Retroversion not reduced may experience a spontaneous termination in two
ways, either by abortion being excited, after which the uterus, now
diminished in size, returns to its natural situation, or it may go on to
increase in this position until a more advanced period of pregnancy, when
if it be not capable of being replaced by the action of the pains,
sloughing takes place in the fundus, and the foetus is discharged, either
by the rectum or vagina, as in a case of ventral pregnancy.
In the _treatment_ of retroversion of the uterus, our object should be,
first, to remove the accumulated contents of the bladder and rectum, and
secondly, to endeavour to restore the uterus to its natural position. The
relief of the bladder must be our first aim, for here is the greatest
source of danger. The elastic catheter should always be used in these
cases, and greatly facilitates the operation of drawing off the water. The
altered direction of the urethra must be borne in mind; in many cases we
must pass the catheter nearly perpendicularly behind the symphysis pubis:
by pressing the uterus backwards, we shall diminish its pressure upon the
urethra, and thus enable the catheter to pass with great ease.[54]
"The catheter should be employed occasionally, and the bowels emptied
daily, either by medicines of a mild kind, or by injections: if this plan
do not succeed in restoring the fundus, we should then consider the
propriety of mechanically replacing it. To aid us in our judgment, we
should consider, first, the period of gestation; secondly, the degree of
development the uterus has undergone; thirdly, the nature and severity of
existing symptoms. The period of gestation ought almost always to
influence our conduct in this complaint, and we may lay it down as a
general rule, the nearer that period approaches four months, the greater
will be the necessity to act promptly in procuring the restoration of the
fundus: the reason for this is obvious, every day after this only
increases the difficulty of the restoration from the continually
augmenting size of the ovum. The degree of development should also be
taken into consideration, as some uteri are much more expanded at three
months, than others are at four. The extent or severity of symptoms must
ever be kept in view; as, for instance, where the suppression of urine is
complete, and not to be relieved by the catheter, in consequence of the
extreme difficulty and impossibility to pass it: here we must not
temporize too long, lest the bladder become inflamed, gangrenous, or
burst; for the bladder, from its very organization, cannot bear distension
beyond a certain degree, or beyond a certain time, without suffering
serious mischief." (Dewees, _Compend. Syst. of Midwifery, 6th Ed._ § 276.)
Our next step should be to relieve the rectum of its contents by emollient
enemata; this is not always very practicable, owing to the flattened state
of it: hence a glyster pipe of the ordinary sort is too large, and meets
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