CHAPTER XX.
CAUSES CONNECTED WITH THE CHILD, OR CHILDREN, WHICH MAY IMPEDE DELIVERY, OR MAKE IT DIFFICULT AND DANGEROUS.
PROCIDENTIA OF THE UMBILICAL CORD.
This means the escape of a portion of the cord before the child itself. It is most frequent in the irregular presentations, as they do not so fully close up the mouth of the Womb, and it is most likely to occur at the commencement of labor, though not impossible at a later stage. Very often the cord descends when the membranes break, being carried down by the rush of the waters; and sometimes it is already in the sack, or bag, before the rupture takes place. This accident is comparatively frequent, being found to occur as often as once in about three hundred cases.
The causes which produce procidentia of the cord, are most likely these:—A large quantity of liquor amnii, and its sudden discharge,—Unnatural presentations,—Deformities of the superior strait of the Pelvis,—A very long cord,—and rupturing the membranes too early. But it may also happen from other causes with which we are unacquainted.
There is seldom much difficulty in detecting this accident, because if the membranes are broken it protrudes into the Vagina, and if they remain whole it can be felt within the sack, and its pulsation will be quite distinct. Sometimes, it is true, it may be so firmly compressed, between the fœtus and the walls of the pelvis, that its pulsation may be very indistinct, or even totally suspended for a time; but this only necessitates a little extra care.
Procidentia of the cord may be very serious for the child; in fact, it is a frequent cause of its death. The reason of this will be evident when the functions of the cord are borne in mind. The circulation in it is as necessary for the life of the child before birth, as breathing is after, and when protruded first it can seldom escape being so pressed upon as to stop its circulation, and hence the danger. To the mother it makes no difference whatever, unless it be told and alarm her; or unless violent efforts are made to correct it. She had therefore better not know if it occurs.
If assistance is not rendered in this accident the consequences are almost always fatal to the child, though in some instances the cord has remained hanging from the Vulva several inches, for an hour or more, and still the infant has been saved.
If the fallen cord is detected before the membranes are broken, it may frequently be put back into the Womb without much difficulty. The accoucheur must wait till the mouth of the Womb is fully dilated, and then watch his opportunity, in an interval between two contractions, to push the cord upwards, between the fœtus and the uterine walls. If he succeeds in this, as is usually the case, he must then break the membranes during the next pain, and this will bring the presenting part at once into the upper strait, and so block up the passage. To effect this manœuvre it is requisite to introduce two or three fingers, and sometimes even the whole hand. It must never be attempted till the mouth is fully dilated, otherwise the membranes may be ruptured too soon, and the delivery be delayed, thus increasing the danger.