Prognosis.—This is favorable, for the prolapse is almost always sponta neously reduced in the first months, and pregnancy and labor generally take their normal course. The prognosis is even good for the con tinuance of pregnancy, when artificial reduction and the introduction of a pessary are necessary (nine cases). But the outlook is much more serious when incarceration occurs (two deaths). Among the seven cases of premature labor or of abortion, there was one death.
• For the child, the prog-nosis is bad in proportion to the rapidity of labor.
Among fifty-six women at term, six died, one in labor, and five during the puerperium.
Among the fifty-six children, nineteen were born alive, fourteen dead, and the fate of twenty-four was not noted.
Treatment.—This consists in favoring spontaneous reduction by ap propriate postures on the patient's part. If it does not occur, the Germans, more audacious than Cazeaux, advise artificial reduction as early as possible, and support by means of a pessary. Hiiter, going still further, recommends these measures even at eight months. .
If reduction fails, the uterus is to be sustained by a suspensory' bandage and removed from all causes of irritation.
If symptoms of incarceration are developed, artificial abortion is justifi able. When labor is protracted, artificial delivery is to bo carefully per formed by' the forceps or version. The uterus is subsequently reduced.
Uterine Deviations.
The uterine deviations are lateral, the obliquities of the older writers; anterior, or anteversions; posterior, or retroversions. That is to say, there are deviations en tnasse or partial deviations; anteflexions, retro flexions, latero-flexions. All are not of equal importance.
1. Uterine Obliquities; Lateral Deviations.
The older writers attached great importance to these, but in reality they are not well-marked and never cause serious complications. They only affect labor, and this by retarding cervical dilatation. We shall return to them in the chapter on Dystocia.
2. Partial Deviations; Flexions.
Conception is, according to Ho1st, not so rare as it is thought to be in cases of uterine flexion. He collected eight cases in point, and it must not be supposed, because conception occurs while the flexion is being treated, that the flexion is cured. If flexion often induces sterility, it is because the flexion is generally complicated by clu-onic inflammations of the mucous membrane and of the parenchyma; by cervical catarrh, by .
erosions, by granulations and by amenorrhcea. But these are not positive
obstacles. When the flexed uterus is healthy, the cause of sterility resides in the faulty position of the cervical orifice,which is directed either backward or forward. It is, therefore, no longer in contact with the end of the urethra at the moment of ejaculation, and, moreover, the bend in the uterus prevents the penetration of the spermatic fluid. Ho1st justly objects to this latter cause, as there should, otherwise, always be retention of the menstrual blood, which does not occur. That which renders con ception possible is the disappearance of complications, the ability of the cervix to retain its normal position and the preservation of the uterine cavity.
[The shape of the cervix is more likely to impede conception than the mere fact of flexion. The conical shape, usually accompanied by pin hole os, is a frequent a,ccompaniment of sterility. To refer only to the data of the late James Marion Sims, he found this conical shape in nearly 85 per cent. of the cases of sterility which he investigated.--Ed.] ' When conception has taken place, pregnancy has little chance of reach ing an end, as abortion very frequently occurs.
Hfiter reverts to the frequency of abortions in uterine flexions, and -considers the larger part of those abortions, which take place in the early months of pregnancy, and the cause of which escapes observation, to be occasioned by these flexions. He thus explains the occasionally frequent recurrence of abortion, without known cause, in the case of certain women. He cites three cases in point, the first one being extremely in teresting: All these abortions occurred without appreciable cause. Anteflexion was found to exist when pregnancy did not. In a fifth pregnancy there was anteflexion and anteversion. The uterus was replaced at times cor responding to the second and third menstruation. The pregnancy was not interrupted. Labor occurred at term and the post-partutn period was normal. [We believe it very doubtfal if abortion was ever produced by simple flexion. There are so many, often latent, causes of miscarriage, that we are scarcely warranted in laying this to flexion. We do not refer here, of course, to cases where version accompanies flexion.—Ed.] He concludes from his observations, that this supposed predisposition to abortion does not, in reality, exist, and that abortion is always occa sioned by a cause which may momentarily escape observation because it is not always easy to discover at once.