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Acute dilatation of the stomach after labor
REVIEWS
AND
121
ABSTRACTS
spection of the perineum and c,crrix showed no tears and the uterus seemed to be acting well. Little by little the pulses began to rise and the patient complained of feeling faint, palsy of the left jaw, peculiar sensations in the hand and of seeing double. The feet were elevated, heat applied, warm wine administered, and camphor and oil with strychnia given subcutaneously. At intervals for the next four hours these symptoms plus ringing in the ears persisted despite the fact, that the uterus remained well contracted. The pulse was small, hard to count a.nd at ‘times imperceptibIe. A consultant felt that she would die, but about twelve hours afterward the patient was quite herself except that she complained of being very tired as though her limbs were bruised from beating. The causes are obscure. ‘The condition might be compared with the shock following an accident in which no visible injury can be demonstrated, hence purely a nervous phenomenon as, for example in the case of a woman who after delivery went into shock when she heard the physician say that he must repair the perineum. The toxemic theory could be dismissed, because nothing in the way of a toxemia c~ould be demonstrated, and her labor was not sufficient to consider it one of fatigue. The part that the endocrine system might play is still a question. The fact remains that there is a definite entity which might be called obstetrical shock occurring with no partieular reason or warning and with no demonstrable hemorrhage. The treatment must be adapted to the individual case, and consists chiefly in stimulation. In some cases all remedies fail and death is sudden. A. C. WILLIAMSON.
Van
der Perk: Acute Dilatatioa Tijdschrift voor Geneesku.nde,
of 1923,
the Stomach i, 454.
(after
Labor.
Yederlandsch
While acute dilatation of the stomach after operations is quite well known, it is not so universally known tll:lt this condition occurs occasionally after labor. Van der Perk reports the case of a primigravida who had gone through a 30 hour labor, G hours of which was consumed by the seeond stage on account of a rigid perineum. An hour before delivery she ‘was given 1 C.C. pituglandol and delivery was aided by manual pressure on the abdomen. The placenta was expelled by CredB’s method 30 minutes postpartum, after which the uterus contracted well. Six hours after delivery the patient felt miserable and began vomiting. Her face was pale and drawn, the pulse was 100 but very weak, breathing superficial and The abdomen was ballooned, most prominent around the umbilicus. The napid. stomach could be outlined. The uterus was well contracted. The patient was placed on the right side; some time later eruetations gave partial relief. Later on she expelled flatus and eight hours later she was quite comfortable. It is notable that the sole treatment consisted in placing the patient on her right side (some authors have recommended left side position). Gastric lavage was not resorted to. :R. E. WOEUS. Weinzierl, hilfe
und
E. : Torsion Gynlkologie,
of the Uterus During 1922, lix, 29.
Labor.
Monatsschrift
fiir
Geburts
The author reports two causes of torsion of the uterus during labor. In the first, whereas in the second there was more than there was a dextro rotation of 200”, 9O”rotation to the left. In both patients the condition was not su.spected and was found accidentally at cesarean sections whieh were performed in the interest of the babies. In both eases a moderate amount of fluid was found in the abdominal Marked hyperemiti was e:avity but no evidence of an old inflammatory condition. present in both, but this cleared up readily after reposition of the uterus. In one case the point of rotation was low down in the cervix so that the bladder partici-
AND
121
ABSTRACTS
spection of the perineum and c,crrix showed no tears and the uterus seemed to be acting well. Little by little the pulses began to rise and the patient complained of feeling faint, palsy of the left jaw, peculiar sensations in the hand and of seeing double. The feet were elevated, heat applied, warm wine administered, and camphor and oil with strychnia given subcutaneously. At intervals for the next four hours these symptoms plus ringing in the ears persisted despite the fact, that the uterus remained well contracted. The pulse was small, hard to count a.nd at ‘times imperceptibIe. A consultant felt that she would die, but about twelve hours afterward the patient was quite herself except that she complained of being very tired as though her limbs were bruised from beating. The causes are obscure. ‘The condition might be compared with the shock following an accident in which no visible injury can be demonstrated, hence purely a nervous phenomenon as, for example in the case of a woman who after delivery went into shock when she heard the physician say that he must repair the perineum. The toxemic theory could be dismissed, because nothing in the way of a toxemia c~ould be demonstrated, and her labor was not sufficient to consider it one of fatigue. The part that the endocrine system might play is still a question. The fact remains that there is a definite entity which might be called obstetrical shock occurring with no partieular reason or warning and with no demonstrable hemorrhage. The treatment must be adapted to the individual case, and consists chiefly in stimulation. In some cases all remedies fail and death is sudden. A. C. WILLIAMSON.
Van
der Perk: Acute Dilatatioa Tijdschrift voor Geneesku.nde,
of 1923,
the Stomach i, 454.
(after
Labor.
Yederlandsch
While acute dilatation of the stomach after operations is quite well known, it is not so universally known tll:lt this condition occurs occasionally after labor. Van der Perk reports the case of a primigravida who had gone through a 30 hour labor, G hours of which was consumed by the seeond stage on account of a rigid perineum. An hour before delivery she ‘was given 1 C.C. pituglandol and delivery was aided by manual pressure on the abdomen. The placenta was expelled by CredB’s method 30 minutes postpartum, after which the uterus contracted well. Six hours after delivery the patient felt miserable and began vomiting. Her face was pale and drawn, the pulse was 100 but very weak, breathing superficial and The abdomen was ballooned, most prominent around the umbilicus. The napid. stomach could be outlined. The uterus was well contracted. The patient was placed on the right side; some time later eruetations gave partial relief. Later on she expelled flatus and eight hours later she was quite comfortable. It is notable that the sole treatment consisted in placing the patient on her right side (some authors have recommended left side position). Gastric lavage was not resorted to. :R. E. WOEUS. Weinzierl, hilfe
und
E. : Torsion Gynlkologie,
of the Uterus During 1922, lix, 29.
Labor.
Monatsschrift
fiir
Geburts
The author reports two causes of torsion of the uterus during labor. In the first, whereas in the second there was more than there was a dextro rotation of 200”, 9O”rotation to the left. In both patients the condition was not su.spected and was found accidentally at cesarean sections whieh were performed in the interest of the babies. In both eases a moderate amount of fluid was found in the abdominal Marked hyperemiti was e:avity but no evidence of an old inflammatory condition. present in both, but this cleared up readily after reposition of the uterus. In one case the point of rotation was low down in the cervix so that the bladder partici-