DYSTOCIA DUE TO OBSTRUCTION AT THE CERVIX.
The obstacles may be due to rigidity of the cervix, adhesion or oblit eration of the same, or to lesions of various kinds, tumors, abscesses, etc., which prevent dilatation.
Rigidity of the Cervix.—Under this expression NV.3 refer to a peculiar condition characterized by passive or active resistance to dilatation on the part of the cervix, which thus retards delivery. There are three varieties of rigidity, termed by writers anatomical, spasmodic, and pathological rigidity.
A.—Anatomical Rigidity or the Mechanical Rigidity of Pajol.—This is often confused with that thickening of the cervix which is frequently noted in protracted labors; but in true anatomical rigidity the cervix has a peculiar feel, resembling oiled leather. Its border is firm, thick and resistant, but not painful; the cervix, although already dilated to a cer tain degree, preserves, as in cases of abortion, a sort of relative length, so that it forms a more or less prominent projection in the vaginal roof, in the centre of which is an orifice of variable size. The cervix itself is not sensitive to pressure, nor is the vagina in any manner, or more sensitive than usual. The uterine contractions occur regularly and strongly, but are without effect; during the contraction the cervix does not become al tered as the head presses upon it, and the stage of dilatation may be pro longed for several days. It is only after labor has continued thus for a certain length of time that we observe heat and sensitiveness of the va gina, and often a little tenderness in the cervix. This condition is most common in primiparte, and especially in premature labors. It is not se rious, as a rule, as regards the foetus, but the woman may be deprived of rest and sleep, and is thus rendered especially susceptible to postpartum troubles.
Baths, warm vaginal injections, and venesection are the best remedies in these cases. Opium and chloral enemata often act very beneficially.
B.—Spasmodic Rigidity. —Here the phenomena are quite different; there is no longer passive, but active, contraction, which may occur dur ing the second as well as during the first stage, or even at the moment of delivery. It may occur in either multipara3 or primiparEe (especially
the latter), of any variety of temperament, and is often due to frequent examinations, violent attempts at dilatation, and, above all, to ergot, and premature rupture of the membranes.
When spasmodic retraction occurs during the first stage, the labor ap pears to be progressing normally, when suddenly the cervix retracts, there being an actual spasm of the circular fibres surrounding the orifice. The pains are sometimes very severe, sometimes almost entirely absent, or separated by irregular intervals, and the uterus, instead of becoming re laxed in the interval between the contractions, remains contracted and tender on pressure; this is especially the case when the membranes have ruptured, the cervix grasping the foetal parts immovably.
To the touch the cervix appears thin, especially at the os, the edge of which is firm and unyielding, like a wire; the part is extremely sensitive to the slightest touch and feels hot. The vagina is also hot and sensitive.
Vesical and rectal tenesmus, nausea, vomiting, great agitation and more or less marked febrile reaction are frequently observed.
Sometimes the spasm of the cervix occurs during the stage of expul sion, as soon as the head is born, and may be situated at the internal, as well as at the external, os. This occurs above all in cases of version and extraction, and it is easy to understand how serious it may be for the child; the cervix, in fact, grasps the neck of the foetus, which is thus held like a stud in its button-hole, and if this continues long the child suc cumbs. Finally, the spasm may occur during the third stage, as we shall see later.
contraction of the cervix is transient; if it oc curs during the first stage, the rule is to wait until it ceases spontaneously. But if it is prolonged for several hours, the obstetrician should interfere.