The American text-book of obstetrics for practitioners and students . velope about to break into the peritoneal cavity j one,indeed, did rupture during the operation. There was a septic ulceration at the 510 AMERICAN TEXT-BOOK OF OBSTETRICS. placenta site so nearly perforating the uterine wall that by a light touch dur-ing the operation the forefinger passed into the uterine cavity. There was alsoa pyosalpinx in this case that, judging by the history, antedated or was coinci-dent with impregnation. The operation saved the patient. Indications for the Operation.—The indications for hysterectomy
The American text-book of obstetrics for practitioners and students . velope about to break into the peritoneal cavity j one,indeed, did rupture during the operation. There was a septic ulceration at the 510 AMERICAN TEXT-BOOK OF OBSTETRICS. placenta site so nearly perforating the uterine wall that by a light touch dur-ing the operation the forefinger passed into the uterine cavity. There was alsoa pyosalpinx in this case that, judging by the history, antedated or was coinci-dent with impregnation. The operation saved the patient. Indications for the Operation.—The indications for hysterectomy duringpuerperal sepsis are furnished by the condition of the pelvic organs when theyare exposed to sight and touch after the abdomen is opened. The three casesdescribed above are the types calling for hysterectomy. It is not often possibleto determine upon hysterectomy before the abdomen is opened, but it should beremembered that in any abdominal section for puerperal sepsis hysterectomymay be necessary. The careful obstetric surgeon therefore should be provided. Fig. 309.—Suppurative ovaritis (rear view). with the implements required for amputation of the womb in every abdominalsection for puerperal sepsis, and be prepared to remove the womb for any oneof the three indications described above, but content with the least radicalmeasure that promises his patient safety. The operation that is quickestdone and shocks the patient least is most successful, provided, of course, thatit is adequate. Technique of the Operation.—There are two points in which the techniqueof hysterectomy for puerperal sepsis may differ from the technique of the ope-ration performed for other conditions. One of these points is the necessityoften of doing pan-hysterectomy ; the other is the necessity often of tying theligatures in a broad ligament much thickened by inflammatory exudate. The writers preference is strongly for amputation of the womb, leaving aslittle cervix as possible, and this he alw
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