Although it is so important that we should lose no time, still
nevertheless it does not appear desirable to operate before labour has
commenced to any extent; for unless the os uteri has undergone a certain
degree of dilatation, it will not afford a sufficiently free exit for
liquor amnii, blood, lochia, which, by stagnating in the uterus after the
operation, would soon become irritating and putrid, in which case they
would be apt to drain through the wound into the abdominal cavity and
create much mischief.[99]
_Different modes of operating._ The incision has been recommended to be
made in different ways by different authors; but the highest authorities,
as also later experience, combine in favour of that in the linea alba.
Richter states, that one great advantage from making it in this direction
is, that when the uterus contracts and sinks down into the pelvis, the
incision in it still corresponds with that through the abdominal parietes,
and therefore admits of a free discharge of pus, &c. through the external
wound; whereas, if it have been made to one side, viz. at the outer edge
of the rectus abdominis muscle, as recommended by Levret for the purpose
of avoiding the placenta, the wound in the uterus when contracted ceases
to correspond with it, and the discharge escapes into the abdominal
cavity. Besides this the abdomen is usually more distended at the linea
alba; the uterus here lies immediately beneath the integuments; the
intestines are usually pressed towards each side; and therefore when the
incision is made on one side they frequently protrude, a circumstance
which rarely happens when it is made in the linea alba, except perhaps
towards the end of the operation. In the linea alba we have only to cut
through the external integuments in order to reach the uterus, while at
the side, we have to cut through considerable layers of muscle.
Public-domain text, read in full here on John Shaqi.
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