The success of this operation, will, in a great measure, depend not only
upon its being undertaken sufficiently early before the patient's strength
is exhausted, but upon a sufficient length of time intervening between the
removal of the thoracic and abdominal viscera and the extraction of the
child. The excellent rule of Dr. Osborn, above quoted, is peculiarly
applicable here; for when softened by the effects of incipient
decomposition, the body will sometimes even be expelled by the unassisted
efforts of the uterus.
In a case of this sort, the perforation of the head is the last part of
the process to be performed. It will be by all means, desirable not to
separate it from the body, but to pass up the curved perforator along the
neck, and make an opening behind the ears: this is effected without much
difficulty, and the head can be brought away whole, or in portions,
according to the nature of the case.
PART V.
DYSTOCIA, OR ABNORMAL PARTURITION.
_Divisions and species._ By the term Dystocia, we understand those labours
which either cannot be completed by the natural powers destined for that
purpose, or at least, not without injury to the mother or her child.[107]
These will, therefore, consist of the two following classes:--
1. Labours that are difficult or impossible to be completed by the natural
powers.
2. Labours which are rendered faulty without obstruction to their
progress.
The first division of dystocia may either arise from a faulty condition of
the expelling powers, or, without any anormality in this respect, it may
depend upon the faulty condition either of the child, or of the parts
through which it has to pass.
As respects the child it may arise from,
1. Malposition.
2. Faulty form and size of the child.
3. Faulty condition of the parts which belong to the child.
On the part of the mother this division of dystocia may arise from a
faulty condition.
4. Of the pelvis.
5. Of the soft passages.
6. Of the expelling powers.
The second condition where labour is rendered dangerous for the mother or
her child, without any obstruction to its progress, may arise from,
1. Following too rapid a course.
2. Prolapsus, &c. of the umbilical cord.
3. From accidental circumstances, which render the labour dangerous, viz.
convulsion, syncope, dyspnoea, severe and continued vomiting, hæmorrhage,
&c.
We propose to consider the different species of dystocia in the order
above enumerated.
CHAPTER I.
FIRST SPECIES OF DYSTOCIA.
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