compression DURING
the
of
umbilical
cord
DELIVERY.
FORCEPS BY
Griffiths
Joseph '
Swayne,
M.D.
Lond.,
?f?ssoy of Midwifery in University College, Bristol,
Physician-Accoucheur IfTeen
eUvery
to the Bristol General
Consulting
" paper on The Effects of Forceps the Infant" at the annual meeting of the British
years ago I read on
Association, ^edical Urmg the previous
a
which
took
^Metrical Frequent
place
in
year Dr. Galabin had
for December, 1877, and Early Use of the
Journal
a
and
Hospital.
a
paper
Bath
in
1878.
published
in the
on
"The Effects
Midwifery Forceps upon Foetal and Maternal Mortality." After bringing forward a mass ?f statistics which bore upon this subject, Dr. Galabin rr^ved at the conclusion that it has not been shown that the e
"
^J?rity, lch
now
,
any considerable proportion, of the still-births occur in Britain would be preventable by a more
or
forceps." In my own paper I arrived at a conclusion to this; and I brought forward in illustration eral cases I had witnessed of injuries received during forceps resort to
^ilar ^
ery which had in
some
instances been fatal
to
the
child,
230
DR.
JOSEPH
GRIFFITHS
SWAYNE
produced rather serious, but fortunately not after-effects. permanent, Upon the subject to which I am no^ of directing attention, I said: "The next four still-births out and in others had
due to a cause of which I do not remember notice any by others: I mean compression of ^ll umbilical cord by the forceps. In one of these the forehead pre* the
twenty-three
to have
are
seen
sented to the left acetabulum.
There
were
no
particular signS
of undue pressure on the head; but I observed when the child was born that the end of one blade of the forceps was con1'
pressing the cord (which happened to be round the childs neck) against the angle of the jaw. In another, the head ha^ been much elongated by pressure; but I attributed death 111 this case also to the cord having been nipped between the edge of one blade and the jaw. In another, the same thing happened, the head being but little altered in shape. In the a fourth, the contour of the head was but little altered; but loop of cord which had prolapsed, though not sufficiently be previously detected, was found, as soon as the head delivered, to be between the posterior blade of the forceps ^ the left frontal bone. Here then we have a source of dangef to the child, arising simply from the use of the forceps, &n ^ which cannot be guarded against by any ordinary amount 0 skill. Nothing is more common than coiling of the cord the child's neck, and it is a condition which cannot be rec?o nised by ordinary vaginal examination before applying
forceps. If, therefore, one blade of the forceps should PaSS *0 just an inch too far beyond the ear, it would be very likely cause such an accident, especially if the head be so high the ear cannot be felt, or present unfavourably, for instan?e with the forehead in the anterior semi-circle of the the head be much altered in shape and elongated by labour."
1
pelvis>
protract6
cases of forceps delivef^ in in difficult labour; 23 of these the child was either dead or died shortly afterwards, making a death-rate of a^?
Up
to that time I had met with 153
b?rI|
1
in
6?.
caused
\va5
instances, as I had then recorded, death forceps by compression of the umbilical cord by the forceps> In four
1
Brit. Med.
Journ., 1878,
vol. ii., p. 459.
ON
at
COMPRESSION
this peculiar
cause
not then been
Ccurred
to
me
OF
of still-birth
recognised by
as
UMBILICAL
THE
often
as
once
(which,
CORD.
as
far
British obstetric
38
in
cases
and
231
as
I
know,
authorities) a
fraction.
lere could be no doubt about it; for the birth of the child's ^ ead with the forceps in situ at once revealed'this instrument the direct cause of the infanticide. In order to ascertain y
ether my experience of forceps cases up to 1878 is confirmed those I have recorded from that time up to the present, I y state that since 1878 I have attended 71 forceps cases with
^eath-rate
one case
.^ticle in j
of
12
infants,
or,
I should rather say, 10; for in
of
(one
.
.
.
desquamation
extensive
hydramnios)
of the
showed that the child had been dead for several days: other, the child died soon after its birth from a very with ectopia cordis. Thus we .
o
ine
arSe exomphalos, accompanied aVe
still-births in 71 cases, which is at the rate of 1 in 7^ less than the death-rate of 1 in 6? recorded before Amongst the 10 still-births there were 2 in which death dearly due to pressure of the forceps on the cord, which C?^ec* round its neck?once in one case and twice in the Jo
ases? s
^
or
oth er-
On comparing the two lists of cases?viz., those before an
the
of
umbilical
cord
DELIVERY.
FORCEPS BY
Griffiths
Joseph '
Swayne,
M.D.
Lond.,
?f?ssoy of Midwifery in University College, Bristol,
Physician-Accoucheur IfTeen
eUvery
to the Bristol General
Consulting
" paper on The Effects of Forceps the Infant" at the annual meeting of the British
years ago I read on
Association, ^edical Urmg the previous
a
which
took
^Metrical Frequent
place
in
year Dr. Galabin had
for December, 1877, and Early Use of the
Journal
a
and
Hospital.
a
paper
Bath
in
1878.
published
in the
on
"The Effects
Midwifery Forceps upon Foetal and Maternal Mortality." After bringing forward a mass ?f statistics which bore upon this subject, Dr. Galabin rr^ved at the conclusion that it has not been shown that the e
"
^J?rity, lch
now
,
any considerable proportion, of the still-births occur in Britain would be preventable by a more
or
forceps." In my own paper I arrived at a conclusion to this; and I brought forward in illustration eral cases I had witnessed of injuries received during forceps resort to
^ilar ^
ery which had in
some
instances been fatal
to
the
child,
230
DR.
JOSEPH
GRIFFITHS
SWAYNE
produced rather serious, but fortunately not after-effects. permanent, Upon the subject to which I am no^ of directing attention, I said: "The next four still-births out and in others had
due to a cause of which I do not remember notice any by others: I mean compression of ^ll umbilical cord by the forceps. In one of these the forehead pre* the
twenty-three
to have
are
seen
sented to the left acetabulum.
There
were
no
particular signS
of undue pressure on the head; but I observed when the child was born that the end of one blade of the forceps was con1'
pressing the cord (which happened to be round the childs neck) against the angle of the jaw. In another, the head ha^ been much elongated by pressure; but I attributed death 111 this case also to the cord having been nipped between the edge of one blade and the jaw. In another, the same thing happened, the head being but little altered in shape. In the a fourth, the contour of the head was but little altered; but loop of cord which had prolapsed, though not sufficiently be previously detected, was found, as soon as the head delivered, to be between the posterior blade of the forceps ^ the left frontal bone. Here then we have a source of dangef to the child, arising simply from the use of the forceps, &n ^ which cannot be guarded against by any ordinary amount 0 skill. Nothing is more common than coiling of the cord the child's neck, and it is a condition which cannot be rec?o nised by ordinary vaginal examination before applying
forceps. If, therefore, one blade of the forceps should PaSS *0 just an inch too far beyond the ear, it would be very likely cause such an accident, especially if the head be so high the ear cannot be felt, or present unfavourably, for instan?e with the forehead in the anterior semi-circle of the the head be much altered in shape and elongated by labour."
1
pelvis>
protract6
cases of forceps delivef^ in in difficult labour; 23 of these the child was either dead or died shortly afterwards, making a death-rate of a^?
Up
to that time I had met with 153
b?rI|
1
in
6?.
caused
\va5
instances, as I had then recorded, death forceps by compression of the umbilical cord by the forceps> In four
1
Brit. Med.
Journ., 1878,
vol. ii., p. 459.
ON
at
COMPRESSION
this peculiar
cause
not then been
Ccurred
to
me
OF
of still-birth
recognised by
as
UMBILICAL
THE
often
as
once
(which,
CORD.
as
far
British obstetric
38
in
cases
and
231
as
I
know,
authorities) a
fraction.
lere could be no doubt about it; for the birth of the child's ^ ead with the forceps in situ at once revealed'this instrument the direct cause of the infanticide. In order to ascertain y
ether my experience of forceps cases up to 1878 is confirmed those I have recorded from that time up to the present, I y state that since 1878 I have attended 71 forceps cases with
^eath-rate
one case
.^ticle in j
of
12
infants,
or,
I should rather say, 10; for in
of
(one
.
.
.
desquamation
extensive
hydramnios)
of the
showed that the child had been dead for several days: other, the child died soon after its birth from a very with ectopia cordis. Thus we .
o
ine
arSe exomphalos, accompanied aVe
still-births in 71 cases, which is at the rate of 1 in 7^ less than the death-rate of 1 in 6? recorded before Amongst the 10 still-births there were 2 in which death dearly due to pressure of the forceps on the cord, which C?^ec* round its neck?once in one case and twice in the Jo
ases? s
^
or
oth er-
On comparing the two lists of cases?viz., those before an
