The rupture of the amniotic sac occasionally takes place either too early or too late ; that is, either before the complete distension of the mouth of the womb, or after the fetus has entered the vagina. In many cases the head does not present itself correctly in the pelvis until the sac has ruptured, so that a previous examination frequently gives no definite result. Too early rupture of the sac may cause an unfavourable change in labour. It may render the pains excessively severe and spasmodic ; or it may cause the umbilical cord to prolapse, thereby placing the infant in certain danger of suffocation ; or it may exert a harmful influence upon the position of the foetus. Early rupture is a frequent occurrence in faulty positions of the foetus and in marked narrowing of the pelvis. Retarded rupture of the sac may delay delivery, or it may detach the entire placenta prematurely, thereby greatly endangering the lives of mother and child. Other disturbances of labour may be due to changes in the decidua, such as may be caused by dropsy of the ovum, low position of the placenta, and twisting of the navel string around the neck of the foetus. All these accidents may be discovered by a careful examination during or before delivery, and grave dangers thus obviated.
The decidua sometimes causes disturbances during the third stage of labour. The inability of the womb to contract properly furnishes another
source of danger. The placenta may not be detached and expelled in due time, and dangerous hemorrhages are very liable to occur. Women suffer ing from chronic inflammation of the womb, and those having a flattened uterus, are especially liable to meet with this accident. In case of haemor rhage the parturient woman sinks back in a faint ; her pulse becomes extremely weak, and she suffers from great thirst and air-hunger. The womb is usually relaxed, and an endeavour must be made to cause it to contract by vigorously massaging and squeezing the uterus. The patient should be warmly covered, and should be placed with head and shoulders slightly lowered. Stimulating beverages (coffee, wine, etc.) should be administered. In some cases it is advisable to place a sand-bag, weighing from ten to twenty pounds, across the abdomen, in order to exert pressure upon the abdominal blood-vessels and on the bleeding uterus. The loss of blood may be tem porarily compensated for by repeated injections into the rectum of a pint of a hot solution of salt, of the strength of one teaspoonful of salt to one quart of water. The temperature of this enema should be between and 115° F.
PASTEURISATION.—See NURSLING, NOURISHING OF.