A Case of Retention of the Fœtus by an Internal Contraction Ring Treated by Continuous Weight Contraction.

Abstract

THE history of the case which came under my own observation is as follows : -S.W., set. 42, a very stout woman, and the mother of 10 children, the last being born four years previously. Her last menstrual period ended during the first week of March 1911. All her past labours had been iincomplicated and her pelvic measurements were above the average. She was admitted as an emergency case into the City of London Lying-in Hospital on December 30 midnight (11-55p.m.). Labour had started a t 10a.m. the same day with escape of the liquor amnii. On admission her pulse-rate was 84 and temperature 99°F. The uterine contractions were very infrequent, and the 0s was about the size of half-a-crown. The child presented by the face in the second position. The fcletal heart was not heard. As her condition was that of uterine inertia 20grs. chloral hydrate were administered, after which she dozed and slept for some hours. During the morning of the 21st her condition remained much the same, the pains still being infrequent, and the 0s dilated slowly, not being fully dilated till midday. At 1 p.m. it was noticed that her pulse-rate was 116, and 2-30, when I saw her, it had risen to 132 without any apparent reason, and with this exception the patient's condition was not urgent. The uterus was soft and not tender, nor were its contractions severe; no ring could be felt, though, owing to the thickness of the patient's abdominal wall it might have been present and yet have escaped detection. I deemed it advisable to deliver the patient, and the forceps was applied to the face under CHC1,. The head was easily brought down to the outlet, the chin rotated forwards, but the utmost difficulty was experienced in bringing the head over the perineum, and it was not until one blade of the forceps was used as a vectis that the head was completely delivered. The cause of this difficulty was now evident as the shoulders of the child were detained above a thick ring which encircled the lower part of the neck. The child was dead and its skin stained by meconium.To have performed an embryotomy would have been extremely difficult and the results of this operation in previous cases had seemed to me to be unsatisfactory so that I determined to try the effect