A System of Midwifery

by Edward Rigby

In the second month, the abdomen becomes somewhat flat: the portio vaginalis can be now reached by the finger with greater ease than at any time of pregnancy, which is not from the uterus itself being lower in the pelvis, but from not yet having altered its position; any increase of its size therefore will cause its inferior extremity to be felt lower down and nearer to the os externum. The os uteri has undergone a considerable change, inasmuch as its edges have lost their lip-like figure; they now form a ring or rather dimple-like concavity at the lower end of the cervix, its canal being closed by the gelatinous plug already mentioned.

In primiparæ, or women pregnant for the first time, the margin of the os uteri thus closed is not only circular but perfectly smooth; whereas in multiparæ, not only is the cervix usually larger in every direction, but the os uteri itself is larger, thicker, and of an irregular shape; it is also knotty here and there from little callous cicatrices, where its edge has been torn in former labours.

In the third month of pregnancy the uterus rises above the brim of the pelvis. A slight protrusion of the abdomen may be sometimes observed above the pubes; the os uteri is not reached so easily as in the preceding month. The alteration which takes place in the situation of the uterus during the third month appears to result from gradual shortening of the broad ligament as it increases in size. As the uterus rises it pushes up that portion of the small intestines which rests upon it; these however being confined by the mesentery to the spine, and therefore prevented ascending before the uterus, at length slip down behind it, and the fundus being freed from the superincumbent pressure rises in a direction upwards and forwards into the cavity of the abdomen. The direction of the uterus becomes much altered; the os uteri is no longer in the middle of the pelvic cavity, but inclines towards the upper part of the hollow of the sacrum, whereas the fundus approaches more and more to the anterior parietes of the abdomen.

In the fourth month, the fundus uteri has risen about two or three fingers’ breadth above the symphysis pubis; this is not very easily ascertained even in a thin person, still less where the patient is stout and the parietes of the abdomen therefore thick. The directions which the celebrated Rœderer has given for making an examination of the abdomen during the early months of pregnancy, are well worthy of notice. Having evacuated the bladder and rectum, the patient should be placed in a half-sitting posture with the knees drawn up, so as to relax the abdominal parietes as much as possible: she must then breathe slowly and deeply; and if the hand be suddenly pressed against the abdomen a little above the symphysis pubis, at the moment of her making a full expiration, we shall in all probability feel the hard globe of the uterus.

In the fifth month, the fundus will be felt half way, or a little more, between the symphysis pubis and umbilicus. The increased size of the abdomen cannot be concealed by the dress; the portio vaginalis has become distinctly shorter, and the os uteri is situated higher in the pelvis and more posteriorly.

In the sixth month, the fundus has risen as high as the umbilicus; the irregular folds of the skin which form the fovia umbilici or navel depression begin to disappear; the first perceptible movements of the child may occasionally be felt; the portio vaginalis has lost half its length, being scarcely half an inch in length.

Cervix uteri about the sixth
or seventh month.

In the seventh month, the fundus rises an inch or so above the umbilicus, the folds of which have nearly disappeared. In some cases it begins to protrude, forming a species of umbilical hernia: this varies a good deal in different individuals, being more marked in primiparæ; whereas in women, whose abdomen has been distended in previous pregnancies, little or no convexity of the navel is produced until a later period, and not always even then, the umbilical depression being merely diminished in point of depth, and its folds not so strongly marked. The movements of the child are now perfectly distinct; the portio vaginalis is still shorter, and approaches more and more to the upper part of the hollow of the sacrum. The anterior portion of the inferior segment of the uterus, or that part which extends from the os uteri towards the symphysis pubis, is now considerably developed and convex, and on pressing the point of the finger against it, the presenting part of the child will be felt. When this is the head as is usually the case, it will feel like a light ball which rises when pushed by the finger, but which, if the finger be held still, in a few moments descends and may again be felt.