Obstetrics for Nurses

CHAPTER XXV

SOLUTIONS AND THERAPEUTIC INDEX 340

ILLUSTRATIONS

FIG. PAGE

1. The normal female pelvis 18

2. The planes of the brim, the cavity, and the outlet 19

3. Visceral relations 20

4. Uterus and appendages 22

5. Normal position of pelvic organs 24

6. The external genitals 25

7A. Varieties of hymen 27

7B. Varieties of hymen 28

8A. The excreting ducts of the mammary gland 29

8B. Lobules and duct of the mammary gland 29

9. Nipple, areola, and the glands of Montgomery 30

10. Supernumerary milk glands in the axillæ 31

11. The three ages of the breast 31

12. Development of the ovary 34

13. Graafian follicles 35

14. Human spermatozoa 36

15. The chorionic villi about the third week of pregnancy 38

16. Diagram illustrating relations of structures of the human uterus at the end of the seventh week of pregnancy 39

17. Maternal surface of the placenta and membranes 40

18. Fœtal surface of human placenta 41

19. The egg at term with uterus removed 42

20. Normal attitude of fœtus 43

21. Fœtal skulls showing sutures 44

22A. and B. Child’s head at term, showing diameters 45

23. The fœtal circulation 49

24. Gravid uterus at the end of the eighth week 52

25. Striæ gravidarum 54

26. Bimanual examination 60

27. Abdominal enlargement at different months of pregnancy 63

28. Height of the uterus at various months of pregnancy 64

29. Twins 83

30. Diagram representing the sites for the various forms of tubal pregnancy 90

31. Abdominal binder with crosspiece to hold vulvar pads 100

32. T-binder, used in all cases after the fifth day post partum 100

33. Breast binder 101

34. Baby’s dress with winged sleeves 102

35. The bag of waters begins to act on the cervix 111

36. The effect of the pains. The cervix before labor begins 112

37. The effect of the pains. The cervix begins to be “effaced” 112

38. The effect of the pains. The cervix is effaced, and the dilatation of the os begins 113

39. The effect of the pains. The cervix is effaced and the os continues to dilate 113

40. The cervix is effaced and the os dilated 115

41. Child in second stage of labor 116

42. The head passing over the perineum 117

43. Normal expulsion of the placenta according to Schultze 118

44. The child in left-occipito-anterior position 122

45. The child in right-occipito-anterior position 123

46. The descent of the head in right-occipito-anterior position 124

47. Internal anterior rotation and extension of the head in a left-occipito-anterior position 124

48. Extension 125

49. Extension completed. Expulsion 125

50. A cephalhæmatoma 127

51. Points of greatest intensity of fœtal heart tones 130

52. Handling forceps, kept sterile in a jar of alcohol 132

53. Palpation. What is in the pelvis? 134

54. Palpation. What is in the fundus? 135

55. Palpation. Where is the back? Where are the small parts? 136

56. Patient draped for internal examination 137

57. Delivery in side position 141

58. Sheet twisted into a sling 147

59. Repair of perineum 148

60. The progress of involution 152

61. The breech. Left-sacro-anterior position 166

62. The breech. Left-sacro-posterior position 167

63. Extraction of the breech 170

64. Breech delivery. Extraction of the trunk 171

65. Breech delivery. Delivering the shoulder 172

66. The delivery of the after-coming head by the Smellie-Veit maneuver 172

67. Shoulder presentation 173

68. Face presentation 175

69. Descent of the chin in face presentation 176

70. Delivery in face presentation 177

71. Exaggerated lithotomy position 181

72. Dorsal position when assistants are available 182

73. Instruments for artificial delivery of the head 183

74. Forceps operation. Introduction of the left blade 186

75. Forceps operation. The introduction of the right blade 187

76. Forceps operation. Locking the handles 187

77. Forceps operation. The way the blades should grasp the fœtal head 188

78. Forceps operation. Traction on the handles 189

79. Forceps operation. The delivery of the head 189

80. Version. Seizing a foot 190

81. Version. The child rotates as pressure is made upon the head and traction upon the foot 191

82. Version is complete when the knee appears at the vulva 192

83. The Walcher position 194

84. The Wiegand compression of the child’s head to force it into the pelvis 195

85. The Naegele perforator 196

86. Apparatus for getting a sterile specimen of urine from an infant 201

87. Tampon of the uterus 203

88. Tampon of vagina 204

89. Pean forceps 208

90. Hand bulb syringe; and Vorhees bags; bag rolled and grasped by Pean forceps ready for introduction 209

91. Vorhees bag in place 210

92. Episiotomy 212

93. Various forms of pelvic deformity 215

94. The pelvimeter 216

95. The various diameters of the inlet 216

96. Measuring the distance between the anterior superior spines of the pelvis 217

97. Measuring the external conjugate 218

98. Measuring the diagonal conjugate with the finger 219

99. Various forms of placenta prævia 229

100. The knee-elbow posture 236

101. The knee-chest posture 236

102. The exaggerated lithotomy position obtained with a sheet sling 237

103. The improvised Trendelenburg position 237

104. The dorsal position with stirrups 238

105. Dorsal position across the bed 239

106. Flexed dorsal position with feet on the table 240

107. The Sims position 241

108. Examples of imperfect nipples 245

109. A standard nipple shield 246

110. A standard breast pump 251

111. Germs most frequently found in cases of puerperal fever 256

112. Rubber bath tub 266

113. The Pettit cord clamp 268

114. Standard breast pump; Standard nursing bottle; the breast tray; the Wansbrough lead nipple shield; the Brophy nipple for harelip and cleft palate 271

115. Proper position of mother while nursing child 274

116. Proper method of taking rectal temperature 276

117. Method of passing the tracheal catheter 279

118. Byrd’s method of artificial respiration. Extension and inspiration 280

119. Byrd’s method of artificial respiration. Beginning flexion and expiration 280

120. Byrd’s method of artificial respiration. Flexion and compression 281

121. Method of giving gavage 284

122. Apparatus for gavage or lavage 286

123. Cleft palate nipple 288

124. The device for feeding the child with cleft palate 288

125. Device for assisting the cleft palate child to nurse 289

126. Method of strapping an umbilical hernia 290

127. Proper position for introduction of a suppository 299

128. Hydrocephalus 307

129. Anencephalus 308

130. Elements of human milk 312

OBSTETRICS FOR NURSES

CHAPTER I. Anatomy

ANATOMY

The study of obstetrics is an investigation of the passage, the passenger, and the driving powers of labor, as well as of the various complications and anomalies that may attend the process of reproduction.

The passage is composed of a bony canal, called the pelvis, and the soft tissues which line and almost close its outlet.

=The pelvis= is made up of four bones; the sacrum, the coccyx, and two other large structures of irregular shape, called the hip, or innominate bones. Joined by cartilage and held in place by ligaments, they form a cavity or basin which, in the male is deep, narrow, small and funnel-shaped, while in the female, slighter bones, expanded openings and wider arches make a broad, shallow channel, through which the child is born.

The bony pelvis is divided for description into two parts, the upper or false pelvis, and the lower or true pelvis. The upper pelvis is formed by the wings of the innominate bones and has but two functions of importance to child-bearing. It acts as a guide to direct the child into the true passage, and when measured by the pelvimeter, it gives information as to the shape and size of the inlet to the true pelvis. The true pelvis is of most concern to the obstetrician, because anomalies in its size or shape may impede the progress of labor or render it impossible. The pelvis is divided conveniently into three parts: the brim, the outlet, and the cavity.

The brim, inlet, or upper pelvic strait, is the boundary line between the false and true pelvis. It is traced from the upper border of the symphysis along the iliopectineal line on both sides to the promontory of the sacrum. The shape and size of this opening varies much in different races and individuals, both normally and through disease; and when pathologically altered, both shape and size may exercise a marked influence on the course of labor. In American women, the outline of the brim is roughly heart-shaped, like an ovoid with an indentation where the promontory of the sacrum impinges upon the opening.

The brim or inlet has four important diameters to be remembered; important because the hard, round head of the child must pass through them by accommodating its diameters as favorably as possible to those of this opening. These diameters are named respectively the anteroposterior or conjugate diameter, the transverse, and the right and left oblique diameters. The two oblique diameters attain their greatest importance when the pelvis is irregularly distorted, but the others are essential in every case where labor impends. It is to secure an estimate of these latter diameters that the bony prominences are measured. This upper opening lies not horizontally, but in oblique relation to the body in standing position, and the weight of the abdominal viscera rests largely upon the bones and in consequence does not crowd into the inlet unless forced in by corsets or faulty habits.

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