. Obstetrics for nurses. be introduced by the physicianbetween the presenting part and the cervix to replace the rupturedbag of waters, and thus shorten wliat might otherwise be a prolongeddry labor. In multiparous patients the first stage is generally shorter than inprimiparae, due to the fact that after the cervical canal has beenobliterated the externalOS offers but little resist-ance and dilates veryreadily. To recapitulate, theonset of labor may beheralded by any of thefollowing signs: 1. Definite intermit-tent painful uterine con-tractions. 3. The rupture of thebag of waters. 3. The appe
. Obstetrics for nurses. be introduced by the physicianbetween the presenting part and the cervix to replace the rupturedbag of waters, and thus shorten wliat might otherwise be a prolongeddry labor. In multiparous patients the first stage is generally shorter than inprimiparae, due to the fact that after the cervical canal has beenobliterated the externalOS offers but little resist-ance and dilates veryreadily. To recapitulate, theonset of labor may beheralded by any of thefollowing signs: 1. Definite intermit-tent painful uterine con-tractions. 3. The rupture of thebag of waters. 3. The appearance ofa show. Second Stage.—Thechild descends little or not at all during the first stage, but upon its completion the entire energyof the uterine contractions is directed toward the expulsion of the child,and its head moves gradually toward the vulva. Descent is explained,partly by the force of the uterine contractions, assisted by the abdominalmuscles, and partly by the fact that the child straightens out, so that. Fig. 56.—Diagram showing distention of the vaginaand thinning out of the perineum by the advancinghead. (Williams.) 108 TEXTBOOK OF OBSTETRICS FOR NURSES while its upper portion is firmly stemmed against the fundus its present-ing part is slowly pushed down. Expulsive pains appear soon after the beginning of the second stageand continue until delivery is accomplished. Most frequently the actualpain is located over the sacral region and is associated with cramps inthe legs due to pressure upon the nerves supplying them. Firm rub-bing of the back and occasionalstraightening of the legs will givesome relief. The pelvic congestion obtainingthroughout the latter part of preg-nancy has made the tissues of theperineum more elastic than normaland the advancing head slowly over-comes this last resistance. Theperineal body is pushed outwardand upward, and becomes so thinnedthat its anterior margin is scarcelythicker than heavy paper. The out-let is gradually stretched
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectobstetrics, bookyear1
