PROLAPSUS OF THE UTEEUS 



313 



The surface formed by the mucosa shows the cotyledons, 

 which are sometimes still connected with the foetal placentse of 

 the chorion, so that the foetal membranes surround the inverted 

 uterus like a sac. In a complete prolapsus the vagina is 

 always inverted, showing about four inches from the vulva, the 

 palma plicata appearing like a wide band all around the 

 inverted part, being narrowest right here (fig 74). 



After removal of the secundines the mucous membrane 

 looks dark red, due to the influence of the air and venous 

 stasis. The older the inversion the greater the changes which 



Fig. 74. — Prolapsus Uteri. 



take place. After a few hours the mucosa is of a bluish-red 

 color, showing dark spots here and there ; these must not be 

 looked upon as due to gangrene. They depend partly upon the 

 disturbed return flow of the blood and partly on submucous 

 hemorrhages (hgematomata). When the prolapsus is permitted 

 to hang any longer, oedema of the submucosa and muscularis 

 and finally gangrene set in. 



Prolapsus following abortion is not as extensive as the one 

 following ordinary labor. The dimensions of the prolapsus 

 correspond with the size of the uterus at the time of pregnancy. 



