. Gynecology : . of the cervix or perineum. If symptoms are not too severe, and there is reasonable expectation of an earlypregnancy, the patient should be treated palliatively and operation deferred. The question of operation sometimes arises where there is considerable pro-lapse, but no symptoms. If it is apparent that the condition is likely to get worse,operation is advisable. If the prolapse seems to have reached its limit, the deci-sion must be conservative. Judgment as to the future outcome of a given caseis only gained by experience. MALPOSITIONS OF THE UTERUS 475 PROCIDENTIA Procident
. Gynecology : . of the cervix or perineum. If symptoms are not too severe, and there is reasonable expectation of an earlypregnancy, the patient should be treated palliatively and operation deferred. The question of operation sometimes arises where there is considerable pro-lapse, but no symptoms. If it is apparent that the condition is likely to get worse,operation is advisable. If the prolapse seems to have reached its limit, the deci-sion must be conservative. Judgment as to the future outcome of a given caseis only gained by experience. MALPOSITIONS OF THE UTERUS 475 PROCIDENTIA Procidentia, as we have defined it, relates to an extreme degree of prolapse,and is applied to the condition in which the cervix extrudes from the vaginalintroitus. It may seem somewhat arbitrary to make a sharp distinction betweenpartial prolapse and procidentia, as they are different stages of the same distinction, however, is convenient, as there are definite clinical differencesbetween the two Fig. 196.— cervix ulcerated. (Drawn after an illustration by Watkins.) Procidentia, though it may occur at any age from twenty-five on, is morecommonly an affliction of middle or later life. It is, as a rule, very graduallydeveloped, the condition being accelerated by the physiologic weakening of thepelvic supports that occurs at and after the menopause. Rarely it may beseen in young women a few months after labor. The change from prolapse to procidentia—i. e., the protrusion of the cervicalorifice beyond the vaginal introitus—sometimes gives the patient the impression 476 GYNECOLOGY that the condition has developed suddenly, especially if the prolapse has notbeen noticed or if the perineum has been sufficiently small to obstruct tempo-rarily the onward progress of the down-coming cervix. It should be remem-bered, however, that the presence of a procidentia indicates a gradual andusually slow progress. It is not brought on suddenly from a nor
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