

Parturition 367 



diameter taking advantage of the wide sweep between the sub-pubic 

 arch and the movable coccyx. The head, as it were, screws itself 

 through the pelvis. 



The soft parts are dilated by the descent of the amniotic bag, which, 

 under the contractions of the uterine and abdominal walls, plays an 

 important preparatory part. Hasty rupture of the membranes may 

 render the labour dry and tedious. When the os, the vagina, and 

 vulva are fully dilated, the membranes burst, the ' waters ' escape, and 

 the uterine walls contract with renewed vigour. The muscular tissue 

 of a feeble uterus may be stimulated by the administration of ergot ; 

 but this drug must not be- used until the os is wide open, or, in a vain 

 attempt to drive the foetus through the unyielding os, the uterus may 

 rupture itself. To aid the expulsion of the foetus, the nurse may advise 

 the woman to blow hard into a bottle ; in this way the lungs are filled, 

 the diaphragm is depressed and fixed, the abdominal cavity is dimin- 

 ished, and its muscles are set to work. By * holding her breath,' or 

 by hauling on a jack-towel fastened to the foot of the bed, the patient 

 fixes the diaphragm and ribs, and thus gives the oblique, transverse, 

 and straight muscles the greatest advantage. But the presence of the 

 head in the vagina excites strong reflex contractions which fatigue the 

 woman much less than voluntary acts would do. During the final ex- 

 pulsive act the escape of the contents of the rectum is almost inevitable. 



When labour is threatening, the bladder and rectum should be 

 thoroughly evacuated to clear the way for the foetus, and to diminish 

 the risk of the occurrence of a rent or gangrenous perforation. 



During the detachment of the placenta the large veins which run 

 obliquely into it through the muscular wall of the uterus are torn across, 

 but the immediate and energetic contraction of the muscle closes their 

 open mouths and prevents flooding. To check post-partum haemor- 

 rhage the inert uterus must be stimulated to contract by cold, by bi- 

 manual pressure, by ergot, or by electricity. The lingering attachment 

 of a piece of placenta checks contraction and is an incentive to bleed- 

 ing ; the uterus must at once be cleared. 



Pelvic abscess, which may occur from cellulitis after parturition, 

 and from other causes, is associated with deep-seated tenderness and 

 fulness, and often with a bulging which may be made out through the 

 rectum or vagina. The abscess may break through into either of 

 these passages, or into the bladder or peritoneal cavity or on to 

 the surface of the abdomen or pubes. It may be dealt with after the 

 manner of iliac abscess from spinal disease. In the case of the male 

 the contents of a pelvic abscess may follow the spermatic cord towards 

 the scrotum. 



Pelvic hsematocele (at/za, blood \ KTJ\T], tumour] is a collection of 

 blood in the retro-uterine pouch, or in the sub-peritoneal tissue around 

 the uterus. The bleeding, which generally occurs at the time of 

 menstruation, is from some congested vessels of the generative organs. 



