The practice of obstetrics, designed for the use of students and practitioners of medicine . ial care being takento clear the comua of debris, which frequently accumulates in these situations(Fig. 1263). The operator may know when he has reached the uterine wall bythe characteristic grating sensation. Choice of Instruments.—Much has been said as to whether the sharp or dullcurette is to be used. It will often be best to use both, first the dull curette inorder to remove the loosely attached decidua and placental tissue, and later thesharp instrument for the detachment of smaller adherent fragm
The practice of obstetrics, designed for the use of students and practitioners of medicine . ial care being takento clear the comua of debris, which frequently accumulates in these situations(Fig. 1263). The operator may know when he has reached the uterine wall bythe characteristic grating sensation. Choice of Instruments.—Much has been said as to whether the sharp or dullcurette is to be used. It will often be best to use both, first the dull curette inorder to remove the loosely attached decidua and placental tissue, and later thesharp instrument for the detachment of smaller adherent fragments and thethorough cleansing of the uterine walls. During and subsequent to the operationthe uterine cavity is freely irrigated. It is not necessary to pack the uterus orvagina after the operation, unless this procedure is called for by severe hemor-rhage or atony (see page 885). (D) OPERATIONS FOR THE CORRECTION OF INJURIES. I. CELIOTOMY IN RUPTURE OF THE UTERUS. See Rupture of the Uterus, page 589. 1032 OBSTETRIC SURGERY. II. CELIOTOMY FOR SEPSIS OF THE UTERUS. See Fever, page Fig. 1267.—Repair of a Deep Laceration of theCervix. III. REPAIR OF INJURIES TO CERVIX, VAGINA, RECTUM,PERINEUM, AND CLITORIS. 1. Cervical Lacerations.—The varieties of these lacerations have been de-scribed on page 593. Some writers have advised the immediate repair of all cervical lacerations, but itis now pretty generally con-ceded that it is neithernecessary nor safe, since itincreases the danger of sep-sis and has no compensa-tory advantages, but ratherinterferes with deep lacerations, how-ever, that cause severehemorrhage and favor ex-tension of infection to theparametrium should bepromptly sutured. The instruments neededare two pairs of volsellumforceps, and a needle-holder and large curved needles. In rare cases, as in cicatricial fixation of the cervix or in the case of a primipara with very small birth canal, a large speculum may be required. The patient being in th
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectobstetrics, bookyear1
