SPASM OR RIGIDITY OR OTHER ABNOR MALITIES OF THE CERVIX.—These are potent and frequent causes of dystocia, their tendency being to very materially prolong the first stage of labor. The spasm of the cervix may be due to reflex conditions, such as malpositions of the foetus, but a most frequent cause is a gen eral neurotic state of the patient. The pains existing are very severe and lasting, while no material progress takes place in the cervical dilatation.
The diagnosis is positive if, on exami nation, the edges of the os are found very rigid, but thin, having a razor-like edge, very hot, extremely painful, and tightly hugging the head.
Rigidity of the cervix is, as a rule, the result of previous cervical lacerations or of a prior existing chronic cervical en dometritis, both_ conditions producing more or less marked cicatrizations of the cervix. In old cases the cervix is sometimes as hard as iron.
Atresia of the cervix in labor is in all eases due to inflammation of the cervix, which, in the early stages of pregnancy, leads to adhesion of the granulating sur faces of the cervical canal. When labor
begins, the upper part of the cervix yields and thins out, while the lower portion remains undilated. and the os is not to be discovered by digital exarnina tion. As labor advances the cervix de scends, and finally appears at the vulva or even protrudes beyond the orifice in the form of a dark-red, thick-walled, fluctuating tumor, which becomes tense with every pain. The os is concealed by the perineum, and is to be sought for on the posterior aspect of the presenting mass. It may be median or to one or the other side of the middle line. When detected, its position is indicated by a small circle of brighter hue than the rest of the surface. The treatment consists in scratching with the finger-nail and then dilating with the finger. Rupture of the membranes should in all cases be delayed as long as possible. Campbell (Brit. Med. Jour., Oct. 23, '97).