. The science and art of midwifery . e seat of the torsion is ordinarily in closeproximity to the umbilicus. It occurs but rarely at the placental endor in the center of the cord. The umbilical vessels are usually nearlyoccluded at the seat of the torsion, butstill permeable. Thrombi of varyingconsistency are often found in the ves-sels. Sero-sanguinolent fluid in the ab-dominal cavity of the foetus, oedema, andcystic degeneration of the cord, are alsopathological conditions frequently at-tending torsion. II. Knots.—Knots in the umbilical cord, which occur once in two hundred ,. - ,, » ., Fig.
. The science and art of midwifery . e seat of the torsion is ordinarily in closeproximity to the umbilicus. It occurs but rarely at the placental endor in the center of the cord. The umbilical vessels are usually nearlyoccluded at the seat of the torsion, butstill permeable. Thrombi of varyingconsistency are often found in the ves-sels. Sero-sanguinolent fluid in the ab-dominal cavity of the foetus, oedema, andcystic degeneration of the cord, are alsopathological conditions frequently at-tending torsion. II. Knots.—Knots in the umbilical cord, which occur once in two hundred ,. - ,, » ., Fig. 182.—Knot of umbilical cord. may result from the passage ol the (Leymano fcBtue through a twisted loop of the cord, whether the passage be effected during pregnancy by the spontaneousfetal movements, r at term by the uterine expulsive efforts, or by themanipulations of the accoucheur. Knots formed during parturition * Rem:, ibid., Bd. iii. Befi 2,1878, | Schauta, Arch, f. Gynaek., Bd. ivii, II. ft 1, 1881, 296 THE PATHOLOGY OF PREGNANCY. are loose and easily untied. They are unattended by any diminutionin the gelatin of Wharton. Those occurring during pregnancy aremore closely and firmly drawn, and more difficult to loosen than theformer variety. The cord is partly or completely denuded of thegelatin at the seat of the knot, and plainly shows the location ofthe latter, after its solution, by well-marked indentations. Knots inthe cord, of either variety, are comparatively insignificant, although atightly contracted one, in a thin cord, may occasion grave or evenfatal disturbance of the umbilical circulation. III. Hernia.—Hernia of the umbilical cord consists in the escapefrom the abdomen, at the point of insertion of the cord, of some or allof the fetal abdominal viscera. It is due either to arrested embryonicdevelopment, which prevents the comjilete closure of the abdominalcavity, or to the failure of the fetal intestines, originally situated out-side the
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