OBSTETRICS.
On Painful Distension of the Vagina after the Birth of a Child. By
Dr. Leopold.—Dr. Leopold states that he has several times met with
examples (never in primiparae) of excessive suffering, coming on from
half an hour to an hour after the passage of the child, and referred to the
vagina. It is of the most agonizing character, described by the women
as worse than when the child is passing, and causing them to twist and
toss about in agony. It arises from distension of the vagina, either by
accumulated coagula, or a very large placenta. In the first case, owing
to the quantity of blood lost, there are always the early symptoms of
uterine haemorrhage; and the women, usually having suffered already
from haemorrhage in former labors, are dreadfully frightened at their
danger. The softish but not distended uterus is felt pushed up into the
umbilical region. The hand should be at once introduced into the va-
gina, and after the coagula are completely removed, it should be retained
there for at least half an hour, keeping two fingers on the watch within
the relaxed os uteri, and irritating this if required.
In the other case there is always a large placenta, which will not yield
to moderate traction, partly because its size prevents it from easily tra-
versing the vaginal passage, partly from a spasmodic action of the con-
strictor cunni, and partly because the membranes still remain in connec-
tion with the uterus to some extent. Notwithstanding the pain it will
cause, the entire hand must be passed into the vagina, so as to embrace
the whole placenta and bring it down.—Neue Zeitschrift filr Geburts-
kinde, from Brit, and For. fled.-Chi. Rev.