provided there be no doubt as to the necessity. The strength of the 

 woman is then unimpaired, she can bear the operation better, and 

 runs less risk of inflammation. For the method of performing this 

 operation, see text books. 



PROLAPSUS OF THE CORD, 



Whenever it occurs, may become a cause of preternatural labour. 

 It may be produced in various ways, as for instance, by transverse 

 presentation ; by over-distention of the uterus by a large quantity 

 of liquor amnii ; by sudden rupture of the membranes and a gush 

 of the contained fluid ; by presentations of the feet or knees, the 

 lower portions of the uterus not contracting sufficiently around the 

 child; and by excessive length of the cord. (Fig. 36.) 



The prognosis is, of 

 Fig. 36. course, unfavourable, the 



child being very liable 

 to perish from asphyxia 

 produced by pressure 

 upon the cord. 



Tieatment. — Various 

 expedients have been re- 

 sorted to, in order to re- 

 place the cord, none of 

 which have been entirely 

 successful. It has been 

 proposed to push it up 

 beyond the brim and 

 hold it there till the head 

 has engaged ; or to hook 

 it over the limbs of the 

 child ; or to enclose it in 

 a little bag attached to a 

 catheter or slender rod, 

 then return it, withdraw 

 the rod, and leave the bag and cord in the uterus. If, however, the 



