Rupture of the uterus through the Cesarean cicatrix / by George L. Brodhead.

  • Brodhead, George L., 1869-1952.
Date:
1908
Catalogue details

Licence: In copyright

Credit: Rupture of the uterus through the Cesarean cicatrix / by George L. Brodhead. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    proximation of the edges of the wound is secured, and interrupted sutures of chromic catgut are used, the result will be perfect, as far as complete union of the parts is concerned. Diagnosis of Rupture.—In many cases, especially in the com- plete variety, there are the typical symptoms of sudden cessa- tion of pain following a severe uterine contraction, with evi- dences of shock, increase in the pulse rate, vomiting and cold sweat. The fetal parts can be palpated with greater ease, the fetus is more movable, and the contracted uterus may be felt. By vagina, the presenting part has slipped away from the brim, and there may be external hemorrhage. In several of the reported cases, however, the rupture was not suspected until the operation for section was performed, and in one case a diagnosis of appendicitis had been made. Evidently, the con- dition was not discovered in some cases, for operation was not performed until hours had elapsed since the rupture had taken place. In our opinion, labor after Cesarean section should be anticipated, but if one is called in to see a patient who is having severe uterine or abdominal pain, at or near term, the abdomen should be opened at once. Repeated Cesarean Section.—Wallace,3 in his exhaustive mono- graph on repeated section, collected 96 cases, 43 of which had had two operations, 15 had had three, one had four, and one, the celebrated Frau Rittgen case, had five, the last resulting fatally from general peritonitis. Kriwski,7 in 1905, reported 88 cases, 72 of which had two sections, 13 had three, and three patients had four. Many other instances have since that time been reported, among them that of Sinclair,2 in which four sections have been successfully performed on the same patient. The mortality of repeated section is stated by Wallace3 to be 6.45 per cent. (4 in 62), or including death from repeated fundal incision, 7.93 per cent. This certainly compares favorably with the mortality of primary Cesarean section, which in the hands, of all operators, is between 5 and 10 per cent. In the hands of experts, the mortality of both classes of cases is probably less than 5 per cent. Mortality of Rupture through the Scar.—Krukenberg,1 referring to the old operation, cpioted a mortality of 50 per cent. Very different has been the death rate in the cases reported and re- ferred to in the literature of the last five years. Of the 20 re- ported cases, 16 recovered, three died, and the result in one case (No. 4)” is unknown. Note must be made of the fact that in