ABNORMAL UTERINE CONTRACTIONS.
The uterine contractions may be exaggerated, diminished, or irregular: and although the exaggeration of the pains does not, as a rule, produce any other result than too rapid termination of labor, it may on account of this very fact become a source of different accidents to the mother and child, which justify us in studying it under the head of dystocia.
Excessive Contractions.
There may be actual exaggeration of the contractions, their intensity, duration, frequency, or the accompanying pain, being singly or collec tively increased. It may be relative, that is to say, the contractions are of normal character, bid really become too strong in consequence of the diminution of the normal resistance (large pelvis, or small foetus), or the relaxation of the soft parts forming the canal, or because the sensi bility is lessened. It is only necessary to compare labor in a primipara with that in a multipara, in order to understand that the resistance offered by the perineum plays an important part in the expulsion of the Pettis, since in cases where the perineum offers only a slight resistance, normal uterine contractions will, by reason of the absence of the usual barrier, become too violent, and under certain conditions cause precipitate labor with its consequences. Excessive contractions are especially ob served near the time of complete dilatation, and they go on increasing until the end of the labor, leaving the woman no interval of rest. They are then frequent; violent, and prolonged, while there is an absence of the intermission between the pains that characterizes normal labor; the uterus appears to be in a state of tenesmus. The pains may be normal, but the os, vagina, perineum, and vulva may stretch so easily, or the child may be so small, that it is rapidly expelled. Excessive contractions are observed in delicate, as well as in robust women; they sometimes appear to be an hereditary peculiarity. They are due, in general, either to exaggeration of the contractility of the uterus, or to excessive hyper trophy of its muscular fibres.
In consequence of the too rapid expulsion of the foetus, rupture of the perineum, vagina, or even of the uterus, (cervix,) may occur, while the latter organ is affected by a subsequent inertia, that leads to retention of the placenta, hemorrhage, and inversion. The fatal circulation may be
fatally obstructed by excessive uterine contractions, or the child may be expelled upon the ground, and thus be injured; the cord may rupture, and the placenta be detached. Although the prognosis is not positively bad, it is far from being insignificant.
consists, in the first place, in confining the woman to her bed at the outset of labor, and insisting on absolute repose and no straining. If her condition permits, chloroform or chloral may be ad ministered. Some writers advise rupture of the membranes, of which we disapprove. Opium is useful, especially when administered subcutane ously. If the lower uterine segment tends to become prolapsed, it should be held up with the fingers. If the entire organ is prolapsed, it must be supported by a bandage, and replaced immediately after delivery. At the time of delivery we should be very watchful in order to foresee, and to recognize when they appear. uterine inertia and hemorrhage, so as to treat them instantly. Finally, after a precipitate labor the woman should be kept in bed for a long time, and should not be allowed to rise until involution is well advanced; this process seems to take place more slowly in such cases. Puerperal troubles are also common.
Feeble Contractions.
Feeble contractions are more commonly met with than excessive, but, as Schroeder has justly observed, it is difficult to establish a rule as to what constitutes feeble pains. Very slight pains may, in a given case, be sufficiently powerful to allow labor to terminate, while very strong contrac tions may be too feeble to cause the expulsion of the fcetus. On the other hand, normal pains are characterized by their increase in strength and duration as labor advances. Now this peculiarity may be absent, the pains are too feeble, short and infrequent, or are sometimes almost entirely absent. This constitutes feebleness of the uterine contractions.