616 ACCIDENTS AFTER PAIiTUBITION. 



"With regard to treatment, this also must depend upon circumstances. 



When rupture of the vagina is recognised during parturition, delivery 

 should be effected as speedily as possible, and with every care, in order 

 to prevent the laceration extending and the foetus passing into it. If, 

 unfortunately, some part of the latter has lodged in the rent, it must be 

 removed therefrom with the utmost precaution, so as not to injure other 

 viscera. The foetal membranes should also be extracted as soon as 

 possible. If there is haemorrhage from the vagina, this may be sup- 

 pressed by ice or injections of cold water if the rent is superior or 

 lateral ; if it is inferior, then a sponge or a cloth soaked in cold water, 

 in which is a small proportion of iron perchloride, should be placed in 

 the canal. Should there be hernia of the bladder or intestines, these 

 must be replaced at once. 



In all cases of wounds, abrasions, or rupture of the vagina, every pre- 

 caution should be observed with a view to the prevention of septic 

 infection. With this object the greatest cleanliness must be observed, 

 all decomposing matters, or those likely to decompose, should, if 

 possible, be scrupulously removed, and injections or " swabbings " of 

 weak solutions of carbolic acid or other antiseptics, practised. If there 

 is much danger of haemorrhage, a suitable tampon of lint or fine tow, 

 saturated in one of these fluids, may be allowed to remain in the vagina 

 for some time. 



Complications of Buptured Vagina. 



We have mentioned some serious complications of ruptured vagina, 

 in which adjacent organs and tissues were involved. These are chiefly 

 the rectum, bladder, and perinaeum, one or more of which may be per- 

 forated and torn, along with the vagina. These ruptures vary in 

 extent and gravity, and while some are necessarily fatal, others are not 

 so ; but they may lead to serious deformity and inconvenience, such as 

 accompany chronic fistulge in important regions. They are recto-vaginal 

 fistula, rupticrc of the jjerz^c^zn?;, vesico-vaginal fistula, and occlusion of 

 the vagina. 



Eecto- Vaginal Fistula. — Injuries to the rectum are generally pro- 

 duced through the wall of the vagina, during the passage of the foetus. 

 When the salient parts of the latter, and more especially the feet, are 

 misdirected and pressed up towards the sacrum of the mother, and if 

 the rectum chances to be distended with fteces, not only will the vagina, 

 but this viscus also may be perforated, and some portion of the foetus 

 soon appears at the anus. If this accident is discovered in time, it may 

 be possible to push back the parts thus misplaced into their natural 

 channel, and complete delivery by the vagina ; but notwithstanding 

 this happy termination, the communication between the vagina and 

 rectum very often remains permanent, and a recto-vaginal fistula is 

 established. 



The treatment of these cases is not always satisfactory, so far as a 

 perfect cure is concerned. Sutures have sometimes been employed to 

 close the wound in the rectum, when accessible. But this surgical 

 operation can rarely be resorted to, and all that may be done is to keep 

 the lacerated parts clean, by frequent injections j;er vaginam and rectum, 

 prevent constipation, and treat the injury on ordinary principles — not 

 forgetting the free employment of antiseptics. 



If sutures are employed to close the fistula, they may be supported by 

 a pessary or tampon placed in the vagina, beneath the fistula. 



