Dead Foetus in Womb - Removal

DEAD FOETUS IN WOMB

This condition, while some- times extremely uncertain of diagnosis, is most important, for, as soon as foetal life is extinct, the mass, with membranes and placenta, becomes a foreign body, and one which is most apt to undergo putrefactive changes; its expulsion, then, becomes a matter of immediate necessity, and often is recognized too late.

If no air reach the dead foetus, 
mummification, calcification, or fatty degeneration ma}- follow; but once 
fetal death is proven (for the symptoms of which the reader is referred 
to the text-books on obstetics) , the uterus should be emptied at once 
and its cavity washed out antiseptically. 

Any of the recognized methods of exciting uterine action will 
bring about the desired object ; but the use of the flexible, bipolar, 
intra-uterine electrode of Apostoli is a safe and sure means, when connected with the faradic current, and is especially easy of administration, 
since no care to preserve the life of the foetus is necessary.

Dropsy of the Uterus

By dropsy of the uterus we understand an accumulation of 
serous or mucous fluid within its cavity. It is generally the 
immediate consequence of stricture or atresia of the orifices, 
and occurs in its true form only after the cessation of menstru- 
ation. 

If tlie efflux of uterine mucus secreted in considerable quan- 
tity, be impeded by the above-mentioned causes, it accumulates 
in the cavity of the body of the uterus when the impediment is 
situated at the internal orifice, and in the cavity of the cervix, 
when it exists at the external orifice. In rare cases also of 
stricture of both orifices, accumulation of fluid takes place in 
the cavity of the body as well as in that of the cervix. 

In stricture of the internal orifice the cavity of the body of 
the uterus dilates in such a manner as to become globe shaped ; 
its walls are uniformly distended, and in general are found in 
a state of eccentric hypertrophy. If the distention attains a 
higher degree the uterus is finally transformed into a thin- 
walled sac with inelastic walls. Investigations, especially of 
cases of considerable hydrometra in aged females, show that 
the elements of connective tissue predominate considerably 
over those of muscular tissue and we must assume that the 
latter are chiefiy destroyed by the distension, and that the 
hyperplasia accompanying nearly every case of hydrometra, 
chiefly aflfects the connective tissue. 

When the cavity of the body of the uterus is considerably 
distended, its mucous membrane becomes thin and degener- 
ates, and its external soft velvet-like appearance is lost, its sur- 
face assuming the smooth, glossy appearance of serous mem- 
branes. If the uterus be further distended it becomes net- 
like in appearance, and is Anally changed into a soft layer of 
connective tissue covered with a single layer of frequently 
degenerated cyhndrical epithelial cells. The latter generally, 
and in the higher degrees of hydrometra, always loose their 
cihas, and appear shorter and thicker, resembling the so- 
called transitory epithelium. I have been unable, even in the 
highest degree of hydrometra, to discover the pavement epithe- 
lial cell, which is found in analogous conditions of the gaU 
bladder. The glands of the uterine mucous membrane in the 
commencement of hydrometra, are generally affected with a 
fatty degeneration of their epithelium, and are finally destroyed, 

leaving indurations in the mucous membrane. Sometimes also 
tlie utricular glands degenerate into small cysts. 

The fluids contained in the cavity of the uterus are at first a 
viscid mucus, sometimes clear or serous, sometimes slightly 
turbid and yellowish or brown in color. In many cases of 
atresia after menstruation has made its appearance for a short 
time only, or several times and then ceased, a hsematometra 
formed at first, may turn into hydrometra, and the hsematine 
being changed into brown pigment, may give a peculiar color 
to the fluid. Upon closer investigation we find varying quan- 
tities of cast-off epithehum and colloid bodies suspended in a 
mucus fluid. After a longer continuance of hydrometra how- 
ever, we generally find the contents strongly alkaline, very 
fluid and nearly or perfectly clear. The mucous substance 
contained in the secreted fluid may have been dissolved by its 
alkalescence.* 

In stricture of the external orifice the cervical canal is dis- 
tended Hke a pouch, and we may mention that the cavity of 
the uterus participates only slightly in the enlargement. Fre- 
quently enough I have observed pouch-hke distention of the 
cervical canal without dilatation of the uterine cavity. In every 
such case there was stricture only at the external orifice. Ob- 
struction of the cervical canal being the chief cause of disten- 
tion of the cavity of the uterus, we are led to assume that in 
such cases there is no hypersecretion of the uterine mucous 
membrane, consequently that the cervical mucous membrane 
alone is diseased, or, which seems possible, that although the 
cervical catarrh may be most severe, a slight catarrh of the 
uterine mucous membrane may co-exist, but that a temporary 
emptying of the cervical canal occm's from time to time and 
the uterus distended by accumulated fluid, contracts and tem- 
porarily assumes its former size, whilst the less muscular cervix 
is distended to its utmost at an earlier period and remains 
 

Causes & Symptoms of Uterine Anamolies

Causes

The exact causes for uterine anomalies are not known, but it's generally thought that a combination of genetic and environmental causes are responsible. For example, a particular uterine anomaly characterized by a T-shaped uterus has been found in women whose mothers took the drug diethylstilbestrol (DES) during their pregnancy.  Because few women with an irregularly shaped uterus also have close relatives with the same problem, the condition is not thought to run in families.

Incidence

An incidence of uterine anomalies as low as 0.1%  has been reported. Observations made at the time of delivery indicate an incidence of 2 to 3%.  The most common uterine anomalies are the septate and bicornuate and didelphic uteruses.  The unicornuate uterus is the least common type.

Symptoms

In many cases a uterine anomaly causes no problems and in fact may remain undetected until menstruation begins or pregnancy is attempted. If a uterine anomaly such as bicornuate uterus results in a rudimentary uterine horn with no outlet, menstrual outflow will be obstructed. This can result in pain and/or a mass similar to endometriosis that gets worse during periods. If untreated, blood collects in the uterus and may become infected.  

A uterine anomaly may also be associated with dyspareunia and reproductive problems. These include:

• Infertility
• Ectopic pregnancy
• Recurrent miscarriage
• Premature delivery
• Intrauterine fetal growth restriction
• Abnormal fetal presentation – breech and transverse lies

Uterine Anamolies in Woman

 UTERINE ANAMOLIES IN WOMEN

As an embryo divides and grows, sometimes the uterus fails to develop correctly.  A girl with this type of birth defect will have an irregularly shaped uterus also known as a congenital uterine anomaly. Uterine anomalies are thought to be quite rare. 

Sometimes they cause no problems and remain undetected. However, reproductive problems are quite frequent. In case of repeated, unexplained miscarriage and/or premature birth, a uterine anomaly may be suspected. Uterine anomalies can be diagnosed accurately, and often can be corrected making it possible for a woman to have a baby.

A common confusion that may occur is that people sometimes think that a prolapsed uterus or tipped uterus is a uterine abnormality.  However, they are considered uterine conditions rather than abnormalities or anomalies.

Types of anomalies

Uterine anomalies are often categorized as follows:

• Septate Uterus – a wall or septum partially or fully divides the uterus into two cavities.
• Unicornate Uterus – a banana shaped uterus with a single horn and sometimes a rudimentary second horn.
•  Bicornate Uterus – characterized by a heart shape.
• Uterus Didelphys – a double uterus that may also be associated with a double cervix and/or vagina

We Will discuss the Causes of Uterine Abnormalities.

Cessation of Menstruation - Uterus Problem

                      CESSATION OF MENSTRUATION

The time when the menstrual dis- 
charge ceases is regulated by its first appearance, commonly con- 
tinuing for the space of thirty years. Cases are, however, on 
record, where the catamenial function has regularly continued for 
a much longer period, the female, for example, begins to menstru- 
ate about her fifteenth year, but does not cease until the fiftieth, 
fifty-fifth, and in some very rare instances not until the sixtieth 
year ; but it is generally found that about the forty-fifth year indi- 
cations are experienced of the coming event.

 In some rare cases 
the discharge due to cessation of menstruation gradually diminishes, and at length totally disappears 
without producing any feelings of inconvenience, but this is not 
common ; there are generally irregularities, the discharge some- 
times being absent for six or seven weeks, and then appearing 
either more copiously than natural, or in deficient quantities. 
Again, you may, on the other hand, have the discharge not only 
profuse, but frequently repeated, and often sanguineous ; in truth* 
in almost every case where there is profuse discharge, blood is 
effused; this, you will recollect, is easily distinguished by its 
power of coagulation. This period is usually designated by 
women "the dodging time," an epithet which characterises their 
condition with tolerable exactness.

 There is often during cessation of menstruation a 
considerable degree of constitutional irritation, with an increased 
determination of blood to the head, or to some other part of the 
body. If you are consulted by a female at this period, you will 
see "the great necessity of directing attention not to the uterus alone, 
but to the state of the constitution at large. Most women look 
upon the cessation of menstruation as a critical time, which they 
call " the turn of life," and although their fears are often ground- 
less, for it is not reasonable to suppose that the cessation of this 
function (which is as natural as its commencement) should inva- 
riably and of necessity give rise to disease, yet it is an unques- 

tionable fact, that if there be a morbid disposition in any part of 
the body, more especially should it exist in the womb or in the 
breast, there will be a more rapid progress at this, than at any 
previous period. 

The older authors attempted to explain this  cessation of menstruation
circumstance by the supposition that the " menstruous blood" pos- 
sessed qualities of a peculiar noxious quality, and, therefore, very 
naturally considered its retention to be the cause of disease in 
some part of the body.