HERNI.E.
1. Hernia of the Bladder.—Cyelocek.—Prolapse of the bladder and re tention of urine is a frequent cause of dystocia, since it interferes with the regularity and intensity of the uterine contractions. It is. not by any means easy to pass the catheter, since the head is pressed against the neck of the bladder, and cannot be dislodged; we should not hesitate to use a metallic instrument, although we may sometimes succeed with an elastic catheter, especially if the woman is placed in the knee-elbow posi tion. In some instances, it is ,impossible to withdraw the urine in any way, and the distended bladder finally ruptures. Vaginal cystocele may apparently become a cause of serious obstruction, but this disappears on using the catheter. As soon as the bladder is emptied it may be held up by two fingers, while, if necessary, labor is terminated by forceps (Fig. 136).
2. Hernia of the Intestine.—Enterocele.— Epiplocele.— The intestine, or mesentery, may become engaged in the anterior or posterior cul-de-sac and constitute a true vaginal hernia; they may even descend as low as the perineum and form a perineal hernia. Finally, we designate under the name vagino-labial hernia a hernial tumor situated in the labium. These not only present a mechanical obstacle on account
of their size, but they may become inflamed by reason of the pressure to which they are exposed, and strangulation may result. They must first of all be reduced, and kept so during the entire course of the labor.
Vesical Calculi.—Vesical calculi have rarely been noted as complica tions of pregnancy and delivery; they may, however, become a very seri ous cause of dystocia. If discovered before labor, they should above the superior strait, and retained there until the head has descended below them; if they are not detected until the time of labor, and are firmly impacted between the head and the symphysis, it is necessary, if the head cannot possibly pass the obstacle, to extract them either through the•previously dilated urethra, or through an incision in the vesico-vagi nal septum, the wound being immediately closed. Ilugenberger (1875) reported 23 cases, in seven of which delivery occurred spontaneously; in eight interference was required. In seven instances the calculus was removed during labor. Winckel states that there are in all 29 recorded cases, in all of which the results were more or less serious.