We quite agree with Professor Naegelé, that unusual shortness of the cord
can rarely if ever retard labour; and that where the cord really produces
an impediment to its progress, it is from being twisted round the neck, or
some other part of the child. (_Lehrbuch_, 2d ed. p. 289.) This generally
arises from its unusual length, and from its having formed several coils
around the child: we have met with it forty-eight inches long, and twisted
four times round the child's neck; but Baudelocque mentions a case where
it actually measured fifty-seven inches, "forming seven turns round the
child's neck." (Heath's _Transl._ vol. i. § 516.) Mauriceau has given an
instance (_Obs._ 401.,) where the cord had "longueur d'une aune et un
tiers de notre mesure de Paris:" which, converted into English measure,
amounts to somewhat more than sixty-one inches.
Although nothing is of more common occurrence than the cord being twisted
once or twice round the child, it nevertheless, happens, but very rarely,
that its advance is thereby obstructed. In a case of this sort, the labour
usually commences quite favourably; the os uteri dilates, and the head
advances to a certain extent, beyond which it makes no other farther
progress; the uterine contractions are attended with much pain in the
fundus, during which the head advances somewhat, but retires again during
the intervals. Where the head is already near the os externum, this may be
easily attributed to the elasticity of the soft parts, until the delay
which takes place to the farther progress of the labour warns the
practitioner that something more than ordinary is the cause. But where
this takes place, and the head is still in the pelvic cavity; where at the
same time, although it refuses to advance, it is quite moveable, and
allows the finger to be passed freely round it; where any attempt to
extract it with the forceps has not only met with great opposition, but
has greatly aggravated the sense of painful dragging in the upper parts of
the uterus there will be pretty certain evidence of the cord being either
too short, or, what is most probable, of its being twisted round the
child. In each of the three cases recorded by La Motte, the head had
descended to the os externum; whereas, in two others described by Burton,
it was evidently much higher up: he ruptured the cord in both instances;
La Motte succeeded in cutting the cord with a pair of scissors in one
case, in another he appears to have separated the placenta, and in the
other to have delivered by little else than force. Where upon introducing
the hand we find it impossible to undo the coil of the funis, we should
endeavour to slip it first over one and then the other shoulder, as we
have recommended under the more ordinary circumstances: should this fail,
we must try to cut it through either by a finger nail slightly notched for
the purpose, or by the introduction of a Smellie perforator well guarded.
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