AFFECTIONS CONNECTED WITH DELIVERY OR PARTURITION.
The delivery of the child may be contrary to natural course from three causes : 1. From delivery before the completion of the development of the child to the extent of enabling it to exist as an independent life; abortion. 2. From delivery after the time when an independent life could be sustained, but before there is complete development for natural birth; premature birth. 3. From development out of the uterus itself, as in the Fallopian tube; extra-uterine gestation.
When the period of development has attained its natural dura tion and the growth of the child is complete, so that it is ready to be born, there may be affections connected with its birth, from uterine or other causes, which are briefly classified as fol lows : Atony, or want of power in the muscular walls of the uterus for due expulsive effort.
Over-distention of the uterus. (a) From excess of the liquor amnii or fluid surrounding the child. (b) From presence of twins or triplets.
Mechanical obstruction to the action of the uterus from a variety of causes. (a) From occlusion or closure partly or wholly of the mouth or neck of the womb or of the passage below. (b) From rigidity, narrowness, cicatrix, cystic growth, cancerous growth, prolapsus of the bladder, distention of the lower bowel, or, prolapsus of the bowel. (c) From tumor; uterine, ovarian, pelvic, or external. (d) From polypus. (e) From fracture of the pelvis or bony basin which supports the abdominal organs. (f) From exostosis or bony thickening of the pelvis. (y) From dis torted, or contracted, or diminutive pelvis. (h) From dislocation of the lower or lumbar vertebrae into the pelvis. (1) From fixid ity or anchylosis of the terminal bone of the spinal column, the coccyx. (j) From extreme anteversion of the womb with pendu lous abdomen. (k) From peculiarities of the child, namely, exces sive size, malposition, malformation, or enlargement from disease. (l) From unusual thickness and resistance of the membranes which envelop the child. (m) From unusual shortness of the umbilical cord, the vascular cord which connects the body of the child with the placenta or after-birth.
Hemorrhage, or loss of blood during labor, is one of the seri ous accidents which sometimes occur, and which occasionally prove fatal during childbirth. In these days, however, so exact has obstetric practice become in the hands of scientific practi tioners, that fatal loss of blood or hemorrhage during parturition is comparatively rare. In no department, in short, has medical science come nearer to exactitude of rule, and with more success from exactitude, than in this department of the treatment of the parturient woman.
Uterine hemorrhage during delivery is said to be of the three following kinds: 1. Unavoidable hemorrhage, or placenta pravia, from the pla centa presenting itself for birth before the child. The placenta is the interconnecting organ between the mother and the child; and, as the mother supplies it with blood, as the child derives its supply of blood exclusively from it and returns its blood to it by the umbilical cord, and as it is a net-work of blood-vessels, it is almost impossible that it can be expelled first without the acci dent of loss of blood. Hence this hemorrhage is styled unavoid able. Fortunately here medical art, again, comes in, and by changing artificially the mode of delivery, brings down the child first and averts the danger. The operator skilfully converts the accidental into the natural condition, and secures the safe de livery.
2. Accidental hemorrhage, in which the placenta is acciden tally detached, is a second form of loss of blood which may occur during childbirth. This danger, like the last named, is now usu ally averted by the skill of the obstetrician.
3. Thrombus of the neck of the womb, or of the parts, or labia, beneath is said to be another cause of hemorrhage. The term thrombus is a very absurd one, but it means really in this instance a swelling attended with much distention of the blood vessels, or effusion of blood into the soft tissues, followed by actual loss or escape of blood during delivery. It is a rare acci dent, and is not generally fatal when it does take place.