=Operation.= When it is known some days beforehand that the patient will
be submitted to this operation, she should be prepared as for
ovariotomy. Often it happens that the operation is undertaken after
labour has commenced, and in circumstances which make time very
precious. Even then the abdomen, pubes, and vulva can be shaved and
thoroughly washed with warm soap and water, and lightly rubbed with
ether and cotton wool.
The instruments required are those given on p. 5.
When the patient is under the influence of ether and the bladder emptied
with the catheter, an incision is made in the linea alba from the
umbilicus to the pubes. The belly-wall of a woman advanced in pregnancy
is very thin, and, unless the surgeon be cautious, the knife will come
in contact with the uterus before he is aware of it.
The uterus lies just under the incision, and the operator ascertains
that it lies centrally (often the uterus is somewhat rotated to the
right or left), and then makes a free incision through the uterine wall
and extracts the fœtus and placenta; as the uterus contracts, he slips
his left hand behind the fundus, and grasps the uterus near the cervix,
and effectually controls the bleeding. The assistant passes a large warm
flat dab into the belly to restrain the intestines and omentum. The
uterine cavity is sponged out, and the finger passed through the os
uteri into the vagina in order to ensure a free passage for blood and
serum.
The incision in the uterine wall may be closed either by a double or a
single set of silk sutures. When two layers of sutures are employed, the
first set involve the mucous and adjacent half of the muscular layer[;]
these sutures should be fairly close together, for they not only bring
the parts into apposition, but they restrain the bleeding. A second row
of silk sutures is now inserted, including the serous coat and adjacent
half of the muscular layer. These threads should not be tied too
tightly, as the tissues of a gravid uterus are soft and easily tear. In
closing the uterine incision the surgeon should not spend time vainly in
endeavouring to stanch the bleeding from the edges of the incision; this
is best effected by dexterously inserting and securing the sutures.
The recesses of the pelvis are carefully cleaned by gentle sponging, and
the parietal incision is closed as after ovariotomy.
The dressing varies with the fancy of the operator; a piece of
sterilized gauze and a square of Gamgee tissue held in position by a
many-tail of flannel firmly applied is all that is necessary.
Public-domain text, read in full here on John Shaqi.
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