Symptoms.—a. Absolute Shortness. —During pregnancy considerable pain is felt at the fundus uteri, and the foetal movements, though very limited, cause great distress. During labor, dilatation is very slow, in spite of frequent and severe pains. At the intervals of the pains the uterine walls retain a certain hardness. The umbilical souffle may be heard; and finally, in some cases, there is a sense of resistance, followed by tearing with a snap, indicating rupture of the cord. These signs, however are rather hypothetical.
b. Accidental Shortness.—Though still uncertain, the symptoms are more important. During pregnancy, according to Devilliers, pains occur ring weeks or days before delivery, and felt in the region of the kidneys; premature rupture of the membranes, though we think this the excep tion rather than the rule; diminished extent of motion, or very disordered or brusque movements of the fcetus; elevation of the fundus uteri even _ at an advanced period of uterine dilatation; and lastly, the festal souffle.
During labor.—The symptoms are: a tedious labor, due to feebleness and slackness of the pains, the membranes being ruptured and dilatation of the os complete, and there being no apparent obstacle to delivery on the side of either the mother or the fcetus. Sometimes the pains continue regularly, but the advance of the foetal part is slow and difficult; the pains are, as it were, cut in half, and are not as expulsive as they should be. There is a painful point at the umbilicus, corresponding to the fun dus.uteri. The uterus remains hard during the intervals of contraction, and there is a species of erythism similar to that produced by ergot.
The movements of descent and retreat of the head are not really apparent at the lower part of the pelvic canal; they are rather due to the resistance of the perineum and of the soft parts. The umbilical souffle; irregular foetal heart sounds; a premature flow of meconium; hemorrhage before or just at the moment of festal expulsion; and lastly, tension of the cord. only appreciable exceptionally and very late; these are the principal signs.
They are not characteristic, for they may all occur with other conditions; and they may all be wanting.
Demeaux, Zeller, Osiander and Joerg believe that shortness of the cord may cause abnormal foetal presentations. It has certainly sometimes caused displacement of the placenta, partial or total rupture of the cord, and inversion of the uterus. Though of small importance to the mother, the prognosis is more serious for the child; and since interference is often required, shortness of the cord is a real cause of dystocia, and will be con sidered in the chapter upon that subject.
At first wait, then rupture the membranes, and terminate the labor as quickly as possible; such is in brief the treatment.
VIII. Knots of the Cord.—Knots of the cord may be simple (Fig. 144) Viii. Knots of the Cord.—Knots of the cord may be simple (Fig. 144) or complicated, single or multiple. (Figs. 145 to 152.) Chantreuil divides knots into old knots, formed during pregnancy, the tissues of which are compressed and atrophied, and recent knots, formed during labor.
Among the causes of these knots may be mentioned, length of the cord, abundance of liquor amnii, and exaggerated movements of the mother and the foetus. These knots, while sometimes harmless, occasionally compro mise the life of the child. Lee has cited a case in which circulation became absolutely impossible; more recently Ganiot, in a case of twin preg nancy, lost both children from the existence of a hard square knot that united both cords. Blot, Tarnier, Depaul have denied, in the academio discussion of this subject in 1881, the possibility of this occurring. Tarnier claimed that at least three knots were necessary to interrupt the circula tion; Blot and Depaul would not even admit this, the latter having seen an infant born living, the cord of which showed five contiguous knots. We ourselves have always seen 'the cases where there were knots on the cord born alive, and we regard the case of Lee as altogether exceptional.