We have already stated our disbelief that an oblique position of the
uterus can have any influence in producing malposition of the child. With
the exception of extreme anterior obliquity, or pendulous belly, we
equally doubt that it can have any effect in retarding the labour when the
child presents naturally. The highest authorities in midwifery during the
last hundred years unite in asserting that this celebrated opinion of
Deventer, was a misconception.
_Pendulous abdomen._ Where, from great relaxation of the anterior
abdominal wall, (a frequent result of repeated child-bearing,) the fundus
is inclined so forwards as almost to hang over the symphysis pubis, the
child's head does not readily enter the brim of the pelvis, nor can the
uterine contractions act so favourably in dilating the mouth of the womb;
and in this manner the first part of labour may be considerably retarded.
Pendulous abdomen to this great extent is not very common; and in ordinary
cases the horizontal posture, especially upon the back, is quite
sufficient to allow the head to engage in the pelvis. "We have found more
than once," says Dr. Dewees, "in cases of extreme anterior obliquity, that
it is not sufficient for the restoration of the fundus that the woman be
placed simply upon the back; but we are also obliged to lift up and
support by a properly adjusted towel or napkin, the pendulous belly until
the head shall occupy the inferior strait. To illustrate this, we will
relate one of a number of similar cases in which this plan was
successfully employed. Mrs. O., pregnant with her seventh child, was much
afflicted after the seventh month with pain and the other inconveniences
which almost always accompany this hanging condition of the uterus; was
taken with labour pains in the morning of the 10th of October, 1820. We
were sent for about noon. The pains were frequent and distressing, and,
upon examination per vaginam, the mouth of the uterus was found near the
projection of the sacrum, dilated to about the size of a quarter dollar,
but pliant and soft. During the pain, the membranes were found tense
within the os uteri, but did not protrude beyond it.
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