Case of spontaneous expulsion of child : with remarks / by Robert Dyce.

  • Dyce, Robert, 1798-1869.
Date:
1850
Catalogue details

Licence: Public Domain Mark

Credit: Case of spontaneous expulsion of child : with remarks / by Robert Dyce. Source: Wellcome Collection.

    10/14 (page 8)
    the combined and uniform action of the whole organ, Douglas’ form of spontaneous expulsion is accomplished. But in the other form, or Denman’s, I conceive that the uterus, although it may still be acting energetically, is still not acting equally; that while the posterior fibres are strongly contracting and forcibly pressing the breech into the back of the pelvis, the anterior fibres may be acting much less strongly, —consequently the resistance they offer is not only not suffi¬ cient to keep the arm down in the vagina, but actually allows itself to be overborne, and the arm to be pushed along with the shoulder and head beyond the brim, so that it recedes from its situation in the vagina, while the breech, by the continued strong action, occupies its place ;—thus forming Denman’s u spontaneous evolution.” But besides this unequal uterine action, I consider that the posi¬ tion which the child assumes at the brim has an important influence over the two forms of labour,—viz. upon the relative proportion which the body, on one side, and the neck and head on the other side of the presenting part, bears to the centre of the brim of the pelvis. If, for instance, in a case of arm-presentation, a greater proportion of the neck and head be perceivable on examination than there is of the body on the other side of the presenting arm, and the uterine action is strong and uniform, then one of two things will happen : if the child is at the full time and large, it will be jammed into the pelvis, and delivery will not be accomplished but by turning; while if the child be immature or small, then the arm will remain down, be protruded along with the shoulder externally, and the breech falling into the hollow of the sacrum, spontaneous expulsion, as at present understood, will be accomplished. If, however, on the other hand, more of the body of the child is perceivable on the one side of the presenting arm than there is of neck and head on the other, the shoulder perhaps just resting on the brim, then I imagine the unequal action of the uterine fibres, favoured by this position of the child, will enable the arm to rise, and eventually to disappear, while the breech, with the legs doubled up, will descend and fill the pelvis, and form spontaneous evolution. I would still, therefore, recognise and retain Denman’s name of spontaneous evo¬ lution for the cases in which the arm recedes ; and Douglas’ and Gooch’s name of spontaneous expulsion for those in which the arm remains down. It has been a question with some authors, seeing that occasionally an otherwise impracticable form of labour may be terminated by the natural powers alone, whether it is right to wait for this process. Denman, amongst others, was very favourably inclined to this delay; but it is now an established rule in midwifery, that we are not warranted in waiting for it, because the delay must be extremely hazardous to the mother, and almost certainly fatal to the child. There are, however, though rarely, cases occurring, and the one now read to the Society corroborates the observation, that u under certain concurring circumstances, a fair opportunity may be permitted