PROGNOSIS.-A state of patency of the cervical canal can usually be ob tained, but it is often difficult to main tain it in the virgin and the old woman without occasional dilatation. The sterility can usually be relieved in quite young people; but, after the condition has lasted long enough to produce hyperplasia or endometritis, the steril ity is apt to persist. In married women with stenosis and sterility, who do not apply for several years for treatment, the sterility is seldom relieved by dila tation, whereas it often is in the young married woman who applies within a year or two of the date of her marriage.
— In ordinary cases of partial stenosis presenting symptoms, and in young women with small cervix, dilatation with graded sounds twice weekly, the same as for urethral strict ure, will cure stenosis of the external os in a short time. Stenosis of the inter nal os may require the dilatation twice weekly for three or four months, then once weekly for a year. The cervix is not only dilated, but stimulated to in creased development. Before each dila tation the patient should take a vaginal douche, and the vaginal fornices and endometrium should be disinfected with a 5-per-cent. carbolic-acid solution through the speculum by the physician, and the uterine cavity should be disin fected by tincture of iodine, ichthyol, etc.
In old cases the cervix will probably require forcible dilatation by bladed di lators as well as a curettage for the endo metritis. The uterine cavity and cervix should be packed tightly for twenty-four hours after the operation, and the cervix be kept dilated by the passage of a large sound or bougie (size of a No. 1S urethral
sound, American scale) two or three times monthly for several months.
Incision of the cervical canal is almost never required, except for cicatricial con traction or rigid anteflexion. In the lat ter case incision of the posterior wall of the cervix in the median line to the inal junction (Marion Sims) and a doub ling in of the ends so as to obliterate the raw surfaces (E. C. Dudley) may render the cure of the stenosis of the internal os easier.
The following plastic operation on the cervix has been devised in order to pre vent recurrence of the stenosis after di vision of the external os cervicis. It consists of the preparation of flaps from the vaginal aspect of the cervix and im plantation of them in the angles of the wound made by the division. In this way union of the sides of the angle of the wound is prevented, and the re mainder of the cut surfaces are held apart until cicatrization has occurred. A. Rosner (Centralb. f. Gyn., Feb. 27, '97).
Laceration of the Cervix.—Lacerations of the cervix are ordinarily produced by abnormal conditions and influences that interfere with the natural course of labor, such as a proportionately-large head, a small or diseased cervix, malpresentation of the foetus, premature rupture of the membranes, precipitate labor, artificial dilatation of the cervix, etc.
The unilateral and bilateral lacerations are the most common varieties, although posterior, anterior, multiple (stellate), diagonal, and annular lacerations occur. They may even extend into the vaginal vault.