Uterine contraction

“ I believe the majority of obstetricians content themselves, when they find the cord is 106encircling the neck, by simply making an effort to stimulate uterine contraction, and to deliver the child as rapidly as is consistent with safety to the mother, and while so doing take the precaution to support the head, to hold it up well against the vulva and prevent undue traction on the placenta.
It is seldom that we fail to resuscitate a child born under these circumstances. The cord as a rule is not encircling the child so tightly so as to prevent our ability to resuscitate it. ”

“ Pain in menstruation, which is much more frequent, is dependent upon other conditions than the activity of the ovaries, and lasts a very much shorter time than does either the function of ovulation, or even than the uterine congestion secondary to it. Outside of actual uterine disease, the pain at this moment is most often dependent on uterine cramp, itself excited by a spasmodic contraction of blood-vessels that interfere with its circulation. ”

“ It is of the first importance however to be certain, before using any forcing means whatever, that there is no physical impediment. If the pelvis should be deformed or small, if the child's head should be unusually large, or dropsical, or if the soft parts of the mother should be undilated and rigid, the most serious consequences must ensue from violent uterine contractions. In like manner if the presentation be unfavorable, particularly if it be one of the trunk, the danger is equally great. ”

“ Quite as mysterious and inexplicable as the development of these complex structures from one tiny cell is the fact that when the new human being is ready to begin life as a separate entity, further changes occur within the mother’s body which produce uterine contractions of such a character as to entirely empty the uterus of its contents. ”

“ But it is not necessary to pass the hand into the uterus for the removal of coagula, because if the binder has been properly applied, and strong pressure made over the fundus uteri, clots cannot accumulate within the uterus, and if they have been permitted to collect in consequence of neglect, then expulsion will immediately follow the use of proper compression of the hypogastrium, without the introduction of the hand. Nor do I consider it necessary, to excite uterine contractions, that the hand should ever be introduced into the cavity of the uterus after the removal of the placenta. ”

“ Deep lacerations of the cervix make conception improbable and interfere with gestation; cervical catarrh in no way affects its progress. Those morbid conditions of the uterine tissues which are unaccompanied by disease of its mucous membrane rarely lead to abortion.
Uterine contractions due to reflex nervous excitability are perhaps the most common of all these causes, yet here the uterus primarily is not at fault. A state of intense excitability is very often due to general causes, to intense febrile action, to congestion or anæmia ”

“ It is rarely, that no pain at all is experienced; there are some women, however, who affirm that in their case menstruation begins quite unexpectedly, and without the slightest warning; but it does not follow that contractions of the uterus do not occur in these women also during menstruation. * * * The local disturbances which occur as an accompaniment even of physiological menstruation are, a sensation of fulness and weight in the pelvis, and pains in the lower part of the back, and these probably all result from the uterine contractions. ”

“ There should be, also, a box, basket or crib, in readiness to receive the baby, furnished with a clean blanket and hot water bottle with a flannel cover.
These are the preparations which may be made during the first stage—that period when the cervix is being slowly 107but steadily dilated by the bag of waters as it is forced downward by the uterine contractions. You feel these as pains beginning in the back, and finally in the lower abdomen and thighs, gradually growing stronger and more frequent. ”

“ Many women and girls show well-marked menstrual molimina, uneasy or actually painful local sensations in the genital organs, sacrache, painful uterine contractions, and disturbances of the general constitutional state, which are dependent upon menstrual congestion of the pelvic organs, upon local engorgement; sometimes such symptoms are the result of uterine contractions caused by hyperæmia of the uterus, and these cases often take a paroxysmal form. ”

“ If the cause of the abortion affects the mother instead of the ovum, she generally experiences, at the time of the accident, a sharp pain about the loins or abdomen, which may continue slightly for several days, and then be renewed, with violent uterine contractions, and some serous and then bloody discharges from the vagina.
The progress of a miscarriage is not as regular as a labor at full term. In many cases there are shiverings succeeded by fever for a day or more preceding the hemorrhage. ”

“ More frequently, but in quite the same way, we find that nursing causes uterine contractions in the early part of the lying-in period, when they are called after-pains. Women who experience them tell us they are more severe while the infant nurses; and they also say that the discomfort disappears after several days, a fact which indicates that involution has made notable headway. The physician is not dependent on such evidence, however; for a simple examination reveals at any time how far involution has progressed. By this means we have learned that nursing facilitates the involution process. ”

“ A slight mucous discharge from the vagina is frequently seen toward the end of pregnancy and may be disregarded, but a gush of watery fluid always means that the sac which contains the fetus has ruptured. Uterine contractions generally follow within a few hours, though in a few instances they will not appear for a number of days. Under any circumstances the event ought to be promptly reported to the doctor. Similarly, he should be notified whenever bleeding from the vagina occurs, since it is important to have him determine its significance. ”

“ After the puerperium the extreme engorgement of the pelvic organs often produces uterine hemorrhage, which should not be confounded with the returning menstruation. Especially after abortion the hemorrhage often persists for a long time unless cured by treatment. Gradual or sudden replacement may occur spontaneously, or the causes may continue active, and even be enforced by cystocele and rectocele. The displacement may also be complicated by disease and displacement of the ovaries. Organic disease of the uterine walls may induce a superadded retroflexion. ”

“ The operator should always remember the danger of perforating the uterus by the curette. This accident, which has happened in the hands of the best surgeons, occurs usually as the instrument is introduced, not as it is withdrawn. It is much more liable to occur after labor or recent abortion, when the uterine tissues are soft, than in the conditions now under consideration. ”

“ Parturition is probably the most frequent cause of retroversion and retroflexion of the uterus. If the woman leaves her bed or goes to work too soon after miscarriage or labor, many conditions are present that favor retrodisplacement of the uterus. The uterus is larger and heavier than normal, as a result of imperfect involution: the uterine ligaments are lax; the vagina and the vaginal orifice are relaxed, and the support of the pelvic floor is consequently deficient; the abdominal walls are relaxed and the retentive power of the abdomen is diminished. ”

“ Anteflexions and anteversions are always rectified; retroversions in rare cases only lead to abortion; adherent retroflexions are most to be dreaded; when the uterine body, bound down to the pelvic floor, expands within the cavity to such a size as to make escape through the brim impossible, abortion must necessarily follow. ”

“ If the cervix, the portion of the uterus most frequently wounded, is found punctured or lacerated, while the ovum is still retained, there is reason for suspicion; if the membranes are torn and extensively detached, while the cervix is but little dilated, such is increased; and it is made almost a certainty, if with the latter condition, nothing remain of the ovum in the uterine cavity but lacerated fragments. Here the abortion would probably not merely have been intentionally induced, but by the direct introduction and agency of instruments. ”

“ The couple, all of whose children had died soon after birth, longed once more for children. The woman had aborted several times, and both were intelligent enough to see that everything could not be right with the sexual organs, and even begged for a gynæcological examination. The result was in a few words: inflammation of both lips of the uterus, a thickening of the cervical canal with a swelling of the posterior uterine wall as hard as cartilage, and retroversio uteri. Menstruation too early, dysmenorrhœa, blood dark, tarry, passing in clots. Yellowish, fetid leucorrhœa. ”

“ For the treatment of prolapsis in non-pregnant women, the general principles are to be applied: To afford artificial support to the superincumbent abdominal viscera; give tone to the broad and round ligaments of the uterus, to the vaginal walls and the perineum; and to remove any complications that induce the falling, such as uterine congestion, hypertrophy, cough, constipation, etc.
The uterus may usually be easily pushed back to its place when the patient is lying down, or, what is better, her head much lower than her pelvis. (Fig. 13) . The knee-chest position is the best one. ”

“ Women are liable, even when young, to a falling of the womb, but it occurs most commonly after the age of thirty-five, in such as lead a laborious life. Amongst other causes may be enumerated violent bearing down efforts, such as are made in straining to pass hardened feces, or in urging an evacuation through a stricture in the rectum, in coughing, lifting heavy weights, etc.
77The immediate causes of the displacements are the pressure on the uterus by the viscera above it, and a diminution in tone of the uterine supports. ”

“ Abnormalities in the generative tract may cause abortions, the most common of these being inflammation of the uterine lining and a malposition of the uterus itself. Gonorrheal infection is a frequent cause of such an inflammation, which so alters the decidua that a satisfactory implantation of the ovum is impossible, and it perishes from lack of nourishment. Uterine misplacements, particularly retroflexion and prolapse, are important causative factors in abortions. This is because the malposition interferes with the blood supply and lesions in the endometrium result. ”

“ Physical shocks, such as falls, blows upon the abdomen, jumping, tripping over carpets, jars, jolting or overexertion, may be the exciting cause of an abortion where there is a marked irritability of the uterine muscles. This factor is largely influenced by individual stability, however, as a slight jar will cause an abortion in one woman, and violent experiences will have no effect upon another, at the same stage of pregnancy. ”

“ It must be remembered that the uterus is often punctured by the injudicious use of the uterine sound, but without any immediate dangerous symptoms. Wounds in the walls of the vagina indicate the use of instruments by an inexperienced hand; in the fundus of the uterus, to one at least accustomed to the introduction of instruments. Spontaneous rupture of the uterus is impossible during the early periods of pregnancy, just when the attempts at abortion are usually made. Rupture due to external violence is, as a rule, accompanied with outward signs of the violence used. ”

“ Inflammatory disorders, such as perimetritis and the formation of exudations in the parametrium, may render the uterus unable to undergo the enlargement necessary to pregnancy. Tissue changes in the uterine musculature may likewise prevent the implantation of the ovum, or the proper development of the uterus during pregnancy. ”

“ Some patients with defective uterine lining will have slight bleeding for a long time, possibly throughout the entire period of pregnancy, because a small area of the placenta has separated, leaving, however, a sufficiently large attached area to nourish the fetus. Such women should, of course, be under a doctor’s care and sedulously avoid all shocks to the uterine musculature, for the separated area may very easily be increased to such a size 170that the fetus will be unable to secure adequate nourishment, and die as a result. ”

“ In dysmenorrhoea the pain is ovarian, more violent, and aggravated with the cessation of the discharge, whilst in abortion it is uterine, more particularly referable to the cervix in the period of dilatation and to the fundus in that of expulsion, and lessens or ceases with the cessation of the discharge. The hemorrhage due to fibroids and polypi may greatly resemble that of abortion, especially if mole formations occur, but the pregnant and aborting uterus is greater in size than the congested menstrual organ. ”

“ An incomplete abortion is one in which the fetus is expelled but the placenta and membranes remain in the uterine cavity. The treatment is removal of the retained tissues, followed by the same care that is given during the normal puerperium. Prompt action in completing the delivery is important because of the hemorrhage that usually persists until the uterus is entirely emptied of its contents. ”