396 DYSTOCIA. 



of several inches hanging out of the vagina, although the os uteri 

 was but very little dilated. Moreover, there are but few accoucheurs 

 in large practice who have not had several opportunities of observing 

 the same thing. 



904. The causes of this accident may be referred, 1. To the ex- 

 cessive quantity of the liquor amnii; 2. To too great a length of the 

 cord; 3. To the too sudden escape of the waters upon the rupture 

 of the membranes. 



905. The procidence of the cord has always been noted by 

 authors as a dangerous accident. Not because it renders the labor 

 more difficult, or causes the woman to run any greater risk, but be- 

 cause the fcEtus is thereby exposed to the hazard of dying before it 

 can be delivered. Its death in this case is indisputably produced 

 by the cessation of the circulation of the blood through the cord, 

 and all the reasons collected in the memoir by Thouret are in- 

 sufficient to weaken this proposition; but the obstacle to the cir- 

 culation has not been understood in the same way by all accou- 

 cheurs. 



Until the time of De la Motte, Avho did justice to this notion, it 

 had been generally supposed that the blood, from becoming chilled 

 by the external temperature, coagulated, or became concrete in the 

 loop of the cord hanging out of the vulva. 



At present, the accidents attending it are attributed to compression 

 alone. In fact, as soon as the waters are all gone off, if the cord 

 descends before the head, the breech, &c., its vessels are almost 

 necessarily flattened during the expulsive efforts. Nevertheless, if 

 the pelvis be very large and the foetus small, and the cord is placed 

 near one of the sacro-iliac notches while the forehead or the occiput 

 is towards the opposite one, the compression of its vessels may be 

 so slight as not to prevent the blood from pursuing its route. 



906. Death takes place from an excess of blood, or apoplexy, if 

 M. Chambon is to be believed; from anemia or syncope, according 

 to Baudelocque, MM. Capuron, Deneux, &c.; from asphyxia, or 

 want of oxygenation of the blood, according to Muller. But neither 

 of these three hypotheses is correct. It is impossible to maintain 

 with Freteaux, that the vein is less compressed than the arteries, or 

 with others, that just the contrary happens. All three of the ves- 

 sels are compressed alike, and the death of the fcetus is to be ex- 

 plained not upon the quantity, but the quality of the blood, it re- 

 ceives. 



907. Prognosis. If the cord is cold, without pulsation, shrunk, 

 and greenish, the death of the child is indubitable; if the labor is 

 still far from its termination, the head strongly engaged, and it is 



