Authors do not ag-ree about the condition of the bladder. While God efroy and Hater have always found the bladder empty, Kyll, llachmann, Boivin and Dug& admit that urine may accumulate in that part of the bladder which is above the point compressed by the uterus.
Course and cases pass unobserved, and the grave symptoms disappear when the uterus rises out of the pelvis, between three and a half and four months. If it remains incarcerated in the true pelvis serious symptoms may appear, and first pregnancy and later the life of the mother may be endangered. But this is not absolute, for the incar ceration is never complete as in retroversion.
When anteversion occurs suddenly, pregnancy is less secure, but all de pends, in this case, on the time which elapses before the reduction of the uterus. Generally, all the grave symptoms disappear when the uterus is once replaced, and pregnancy pursues its regular course.
Treatment. —This consists, first and foremost, in reduction of the dis placed organ. Complications must then be met by appropriate means, but especial care must be exercised in providing for evacuation of the bladder and of the rectum.
[A so-called supra-pubic pad abdominal supporter, will ordinarily cor rect the anteversion after the uterus has risen above the brim. Before this period, the symptoms are rather due to downward sagging of the uterus, and traction, in consequence, on the neck of the bladder. In this case, the open cup-pessary of Thomas may be tried, often with relief to the main symptom—vesical tenesmus.—Ed.] 4. Retroversion.
Uterine retroversion consists in the complete displacement of the organ in the pelvic cavity, so that the fundus is contained in the hollow of the sacrum while the cervix is carried forward beneath the symphysis pubis (Salmon) (Fig. 15).
We thus at once eliminate what the Germans call a partial retroversion, and what Depattl styles a sacriform dilatation. This we will study in the following chapter.
Frequency. —"Although one cannot say that retroversion is a very rare accident, the cases are still so few that it is difficult to collect more than forty or fifty examples from all medical literature. For my part, during
a practice of thirty years, which has alTorded me the opportunity of ob serving nearly everything unusual in obstetrics, I have only seen eight or ten cases of retroversion during pregnancy. P. Dubois had hardly seen more, and his father had never seen a case in his long practice." These are the words of Depaul.
Since Baudelocque, two kinds of uterine retroversion are described and based upon their respective causes.
The first form is slow and progressive, the second form sudden and accidental.
Causee.-1. Gradual Ref rorersiwr. All authors admit that the uterus is lowered in the first months, and that it is originally developed at the expense of its fundus and of its posterior wall.
But, while Denman, Merriman. Desormeaux, Paul Dubois, Danyau and Jacquemier consider the retention of urine to be the occasional cause of retroversion, William limiter, Burns, Moreau and Cazeaux think that the retention of urine is the etTect and not the cause of retroversion,which is, itself, produced by another mechanism. Depaul, in 1853, resolutely took his stand with the former class of authors. He held that retention is an occasional cause of retroversion (Fig. 16), and lie is the more justi fied in holding this opinion as he has seen the bladder distended by an enormous quantity of urine in cases of retroversion not occurring during pregnancy. Jacquemier had already stated, to explain these facts, that, when the distension of the bladder by the urine is long continued, the organ can contain a large quantity of the liquid without being over-dis tended. Then, its walls being partially dilated, and particularly behind, it forms a large sac which displaces the fundus uteri towards the hollow of the sacrum, while the cervix is retained in its ordinary position. De paul adds that, in this case, the bladder, in subsequently rising into the abdominal cavity, draws the cervix upward and this increases the dis placement alre,ady begun. This is the explanation of Boivin and Duges, of Desormeaux and of Dubois, and we adopt it in its entirety.