Detroit Medical Journal, 1901 (Classic Reprint)

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Excerpt from Detroit Medical Journal, 1901 Such a case is the following: - Protracted labor, high forceps delivery, rupture of the uterus, death immediate from hoemorrhage and shock. - Mrs. R. B., seen at post-mortem with Doctor W. B. Sprague, to whom I am also indebted for notes of the case: The patient, aged 37, had borne three children, the first sixteen years before. The cervix and perineum had been badly lacerated at this delivery, and when she came under Doctor Sprague's care she was, evidently, also afflicted with a pyosalpinx. She suffered much during the last pregnancy from pelvic pains, and would occasionally have a discharge, which she described as "like matter, " and following which she was always relieved. Labor finally set in, a month later than expected, with excruciating, inefficient pains. No progress having been made after a lapse of twenty-four hours, forceps were applied with the head in the superior straight. Some force was necessary to delivery, and the child was born asphyxiated. The uterus contracted firmly after the delivery of the placenta. While the doctor turned his attention to the resuscitating of the child, the husband of the patient held the uterus in firm contraction. Fifteen minutes later, the pressure above the uterus having been removed, the patient suddenly screamed out she was dying, the pulse became almost imperceptible, and in spite of hypodermatics of strychnine and digatalin, pressure over the fundus, and other efforts, she passed away within fifteen minutes from the onset of the symptoms. On hearing the report of the previous condition and the occurrences at time of labor, I expressed the opinion that the patient had sustained a rupture of the uterus and had died from internal hæmorrhage: The autopsy proved this to have been the case. The uterine wall had given way over a space of about two inches, low down in the lower segment on the right side, and hæmorrhage into the peritoneal cavity had taken place. (See frontispiece.) An analysis of this case shows that after a tedious labor the patient is apparently safely delivered by a difficult forceps operation. But the previously diseased and now exhausted uterus proves unequal to the task imposed upon it, overdistention of the weakened tissues leads to their giving way as the child passes through the parturient canal, the uterus makes a final effort to repair the damage, but lacking retractive power, it soon relaxes, blood is poured out through the rent, and in a few minutes, almost without warning, the patient is dead from hæmorrhage and shock. The impotence and ineffectiveness of human skill and wisdom is never more apparent than on such occasions, and the practitioner can only stand by and see his patient perish from the unremediable catastrophy. In those cases, however, in which rupture of the uterus takes place before delivery, with partial or total escape of the foetus into the abdominal cavity, or where the patient survives the immediate effects of the accident, prompt action and skillful treatment will, in a large number of instances, be successful in the saving of the mother's life. But even under these more favorable conditions, there are many factors which will militate against success, and foremost among these untoward elements is septic infection: Abortion of a decomposed foetus at the sixth month, rupture of the uterus during manual delivery, abdominal hysterectomy, death on the fifth day from septicoemia. - Mrs. L. A., seen with Doctor B. P. Brodie, July 22d, 1899. The patient, aged 23 years, mother of one child, was a somewhat spare brunette, of medium height, and of very active, restless habit. Three months before she was treated for general malaise: She stated at that time that the menstrual function was regular. In June she consulted the Doctor for a profuse, mal-odorous discharge, and