Death of the Fetus. 733 



b. Death of the Fetus. Fetal Emphysema. 



Simple death of the fetus prior to or during labor does not con- 

 stitute a very important cause of dystokia, though the move- 

 ments of the living fetus probably tend to favor easy labor by 

 overcoming any tendency to a false presentation. The dead fetus 

 may undergo rigor mortis, as in extra-uterine death, and this may 

 tend to complicate its expulsion. 



When the fetus has been long dead, and emphysema or gaseous 

 distension of the tissues occurs as a result of its decomposition, 

 the fetal cadaver becomes very greatly increased in volume, and 

 this may render its expulsion exceedingly difficult or impossible. 

 Not only is there an increased fetal volume in such instances, but 

 the fluids escape and the hair of the fetus becomes dry and ad- 

 heres closely to the uterine walls, .so that it is difficult for the fetal 

 cadaver to glide along the passages. The emphysema intensifies 

 dystokia by distending the uterine cavity and causing paralysis 

 of the uterine walls, from fatigue ; or it leads to infection of the 

 uterine walls, with paralysis of function. The advent of 

 emphysema occurring durijig dystokia is verj- prompt. If the 

 cervical canal is well dilated, and the membranes are ruptured, 

 emphysema may be quite pronounced within 24 hours, the fetal 

 cadaver greatly enlarged, and the hair and epidermis readily de- 

 tached. Within 48 hours the skeleton may begin to lose its 

 integrity, the epiphyses of the bones readily separating. 



The diagnosis of emphysema of the fetus is readily made by 

 the fetid odor, the enlarged puffy condition of the fetal cadaver, 

 and the crepitus when the skin is pressed by the hand. 



The cause of fetal emphysema, fundamentally, is the death of 

 the fetus, followed by putrefaction dependent upon the presence 

 of gas-producing organisms. It is essential, ordinarily, that the 

 OS uteri is open or the tissues of the cervix are seriously dis- 

 eased, as in torsion, and hence incompetent to ward off the exten- 

 sion of the infection through the cervical canal to the fetus. 

 Under other conditions, mummification of the fetus may occur 

 instead. 



Clinically, fetal emph^-sema may be divided into two classes — 

 primary and secondar^^ In the first, the infection and death of 

 the fetus in utero occurs prior to the advent of labor or expulsive 



