DIFFICULT PARTURITION {DYSTOKIA) 315 



In using any pattern of forceps, the greatest care should 

 always be taken to see that nothing is included which is not 

 intended for withdrawal ; it is usually possible to make sure 

 upon this point with the fingers before applying traction. 



The chief secrets of success lie in the use of care and 

 patience, the use of forceps at discretion, and strict applica- 

 tion of antiseptic methods. 



In regard to the latter, not only should the operator care- 

 fully attend to his instruments and his own hands, but he 

 should also carefully cleanse (clipping hair away when neces- 

 sary) the labia and hinder parts of his patient before pro- 

 ceeding to make an exatnination of the interior. 



Accidents and Untoward Sequelae. 



The most common dangers to be feared are those of 

 septicaemia, prolapse of the vagina, and even of the body or 

 cornua of the uterus ; and rupture of, or other injury to, 

 the womb during the removal of the foetuses. Prolapse of 

 the vagina and uterus have already been dealt with on 

 pp. 289 and 300. 



Injury to the womb must be guarded against by the most 

 delicate manipulation of the forceps and fingers, with the 

 recollection that it is by no means impossible to pass the 

 forceps right through this organ, and even to drag the whole 

 of it away through the vagina. This contingency must be 

 especially guarded against when using forceps (such as those 

 marked in Fig. 195) with overlapping joints. The mucous 

 membrane of the vagina is very sensitive, and, as a rule, when 

 a portion of it becomes pinched the patient will give expres- 

 sion to the violent pain which is being caused. Rupture of 

 the uterus is followed by acute pain and vomiting, the 

 patient's face having a most anxious and haggard expression. 

 One must not forget that when any attempt is made to syringe 

 the uterus under such conditions the fluid finds its way into 

 the abdominal cavity. Should the obstetrician have the ill- 



