/ 'Ad ISA A // }'.s TEKO TOM Y 



CHAPTER VI. 



Vaginal Hysterotomy. 



At p. Sf)! reference was made to induration of the cei'vix uteri as a cause 

 of dystokia, and tlie indications for overcominf^ the obstacle were de- 

 scribed more or less fully ; allusion was also made to the manner in 

 which these indications should be carried out. As we are now treating; 

 of obstetric operations for the extraction of the fa'tus, it is necessary 

 that we describe more fully the operation and its consequences, as 

 these are of much importance. 



Vaginal hysterotomy consists in incising the indurated and inextensible 

 neck of the uterus in such a manner and to such an extent, that it will 

 allow the fcctus to pass through its canal. 



For this purpose, the only instrument necessary is a strong probe- 

 pointed bistoury, a bistoury cache, or one of the tinger-scalpels or other 

 embryotoms. When the straining of the animal has propelled the 

 cervix uteri towards the vulva, with partial prolapsus of the vagina, the 

 operation is simple, as the eye can then aid the hand. All that has to 

 be done is to glide the instrument into the os, and make the necessar) 

 number of incisions through the tissues composing the cen-ix — the 

 situation and depth of the incisions depending upon the extent of the 

 induration and the atresia. 



In other cases there is no prolapsus of the vagina, which is quite soft 

 and elastic. Then the left hand may be passed into it, and the index- 

 Hnger being introduced into the os, draws the cervix towards the vulva; 

 the labia of the latter are separated by an assistant, and the operator 

 passes the blade of the instnmient — guiding it by the index-finger of the 

 other hand — into the os, where he gradually and steadily incises the 

 tissues. 



When, however, the walls of the vagina are involved in the induration, 

 this retraction of the cervix cannot be effected, and the part must be 

 operated upon in its ordinary situation : the knife being carried care- 

 fully into the vagina, passed to the necessary depth in the os, and the 

 incision made. Perhaps the bistoury cach6 is the best instrument for 

 such cases. 



It is rare indeed that one incision is suflficient ; generally from two to 

 four are required, and it is better to have a larger number than make 

 them too deep: they certainly must not pass through the entire thick- 

 ness of the cervix. 



The situation of the incisions is a matter of some moment. The 

 lower portion of the cer\-ix should be avoided, in consequence of its 

 proximity to the floor of the vagina, which is in immediate contact with 

 the bladder and urethra : should these be wounded, the results might 

 be serious, if not fatal ; and if the peritoneum is cut or torn during the 

 passage of the fcetus, fluids and discharges will escape into the abdo- 

 minal cavity, and give rise to peritonitis. There is less danger in 

 incising the upper part of the cervix, as the rectum is not so near ; 

 nevertheless, in induration there may be adhesions between them, and 

 an accident is therefore possible — though it must be rare. 



So that, if only two incisions are required, it is advisable to make 

 one on each side of the cervix ; and if four are necessary, to have them 

 at each comer. 



