Minor surgical gynecology : a manual of uterine diagnosis and the lesser technicalities of gynecological practice : for the use of the advanced student and general practitioner . lly to retrovert it in the course of a fewweeks. In that case, it should be removed for a few days. In one in-stance I was obliged to remedy the retroversion by a lever pessary. If the pessary is too small, or has not been properly adjusted, its su-perior (longer) arch may slip behind the cervix, which organ is then foundbetween the two curves of the double horseshoe. The pessary then of PESSARIES. 335 course fails in
Minor surgical gynecology : a manual of uterine diagnosis and the lesser technicalities of gynecological practice : for the use of the advanced student and general practitioner . lly to retrovert it in the course of a fewweeks. In that case, it should be removed for a few days. In one in-stance I was obliged to remedy the retroversion by a lever pessary. If the pessary is too small, or has not been properly adjusted, its su-perior (longer) arch may slip behind the cervix, which organ is then foundbetween the two curves of the double horseshoe. The pessary then of PESSARIES. 335 course fails in its object, and may even give pain. By using an instru-ment with more widely separated lateral branches, this accident will beavoided. The anteversion pessaries, constructed by adding a movable anteriorbar to a Hodge lever pessary, all possess the same defect, that the poste-rior arch stretches the posterior vaginal pouch and counteracts the upwardaction of the movable bar. While they undoubtedly elevate the fundus Correct. nno Fig. 230.—Diagram illustrating separation oflateral branches of Gehrungs pessary to increaseits retentive power. (Gehrung.) Incorrect,. Fig. 231.—Woodwards pessary for re-troversion with anteflexion. and the whole uterus, they do so at the expense of a considerable dilata-tion of the vagina, and the pressure necessarily exerted by the anteriormovable bag is likely to produce excoriation. In retroversion of the anteflexed uterus they possibly may do good,although generally the posterior pouch is too shallow to give the pessarya sufficient purchase to hold or lift up the fundus. The anteversion pessary, shown in Figs. 232 and 233, is a modificationof Hodges lever, again modified by Thomas, and is introduced patient may occupy either the dorsal or lateral recumbent position.
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