Anomalies of Position.
Obliquity of position, Hysteroloria, Metro &rico, Obliquilas uteri.—The foregoing defects should not be confounded with those devia tions in position, without alteration of form, which constitute the various obliquities of the uterus ;—like the inflexions of the uterus they are distinguished according as the organ is directed forwards or backwards in the median line, or laterally in the transverse diarneter of the pelvis.
a. Anti- and retro-versions. Situs uteri obliquus anterior et posterior. — Anti-version of the uterus is by no nieans so common as retro version. Both affections differ from the cor responding anti- and retro-flexions of the organ in this respect, that while in the two latter cases the point of flexion is usually at the seat of junction of the body with the cervix uteri, in the former the uterus remains straight or nearly so, while the entire org,an is directed forwards or backwards, and the seat of flexion is at the junction of the cervix with the va gina. The displacement of the uterus is here far more considerable than in the former cases.
In anti-version the degree of uterine dis placement is limited by the bladder and an terior wall of the pelvis, which generally prevent the fundus from sinking so far for -wards, as to give the entire uterus in the unimpregnated state more than a horizontal direction. An extreme degree of anti-version however sometimes occurs at an advanced period of pregnancy in multiparm, on account of an unusual laxity of the abdominal walls permitting the whole uterus to fall forwards, so as to occupy- the artificial pouch formed by the pendulous abdomen, the fundus filling the bottom of the pouch, while the cervix and os uteri are tilted upwards and backwards, the latter being lifted out of the pelvis, and point ing above the promontory of the sacrum. This malposition materially impedes labour by reversing the natural direction of the uterine axis, so that the propelling force is expended upon those parts that lie opposite to the os, and the fcetal head is prevented from entering the pelvic brim.
Retro-version occurs in conditions of the uterus otherwise normal, or it may happen when the organ is enlarged by disease or preg nancy. When unimpregnated the displaced organ lies entirely, and when pregnant chiefly, within the pelvic cavity. In retro-version, on account of the excavation of the sacrum, the fundus readily descends so low as to admit of the normal relations of position of the os and fundus being nearly reversed. The latter being directed downwards and backwards towards the coccyx, while the former is tilted upwards and forwards, so as to lie behind, or in ex treme cases above, the syrnphysis pubis. In extreme retro-version a line drawn through the uterine cavity would represent nearly the normal axis of this organ, but instead of' pass ing out backwards through the posterior cer vical all , it will pass out forward through the anterior wall, because the stretching of the vagina in these cases will cause a slight degree of flexion of the cervix downwards. The sequelm of this displacement in the case of the gravid uterus, when artificial or spon taneous reposition cannot be effected, are usually premature expulsion of the ovum or sloughing of the uterine parietes and slow discharge of the contents by fistulous open ings into the vagina, rectum, or other parts.
b. Hernia of the uterus. Hysterocele, 11Ie trocele.— This displacement is rare. The uterus may escape from the pelvis by some of the natural openings which ordinarily ad mit of hernia, or by an aperture artificially formed, as, for example, between the muscular fibres of the abdominal walls. In uterine hernia, the displaced organ is often accom panied by other parts, almost always by its own appendages, and commonly by a portion of intestine, or omentum. Uterine hernia may be congenital or acquired. It may occur to the unimpregnated or the gravid organ, and in the latter case the development of the fcetus may proceed to the full extent while the organ occupies this unusual situation.