2. Rupture of the uterus.
3. Sepsis and its sequelæ.
4. Hæmatoma between the layers of the broad ligament.
Laceration of the cervix has been referred to: it begins as a rule at the internal and extends towards the external os uteri; it may be deep or superficial, and is recognized as a sulcus into which the finger can be passed from above downwards: rarely, laceration into the peritoneum may take place.
Rupture of the uterus is liable to occur when the uterine wall has been weakened by the changes which accompany the completion of the menopause, or has been infiltrated by carcinoma, or, more rarely, by vesicular mole.
Sepsis may occur from absorption through a laceration if asepsis has not been maintained: it may lead to an attack of pelvic cellulitis or even septicæmia.
If the uterus is fixed or not freely mobile, and the condition is complicated by any tubal or ovarian disease, great care must be exercised in manipulation.
Gradual dilatation by tents. There are three varieties of tents—sponge, laminaria, and tupelo.
Sponge tents should never be used, for they are extremely difficult to render sterile.
The commonest and the safest to use, because they can be most easily sterilized, are laminaria tents, made from sea-tangle (Laminaria digitata). These are cylindrical rods, which expand evenly, from imbibition of moisture. Tupelo tents are larger than laminaria and expand more rapidly.