Identifier: gynecologygrav2 (find matches)
Title: Gynecology
Year: 1916 (1910s)
Authors: Graves, William Phillips, 1870-1933
Subjects: Gynecology Genital Diseases, Female Women Gynecology
Publisher: Philadelphia and London : Saunders
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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is is done byinserting the scissors in the line of cleavage for a short distance and then openingthem (Fig. 305). This process is repeated carefully, and with the points of thescissors pressing against the cervix until the movable plica of the peritonealreflection from bladder to uterus is reached. The separation of the bladder isnot always easy. In cases of difficulty Watkins recommends separating the 604 GYNECOLOGY lateral portions first, as the adherence of the tissues is less there than along themedian line. Where the peritoneal fold comes into view it is picked up with tissue forcepsand cut. The opening thus made is enlarged either by cutting or by forcingit open with the finger. The next step is the delivery of the uterus through the wound. A narrowretractor is inserted, drawing the bladder well up to the symphysis. The ante-rior wall of the uterus is first seized with traction forceps and drawn downwardand forward, carrying the cervix up and back. By this maneuver one can grasp
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Yi^.Cy. o^texVlatvCmS Fig. 308.—Watkins Operation for Procidentia.Diagram showing position of organs when the operation is finished. the fundus of the uterus with traction forceps and deliver it through the wound.Watkins cautions against the attempt of delivering the uterus by the anteriorwall because its diameters are greater than those of the fundus. With the uterus held forward out of the wound, sutures are now placed asin Fig. 306, connecting the upper end of the vaginal wound with the fundus ofthe uterus. In attaching these sutures one must keep in mind that it is im-portant to superimpose the entire bladder on the uterus, but not to fix the uterusso firmly against the urethra as to interfere with urination. The vaginal wound is now closed over the anterior surface of the uterus by a OPERATIONS FOR UTERINE MALPOSITION 605 continuous catgut suture, which occasionally catches the peritoneum of theuterus. The transverse incision may be sewed up transversely or longitudinally. If t

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