In these cases the size and globular form of the uterus, the tenseness of its parietes, the more or less distinct feel of fluctuation, the absence of the child's movements and of any prominences arising from the projecting portions of its body, the rapid increase which has been observed in the size of the abdomen, the pain in different parts of the uterus, especially in the groins and pelvis, the oedema or anasarca of the lower extremities, serve to mark this condition. On examination per vaginam we also feel the inferior segment of the uterus much expanded, the cervix probably shorter than might be expected for the period of pregnancy; the ballottement is unusually free and distinct. In some instances the patient has suffered so much, either from the effects of the retarded circulation in the lower extremities, or from the impeded respiration as to require the membranes to be punctured in order to reduce the size of the uterus. The child is usually born dead where the accumulation has gone to so great an extent: in the three cases recorded by La Motte, it was dead before birth in the first two, and died immediately after birth in the third. Many of these cases, which have been complicated with disease or malformation of the foetus, have appeared to arise from a syphilitic taint; but in others, of more common occurrence, where there was merely an unusually large quantity of liquor amnii without any disease either of the mother or her child, the cause must still remain a matter of uncertainty. This latter condition is mostly seen in women who have been frequently pregnant; the os uteri in them is generally yielding, and when once it has attained its full degree of dilatation, we may safely rupture the membranes and thus expedite labour considerably. There being an unusually small quantity of liquor amnii can scarcely operate as an obstruction to labour, except where the membranes have been prematurely ruptured. The _umbilical cord_ may obstruct labour, by either being too short, or rendered so from being twisted round some part of the child. Its length varies very considerably. Although we have stated it to average about eighteen or twenty inches,[119] we have met with extreme deviations both within as well as beyond this medium length. The shortest cord which we know of occurred some years ago at the General Lying-in Hospital, "where, after two or three violent pains, the child was suddenly and forcibly expelled the cord was found ruptured at about two inches from the navel of the child, which cried stoutly. After removing the child the matron sought for the other end of the funis, but could not find it; she examined per vaginam but could not feel it; and on introducing her hand into the uterus, found the placenta with the remains of the cord ruptured at its very insertion; so that in this case the cord could not have been much more than two inches long." (Printed Lectures in Renshaw's _Lond. Med. and Surg. Journ._ May 1835, p. 426.)