Identifier: textbt00hirs (find matches)
Title: A textbook of obstetrics
Year: 1899 (1890s)
Authors: Hirst, Barton Cooke, 1861-1935
Subjects: Obstetrics
Publisher: Philadelphia : Saunders
Contributing Library: Yale University, Cushing/Whitney Medical Library
Digitizing Sponsor: Open Knowledge Commons and Yale University, Cushing/Whitney Medical Library

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ure reposition insuch a case by this planabortion should be in-duced, before the symp-toms of incarcerationappear. Treatment of Retro-displacement when theUterus is Incarcerated.—The physicians attentionmust first be directedto the overfilled bladder.Catheterization is usu-ally easy if a prostaticcatheter is employedand if the physicianrecollects that the lowersegment of the bladderas well as the urethra ispressed upon, making of the latter a canal perhaps more than five inches long (Fig. 149VIt might be of advantage, in case of difficultv in reachingthe accumulation of urine, to catch the cervix with a tenaculumand to pull it backward, as suggested by Cohnstein, so asto relieve the pressure upon the urethra. If catheterization isimpossible, suprapubic puncture of the bladder with an aspiratingneedle is always practicable and perfectly safe if done in an asepticmanner. After the bladder is emptied attempts at repositionshould be made as previously described. If these attempts should
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Fig. 149.—Frozen section of retroverteduterus of three and a half to four months. Deathfrom rupture of bladder. J14 PREGNANCY. prove unavailing, abortion must be induced. If it is impossible to effect an entrance into the cervix for this purpose, it is justifi-able to puncture the uterine wall through the vaginal vault, andthus draw off the liquor amnii. The organ may now respondto efforts at replacement, or it may be possible to draw down thecervix and to dilate its canal, to make feasible the evacuation ofthe uterine contents. As a last resort, vaginal hysterectomy isjustifiable. It is, indeed, the operation of election if the wallsof the uterus are badly inflamed, have begun to suppurate, orare gangrenous. Lateral Displacements.— These include lateroposition, latero-version, and lateroflexion. Lateroposition is usually a con-genital defect, due to an abnormally short broad ligament,placing the whole uterine body more to one side of the abdom-inal cavity than the other. Laterofl

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