INVERSION OF THE VAGINA DUEING PREGNANCY 



97 



practice are to be employed to prevent recurrence of the inver- 

 sion. The following methods are iudicated : 



The bandages, fully discussed at prolapsus uteri, are of 

 little use here, as they can only be employed temporarily. The 

 simplest operation consists of suturing the lips of the vulva 

 (labial suture). It may be done with tape, 1 to 1^ cm. wide. 

 The first stitch is put in directly below the superior commissure 

 of the vulva, the second one half way down the labise. When 

 three sutures are put in, the second and third suture are placed 

 at an equal distance between the first suture and lower commis- 

 sure, so that the space be- 

 tween the upper stitch and 

 inferior angle of the vulva 

 is divided into three equal 

 parts by the two lower 

 stitches. In order to pre- 

 vent tearing, the stitches 

 are placed 3 to 4 cm. from 

 the lips and run through 

 the skin, subcutis, muscu- 

 laris, submucosa and mu- 

 cosa. In the other lip the 

 stitches perforate horizon- 

 tally the same layers, only 

 in an opposite direction. 

 It is important to place 

 the first stitch sufficiently ^.^ 14,— The Gate, labial suture, 



high to prevent prolapsus 



of the upper wall of the vagina. Two sutures are mostly suffi- 

 cient. Since these stitches usually have to remain uutil pM.r- 

 turition, ordinary tape does not suffice, as it may tear, leather 

 strings having the same disadvantage. The so-called labial 

 gate is certainly the best agent. It consists of two or three 

 heated copper needles, 12 to 14 cm. long, each with an eye and 

 point. After the needles have been pushed through both hps, 

 the point is broken off by filing a little groove at the point of 

 fracture. Then an eye similar to the one on the other sirle 



