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Delivery through a spurious birth canal
HURD:
DELIVERY
THROUGH
A
SPURIOUS
BIRTH
CANAL
705
ketone bodies and blood sugar, an increase of the nonprotein nitrogen, and a gradual lowering of the hydrogen ion concentration. These changes indicate the gradual return of the organism to the normal nonpregnant state. The most interesting part of this phenomenon is that it takes several days and, as other investigations show, even months, until this return to normal is completed. So the changes during pregnancy, such as the alkalemia, cannot be due alone to direct influences of the fetus and the placenta. REFERENCES
AnseZmino: Die Regulation des Same-Basenhaushalts in der Sehwangerschaft. Supplement VI. Monatschr. f. .Geburtsh. u. Gynlk., 1932. Ansehnino and Hofmann: Arch. f. GynIk. 140: 373, 1930. Bekreti, Berberich, and Eufinger: Arch. f. Gyniik. 143: 537, 1931. Cmtarow, Montgomery, and Bolton: Surg. Gynee. Obst. 51: 469, 1930. Dkdmann and Crossen: AM. J. OBST. & GYNEC. 14: 3, 1927. Jar&o: AM. J. OBST. L GYNEC. 17: 13, 1929. Kydd: J. Biol. Chem. 91: 63, 1931. Yarraok and Boone: Brit. J. Exuer. Path. 4: 261. 1923. Oard and Peters: J. Biol. Chem. 81: 9, 1929. Oberst on2 Ptass: J. Biol.‘Chem. 92: Nos. 13 and 14, 1931. Siedentopf: Die Physiologische Chemie der Geburt, Leipzig, 1932. Siedentopf and Eissner: Stander: Bull. Johns Hopkins Hosp. Ztschr. f. Geburtsh. u. Gytik. 46: 76, 1929. Hopkins Hosp. 47: 382, 1930. 35: 133, 1924. Stander and Cadden: Bull. Johns Williams and Wills: Quart. J. Med. 22: 493, 1929.
DELIVERY RALPH
THROUGH A.
HURD,
A SPURIOUS
BIRTH
CANAL”
M.D., F.A.C.S., NEW YORK, N. Y.
A
PRIMIPARA at term was successfully delivered of a six pound infant after a labor of twenty-four hours. The membranes ruptured spontaneously two hours after the onset of pains, and it was a vertex presentation which began as a posterior and rotated naturally to the left anterior position. The feature of this case relates entirely to the cervix and the unusual mode of dilatation which occurred. She was examined three times rectally and ouce vaginally immediately before removal to the delivery room where labor was terminated by Immediate examination of the cervix showed medium episiotomy and low forceps. that the external OS was intact and that the child had delivered through an artificially created passage in the posterior wall of the cervix at or near its middle third. The descending head apparently had impinged upon this area of the cervical canal so vigorously and had compressed it to such thinness as to force it to give way. The aperture thus created WRS closed with interrupted catgut sutures but unfortunately union failed to occur. Inspection of the cervix several months postpartum revealed nothing unusual in its appearance, but when pulled forward so as to expose its entire posterior aspect, the accessory birth canal could be demonstrated as a cervico-vaginal fistula, and a sound could be passed through the real external OS, into the true cervical canal and Here then is a woman who was out again into the posterior vaginal fornix. not examined vaginally until the very end of a twenty-four-hour labor, and in whom, possibly because of this, the obstetrician failed to recognize an abnormal situation which conceivably might have been averted with the more accurate information obtainable by vaginal palpation. 37 EAST cine,
SIXTY-FOURTH
STREET.
*Read at a meeting of the November 24, 1931.
Obstetric
Section
of the New
York
Academy
of Medi-
DELIVERY
THROUGH
A
SPURIOUS
BIRTH
CANAL
705
ketone bodies and blood sugar, an increase of the nonprotein nitrogen, and a gradual lowering of the hydrogen ion concentration. These changes indicate the gradual return of the organism to the normal nonpregnant state. The most interesting part of this phenomenon is that it takes several days and, as other investigations show, even months, until this return to normal is completed. So the changes during pregnancy, such as the alkalemia, cannot be due alone to direct influences of the fetus and the placenta. REFERENCES
AnseZmino: Die Regulation des Same-Basenhaushalts in der Sehwangerschaft. Supplement VI. Monatschr. f. .Geburtsh. u. Gynlk., 1932. Ansehnino and Hofmann: Arch. f. GynIk. 140: 373, 1930. Bekreti, Berberich, and Eufinger: Arch. f. Gyniik. 143: 537, 1931. Cmtarow, Montgomery, and Bolton: Surg. Gynee. Obst. 51: 469, 1930. Dkdmann and Crossen: AM. J. OBST. & GYNEC. 14: 3, 1927. Jar&o: AM. J. OBST. L GYNEC. 17: 13, 1929. Kydd: J. Biol. Chem. 91: 63, 1931. Yarraok and Boone: Brit. J. Exuer. Path. 4: 261. 1923. Oard and Peters: J. Biol. Chem. 81: 9, 1929. Oberst on2 Ptass: J. Biol.‘Chem. 92: Nos. 13 and 14, 1931. Siedentopf: Die Physiologische Chemie der Geburt, Leipzig, 1932. Siedentopf and Eissner: Stander: Bull. Johns Hopkins Hosp. Ztschr. f. Geburtsh. u. Gytik. 46: 76, 1929. Hopkins Hosp. 47: 382, 1930. 35: 133, 1924. Stander and Cadden: Bull. Johns Williams and Wills: Quart. J. Med. 22: 493, 1929.
DELIVERY RALPH
THROUGH A.
HURD,
A SPURIOUS
BIRTH
CANAL”
M.D., F.A.C.S., NEW YORK, N. Y.
A
PRIMIPARA at term was successfully delivered of a six pound infant after a labor of twenty-four hours. The membranes ruptured spontaneously two hours after the onset of pains, and it was a vertex presentation which began as a posterior and rotated naturally to the left anterior position. The feature of this case relates entirely to the cervix and the unusual mode of dilatation which occurred. She was examined three times rectally and ouce vaginally immediately before removal to the delivery room where labor was terminated by Immediate examination of the cervix showed medium episiotomy and low forceps. that the external OS was intact and that the child had delivered through an artificially created passage in the posterior wall of the cervix at or near its middle third. The descending head apparently had impinged upon this area of the cervical canal so vigorously and had compressed it to such thinness as to force it to give way. The aperture thus created WRS closed with interrupted catgut sutures but unfortunately union failed to occur. Inspection of the cervix several months postpartum revealed nothing unusual in its appearance, but when pulled forward so as to expose its entire posterior aspect, the accessory birth canal could be demonstrated as a cervico-vaginal fistula, and a sound could be passed through the real external OS, into the true cervical canal and Here then is a woman who was out again into the posterior vaginal fornix. not examined vaginally until the very end of a twenty-four-hour labor, and in whom, possibly because of this, the obstetrician failed to recognize an abnormal situation which conceivably might have been averted with the more accurate information obtainable by vaginal palpation. 37 EAST cine,
SIXTY-FOURTH
STREET.
*Read at a meeting of the November 24, 1931.
Obstetric
Section
of the New
York
Academy
of Medi-