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An instrument for rupturing membranes
DECOSTA:
INSTRUMENT
FOR RUPTURING
MEMBRANES
355
of convulsions. Since no one was present when the first convulsion occurred, we can only speculate how the accident occurred. Cesarean section was done, because there was danger of losing the baby from abruptio placentae, The placenta was found partially detached. 122
SOUTH
MICHIGAN
AVENUE
AN INSTRUMENT EDWIN
FOR RUPTURING
J. DECOSTA,
MEMBRANES*
M.D., CHICAGO, ILL.
T
HIS instrument was devised to serve two purposes: One, to simplify the conventional method of rupturing membranes following sterile vaginal examination; and two, to rupture membranes under certain conditions when it is deemed advisable to avoid vaginal examination.
Detiii Fig.
1.
It is not the purpose of this communication to go into the indications or conditions necessary for rupturing membranes. Ordinarily, it is inadvisable to rupture membranes until after a careful sterile vaginal examination. There are occasions, however, when, with an engaged head and partially dilated cervix, one may not desire or consider it necessary to examine the patient vaginally. It is particularly for such circumstances that this instrument is presented. The instrument illustrated in Fig. 1 possessestwo curves: a pelvic curve A that follows the sacral curvature, and a cervical curve B that brings the biting edge into contact with the membranes and affords a convenient finger rest for properly directing these jaws. an angulated *Presented
at a meeting
of the
Chicago
Gynecological
Society,
March
20. 1942.
356
BMERICAN
OF
OBSTETRICS
AND
GYNECOLOGY
base plate on the under surface prevents inversion and pinching of the posterior vaginal wall as well as limiting the excursion of the jaws. A finger is introduced into the rectum and by careful palpation CCL’vied dilatation and the station of the head are ascertained. While the index tiger is so placed, the thumb and middle finger separate th(! labia, the vestibule is gently sponged wit,11 sterile cotton pledgets, and the sterilized instrument is int,roduced into t,hc vagina with the? jaws closed and the base plate pointing up. The tip of the base plat,e is introduced first; the handle is then depressed and rotated as it is advanced so as to bring the base plate posteriorly above the perineal body. The rectal finger then directs the tip to the center of the dilated cervix hp pressure through the rectovaginal septum; the jaws are opened and the> membranes grasped and severed. Forelying amniotic fluid prot.ects t 11~ presenting part from the grasp of the instrument. The criticism that this procedure might injure the cord is avoided by careful rectal palpation t,o insure that the presenting part is engaged and the cord is no6 presenting. The advantages to be derivrd from the. use of this inst,rummt lie in it,s simplicity and in the avoidance oli all additional vaginal examination. 154n E,\sT Cm, STPTWT *
Erratum In the article ’ i Some Aspects of Early human Dewlopment’ ’ by John tk~:li and Arthur T. Hertig, which appeared in the I~ecemhn, 1942, issue of the JOLKSAL, line 1, on page 974, should read : “So far 60 women . . ” instead of * i 61 women, * ’ bit of mucosn. ” Iklete the phrase ” ( Ii’ig. 3j ’ ! and line 13 should read * L polypoid which follows this in the published article. E’ig. :: refers not to ovum Be-ii71, but to ovum Si-7699. On page 980, line 8 from the bottom should read ia The former is three to fice days younger than the latter .,” instwd of “three to four clays .‘.
INSTRUMENT
FOR RUPTURING
MEMBRANES
355
of convulsions. Since no one was present when the first convulsion occurred, we can only speculate how the accident occurred. Cesarean section was done, because there was danger of losing the baby from abruptio placentae, The placenta was found partially detached. 122
SOUTH
MICHIGAN
AVENUE
AN INSTRUMENT EDWIN
FOR RUPTURING
J. DECOSTA,
MEMBRANES*
M.D., CHICAGO, ILL.
T
HIS instrument was devised to serve two purposes: One, to simplify the conventional method of rupturing membranes following sterile vaginal examination; and two, to rupture membranes under certain conditions when it is deemed advisable to avoid vaginal examination.
Detiii Fig.
1.
It is not the purpose of this communication to go into the indications or conditions necessary for rupturing membranes. Ordinarily, it is inadvisable to rupture membranes until after a careful sterile vaginal examination. There are occasions, however, when, with an engaged head and partially dilated cervix, one may not desire or consider it necessary to examine the patient vaginally. It is particularly for such circumstances that this instrument is presented. The instrument illustrated in Fig. 1 possessestwo curves: a pelvic curve A that follows the sacral curvature, and a cervical curve B that brings the biting edge into contact with the membranes and affords a convenient finger rest for properly directing these jaws. an angulated *Presented
at a meeting
of the
Chicago
Gynecological
Society,
March
20. 1942.
356
BMERICAN
OF
OBSTETRICS
AND
GYNECOLOGY
base plate on the under surface prevents inversion and pinching of the posterior vaginal wall as well as limiting the excursion of the jaws. A finger is introduced into the rectum and by careful palpation CCL’vied dilatation and the station of the head are ascertained. While the index tiger is so placed, the thumb and middle finger separate th(! labia, the vestibule is gently sponged wit,11 sterile cotton pledgets, and the sterilized instrument is int,roduced into t,hc vagina with the? jaws closed and the base plate pointing up. The tip of the base plat,e is introduced first; the handle is then depressed and rotated as it is advanced so as to bring the base plate posteriorly above the perineal body. The rectal finger then directs the tip to the center of the dilated cervix hp pressure through the rectovaginal septum; the jaws are opened and the> membranes grasped and severed. Forelying amniotic fluid prot.ects t 11~ presenting part from the grasp of the instrument. The criticism that this procedure might injure the cord is avoided by careful rectal palpation t,o insure that the presenting part is engaged and the cord is no6 presenting. The advantages to be derivrd from the. use of this inst,rummt lie in it,s simplicity and in the avoidance oli all additional vaginal examination. 154n E,\sT Cm, STPTWT *
Erratum In the article ’ i Some Aspects of Early human Dewlopment’ ’ by John tk~:li and Arthur T. Hertig, which appeared in the I~ecemhn, 1942, issue of the JOLKSAL, line 1, on page 974, should read : “So far 60 women . . ” instead of * i 61 women, * ’ bit of mucosn. ” Iklete the phrase ” ( Ii’ig. 3j ’ ! and line 13 should read * L polypoid which follows this in the published article. E’ig. :: refers not to ovum Be-ii71, but to ovum Si-7699. On page 980, line 8 from the bottom should read ia The former is three to fice days younger than the latter .,” instwd of “three to four clays .‘.