INDICATIONS FOR THE ADMINISTRATION OF ERGOT.
Since ergot increases uterine contractility, Bailly has said, " Whenever, whether during labor or the puerperal state, it becomes necessary to in crease the contractions of the uterus—that is , to say, in uterine, inertia during labor, or after delivery—the use of ergot is strictly called for." We are in absolute opposition to this opinion of our colleague. While we may grant the use of ergot after delivery, we proscribe it before labor, during labor and before the termination of the third stage. We adopt in its entirety Pajot's law. As long as the uterus contains anything, be it child, placenta, membranes, clots, never administer ergot. We reserve it, therefore, purely for uterine inertia after the termination of the third stage of labor. First empty the uterus of its contents and then give ergot.
The authorities who advocate the employment of ergot during labor formulate the following rules, and allow it under the following conditions: 1. The cervix should be completely dilated. 2. The membranes be rup tured. 3. The parturient canal be regular in size, or at least large enough to permit the passage of the child. 4. The presentation of the fwtus be such as to allow of the spontaneous termination of labor. 5. Moderate contraction only of the pelvis exists (Bailly alone believes this), and pos sibly the presentation of the pelvic extremity. (Depaul and Gronser give ergot in case of pelvic presentations, when the breech is about to emerge.) 6. Finally, in case of puerperal hemorrhage, placenta pra3via, retention of clots.
Tarnier, in his report to the Academy in 187'2, only grants the use of ergot when the cervix is dilated or easily dilatable, the presentation favor able, the pelvis not deformed. Ile neither advises nor rejects it in pelvic presentations, and decries it more especially in case of hemorrhage during the third stage. Blot says that " the disadvantages are greater than the advantages of using ergot during labor. Afterwards, in case of uterine inertia it is of great value, but it is not the only hemostatic. If we were to compare the cases where ergot has done harm, and those where it has done good, I believe that the first would be far more numerous." Our reasons, in agreement with Pajot, for rejecting ergot before the termination of labor, are: 1. Ergot is dangerous for the fwtus. The contraction of the uterus de termined by ergot i3 spasmodic, tetanic, maintaining the organ in a state of constant tension, which modifies profoundly the utero-placental circu lation. The modification must endanger the fcetus, the more so the more
intense and prolonged the action of the drug.
2. Ergot, by inducing uterine retraction, by applying hermetically, as it were, the uterine walls against the fcetus, renders difficult, sometimes impossible, the extraction of the fcetus where it might become necessary, and consequently will thus indirectly compromise the foetal existence.
3. The action of ergot being exercised on every part of the uterus, on the body as well as on the cervix, may result in retraction of the cervix, and thus militate directly against the end aimed at.
4. During labor the administration of ergot may induce retraction of the cervix on the fetus, and thus directly interfere with spontaneous ex pulsion or extraction.
5. For the mother, the tetanic retraction of the uterus, which too often follows the injudicious administration of ergot, means grave dangers by complicating the operations which may be called for to terminate labor. It renders version impossible, except at the risk of rupture of the uterus.
6. Ergot administered before delivery of the placenta may lead to re tention of this body, by causing retraction of the cervix. The same is true of clots in the uterus.
7. Finally, ergot administered in case of placenta prievia is far inferior to the tampon, which is the heroic measure. • In Germany, Schroeder "rejects the use of ergot before delivery. It only," he says, "causes spasmodic contractions of the uterus and not normal pains. Further, Schatz, with his Toco-dynamometer, has determined that ergot induces an enormous and continuous elevation of the intrauterine pressure during the intervals of the contractions, and that while the pains become more frequent, they are less efficient, until at length they cease altogether. Now, it is precisely this alternate relaxation and contraction which is the essential cause of the expulsion of the foetus, and if ergot defeats this alteration, it can scarcely be called a promoter of labor. Further still, the infant is compromised, for the uterus being in a state of permanent contraction, the interchange of gases cannot take place at the placenta, and the fetus asphyxiates." In a word, then, never give ergot until both child and placenta have been delivered.