A textbook of obstetrics . MP. Fg- ,;57—Central tear in theperineum, with contracted vulvar ori-fice (Ribemont-Dessaignes). narrowness of thevulva is usually overcome bythe advance of the presentingpart, though often at the ex-pense of vaginal and perineallacerations. It may be neces-sary to resort to hydrostaticdilatation, or even, in rare in-stances, to Diihrssens plan ofmultiple incisions. In the caseof extreme narrowness of thevulva there may be a central tearof the perineum, through whichthe presenting part begins toemerge. To avoid a rectal tearin such a case the perineumshould be cut fr
A textbook of obstetrics . MP. Fg- ,;57—Central tear in theperineum, with contracted vulvar ori-fice (Ribemont-Dessaignes). narrowness of thevulva is usually overcome bythe advance of the presentingpart, though often at the ex-pense of vaginal and perineallacerations. It may be neces-sary to resort to hydrostaticdilatation, or even, in rare in-stances, to Diihrssens plan ofmultiple incisions. In the caseof extreme narrowness of thevulva there may be a central tearof the perineum, through whichthe presenting part begins toemerge. To avoid a rectal tearin such a case the perineumshould be cut from the anteriorborder of the perforation to the posterior commissure of the vulva (Fig. 357)- Rigidity of the tissues in the cervix, the vaginal wall, and atthe outlet occasions delay in the majority of all primiparae, butespecially in the case of elderly primiparae—those over thirtyyears of age. Eckhard found the infantile mortality in such casesto be 1 per cent., the maternal mortality to be three times asgreat as i
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Keywords: ., bookcentury1800, bookdecade1890, bookidtex, booksubjectobstetrics
