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CASE OF PARTURITION, CONTRACTED PELVIS, CRANIOTOMY, SEPTICEMIA, PERINEORRHAPHY. RECOVERY.
C.C.T., Chinese female, age 19 years, primipara, was admitted to the Ma- ternity Hospital on September 24th, 1902, at 9 p.m. with a history of having been in labour for twenty hours. During this time she was attended by Chinese midwives who failed to deliver her.
On admission temperature was 102° F., labour pains strong and frequent, and on examination per vaginam the membranes were found ruptured. The head was just engaged in the pelvic brim which was contracted laterally, presentation occipito- anterior, and a commencing caput succedaneum was felt. Both rectum and bladder were empty. As operative interference was not urgent it was decided to watch the patient for a little and see if any progress was made, especially as the pains were good, and the uterus normal for the sceond stage of labour as ascertained by palpation.
In less than an hour patient was again examined per vaginam. Labias and perineum were found to be oedematous, the caput succedaneum had increaed in size, and no progress was made. Nenilles axis-traction forceps was applied with dif- ficulty as the blades refused to lock, until after considerable manipulation. Traction light, and strong produced no impression on the head even after an hour's steady work, and the forceps showed a tendency to slip. A pair of Barne's forceps, also Assilini's were tried, but both slipped, the former suddenly, resulting in a complete rupture of the perineum. With the advice of Dr. ROBERT GIBSON, who kindly saw the case with me, and who tried all the forceps in the Hospital, it was decided to perform as craniatomy especially as the labour pains were very frequent and forcible. Bandl's ring could be distinctly felt a hand's breadth above the pubes, with thinning of the lower uterine segment, and a rupture of the uterus was only a matter of time. Accordingly chloroform was administered, Simpson's perforator and cranioclast used and a male child 8 lbs. weight was delivered in twenty minutes. The placenta came away in ten minutes. Ergot was administered, there was no post partum haemorrhage.
Both uterus and vagina were thoroughly douched out with a warm Lysol douche. The perineum showed a complete rupture into the rectum which was torn to the extent of one inch. It was not thought advisable then to repair the rupture, so the parts were thoroughly cleansed and patient, who was quite worn out, was put to bed.
Temperature next morning was 101° reaching 103. 2° in the evening. The vagina was douched out twice during the day with a weak solution of permanganate of potash. A mixture containing Ext. Ergot. Liq. m. xx with Tinct. Opii. m. v was ordered every four hours. For the next two days the temperature remained steady between 1023 and 103° F. Blood examined showed no malaria, patient had all the symptoms of fever, furred tongue, pulse 90, hot dry skin, headache, etc., also the uterus was very tender, lochia offensive, and as a Sapræmic infection was thought to be present the uterus was douched out twice daily with 1 in 2000 solution of corrosive sublimate.
On the 29th inst. as the lochia was still offensive and bad coloured, and the Temp. 103-4°, chloroform was given, and the uterus thoroughly curetted with a blunt curette, then douched out for five minutes with a Lysol douche. A liberal Slop diet was given, e.g., milk, beef-tea, brandy, chicken broth, eggs and milk, etc., and Pil. Quininae gr. v given every four hours. Bowels were opened with castor oil. For the next five days temperature varied between 100-8 to 103°, pulse 88 to 96, uterine tenderness and headache continued, though getting gradually less and the bowels were kept open with House Mixture given every second night. The corrosive sublimate douche was continued twice a day.
On October 5th (tenth day after parturition) the temperature fell to normal and remained so during the progress of the case. The lochia was now sweet and of the "Serosai" type, uterine tenderness gone, and uterus retracting normally.
Convalescence was uneventful and patient was transferred in a fortnight to the Asiatic Female Ward in the Government Civil Hospital, with the idea of repairing the perineum when all uterine discharge had ceased,