A text-book of practical obstetrics, comprising pregnancy, labor, and the puerpal state, and obstetric surgery . to a consideration of the technique of theoperation, it is well to recall briefly the structures involved inthe operation and to point out the risks to which the maternalstructures are subjected. In the vast majority of women at ornear term there exists normally a certain amount of separation SYMPHYSIOTOMY. 123 at the symphysis, provided this be not ankylosed, when, ofcourse, the operation is per se contra-indicated. The operationis entirely extra-peritoneal, the bladder stripped of
A text-book of practical obstetrics, comprising pregnancy, labor, and the puerpal state, and obstetric surgery . to a consideration of the technique of theoperation, it is well to recall briefly the structures involved inthe operation and to point out the risks to which the maternalstructures are subjected. In the vast majority of women at ornear term there exists normally a certain amount of separation SYMPHYSIOTOMY. 123 at the symphysis, provided this be not ankylosed, when, ofcourse, the operation is per se contra-indicated. The operationis entirely extra-peritoneal, the bladder stripped of the perito-neum, and the urethra lying immediately under the certain instances, however, as Dickinson, of Brooklyn, re-minds us, the peritoneum pouches downward, and there may bedanger of injuring this. As a rule, however, the bladder and the urethra are theonly organs which are likely to be injured, and these, we willshow, need not be if the requisite care is taken during the per-formance of the operation and afterward when the parts arebrought together. We are speaking now, of course, of the. Fig. 59.—The Bulging of Peritoneum and of Bladder into theOpening at the Joint. subcutaneous performance of the operation, the method whichis favored by most practical accoucheurs. The open method ofoperating involves the structures and the vessels which coverthe anterior face of the pubes, and the selection of this methodof operating converts symphysiotomy into a much more seriousoperation and complicates greatly convalescence as well. The two factors which control the result of this operationare election and asepticism. Where the operation is indicatedit should be performed in a timely manner, and to-day there isno excuse for inattention to the stringent rules of cleanlinesswhereby the surgery of the present is so sharply differentiatedfrom that of the past. If but one lesson has been taught bythe results secured during the past three years, it is that sym- 124 OBSTETRI
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Keywords: ., bookcentury1800, bookdecade1890, bookpubli, booksubjectobstetrics
