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Spontaneous rupture of uterus at the moment of opening the abdomen for Cesarean section
REVIEWS
AND
409
ABSTRACTS
Mason reported 19 previously unrecorded eases of vaginal delivery following abdominal sections. None of these scars rupt.ured. On the other hand it must be admitted that many reports of ruptured Cesarean Findley collected and tabulated 63 scars have appeared in literature. such cases up to 1916, and since that time many additional observations have been recorded. Adding a few more cases of normal vaginal delivery subsequent to a Cesarean to two cases described in detail in a previous paper, Williams reiterates his opinion that the mere presence of a scar in the uterus is not sufficient reason for a repeated Cesarean. If the scar has healed without sepsis, the patient may be delivered later by normal labor in safety. Such patients should, however, be managed in a well equipped hospital where in case of necessit.y an abdominal section can be performed without delay. Great care must be taken in proper approximation during the closure of the uterine wound to obtain a scar equal in strength to any part of the uterine wall.
Nacke: Spontaneow Rupture of Uterw at the Moment of Opening the Abdom,en for Cesarean Section. Zentralblatt fiir Gynakologie, 1919, xliii, 334. The title states the author’s unusual experience. Remarkable is the fact that Nacke had the rare opportunity of observing this same phenomenon in two patients. In both instances the laparotomy was performed for a second Cesarean. In both the rupture occurred in the old scar at the moment when the uterus was delivered through the abdominal incision. In his belief, the attachment of the placenta at the site of the scar caused its weakening. The rupture occurred when the protecting counterpressure of the abdominal wall against the weakened area was removed by lifting the uterus through the abdominal opening.
Seitz:
Removal
of Exostosis
of Symphysis
during
Cesarean Section.
Monatsschrift fiir Geburtshiilfe und Gynaekologie, 1919, 1, 15. Xeitz performed this operation in two patients. In the first case two Cesareans had been made previously. During the third section he removed a high spur from the posterior surface of the symphysis and succeeded, as ascertained by direct measuring, in lengthening the true conjugate from 8 to 91/2 cm. An examination made 3 months later proved that the obtained increase of 11,~ em. had remained unchanged. In the second case he found and chiseled away a broad ridge, thus enlarging the true conjugate by 1 cm. Exostoses of this sort can often be palpated, especially in rachitic patients. Their removal during a Cesarean section is easily accomplished and apparently results in a permanent enlargement of t.he true conjugate. There are as yet no records available of labors subsequent to this operation.
Linzenmeier
: Cesarean Section on the Dying or Dead Patient.
Med-
izinische Klinik, 1920, xvi, 439. The writer pleads in favor of the Cesarean attempt on the dying patient. In his personal experience with 4 sections after death he obtained 3 living children. The difficulties in the private house are undoubtedly considerably greater than in hospital practice to obtain permission of the family for the performance of this operation, however,
AND
409
ABSTRACTS
Mason reported 19 previously unrecorded eases of vaginal delivery following abdominal sections. None of these scars rupt.ured. On the other hand it must be admitted that many reports of ruptured Cesarean Findley collected and tabulated 63 scars have appeared in literature. such cases up to 1916, and since that time many additional observations have been recorded. Adding a few more cases of normal vaginal delivery subsequent to a Cesarean to two cases described in detail in a previous paper, Williams reiterates his opinion that the mere presence of a scar in the uterus is not sufficient reason for a repeated Cesarean. If the scar has healed without sepsis, the patient may be delivered later by normal labor in safety. Such patients should, however, be managed in a well equipped hospital where in case of necessit.y an abdominal section can be performed without delay. Great care must be taken in proper approximation during the closure of the uterine wound to obtain a scar equal in strength to any part of the uterine wall.
Nacke: Spontaneow Rupture of Uterw at the Moment of Opening the Abdom,en for Cesarean Section. Zentralblatt fiir Gynakologie, 1919, xliii, 334. The title states the author’s unusual experience. Remarkable is the fact that Nacke had the rare opportunity of observing this same phenomenon in two patients. In both instances the laparotomy was performed for a second Cesarean. In both the rupture occurred in the old scar at the moment when the uterus was delivered through the abdominal incision. In his belief, the attachment of the placenta at the site of the scar caused its weakening. The rupture occurred when the protecting counterpressure of the abdominal wall against the weakened area was removed by lifting the uterus through the abdominal opening.
Seitz:
Removal
of Exostosis
of Symphysis
during
Cesarean Section.
Monatsschrift fiir Geburtshiilfe und Gynaekologie, 1919, 1, 15. Xeitz performed this operation in two patients. In the first case two Cesareans had been made previously. During the third section he removed a high spur from the posterior surface of the symphysis and succeeded, as ascertained by direct measuring, in lengthening the true conjugate from 8 to 91/2 cm. An examination made 3 months later proved that the obtained increase of 11,~ em. had remained unchanged. In the second case he found and chiseled away a broad ridge, thus enlarging the true conjugate by 1 cm. Exostoses of this sort can often be palpated, especially in rachitic patients. Their removal during a Cesarean section is easily accomplished and apparently results in a permanent enlargement of t.he true conjugate. There are as yet no records available of labors subsequent to this operation.
Linzenmeier
: Cesarean Section on the Dying or Dead Patient.
Med-
izinische Klinik, 1920, xvi, 439. The writer pleads in favor of the Cesarean attempt on the dying patient. In his personal experience with 4 sections after death he obtained 3 living children. The difficulties in the private house are undoubtedly considerably greater than in hospital practice to obtain permission of the family for the performance of this operation, however,