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July, 1963 DYSTOCIA—PARKER 283 station 2 plus with contractions, tightly stretching the septum. The septum could not be displaced to either side. The patient was taken to the delivery room where the septum was divided close to the posterior vaginal wall. The end of the septum was ligated and the defect in the posterior vaginal wall sutured. She was placed on her side while the vertex slowly rotated to position ROA during the next hour. When the vertex crowned, she was placed in the lithotomy position again and catheterized. A mid-line episiotomy was done, and she was delivered of a 7 pound 1 ounce normal girl by outlet forceps. The membranes and placenta were delivered three minutes later. The recently sutured posterior vaginal wall was examined and found intact. Most of the vaginal septum was then excised, but not flush with the anterior vaginal wall so as to avoid endangering the sub-lying urethra and bladder. The anterior defect was sutured and the episiotomy repaired. 'CONGENITAL LONGITUDINAL ^ PAGINAL SEPTUM All sutures were of 000 chromic catgut. No packs or drains were used. Estimated blood loss was 200 cc. Cystitis (found on culture to be due to Proteus vulgaris) developed one day post partum, possibly from catheterization prior to delivery. It cleared promptly on being treated with Azo-Gantrisin. There was no infection, drainage, or discomfort related to excision of the vaginal septum. The patient was discharged on the sixth postpartum day. Urinalysis was normal two weeks post partum. The patient was re-examined at five weeks and again at six months post partum. Urinalysis was normal and there were no genitourinary symptoms. The vaginal walls and the episiotomy healed well, with no narrowing of the vagina. The posterior vaginal wall was flush. Anteriorly there was a small asymptomatic soft ridge of tissue where the septum had not been trimmed off completely flush. No dyspareunia remained. She was most appreciative of this change, saying: "I had just taken it for granted that I was supposed to hurt like that when I had relations." Comment In this case the septum actually obstructed the vagina, prevented delivery, and thus caused vaginal dystocia. The bladder was endangered by traction on the bladder base as the descending head stretched the vaginal septum. The septum was divided during labor, because only then was incision obviously necessary. Prenatally it had been hoped that the septum would be displaced to one side at delivery. It would have been prudent to explore the uterine cavity after delivery and to have obtained an intravenous pyelogram. Discussion Symptoms While a longitudinal vaginal septum may be asymptomatic, it usually causes dyspareunia and possibly dystocia. The septum itself does not cause infertility, although infertility may result from associated anomalies.
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-2001] |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1963 |
Identifier | NCHH-17-024 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 24 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-024.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-024 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 283 (image) |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1963 |
Identifier | NCHH-17-024-0305 |
Form General | Periodicals |
Page Type | all; all images; diagram; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | ncarolinamed241963medi_0305.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 24 |
Issue Number | 7 |
Page Number | 283 |
Health Discipline | Medicine |
Full Text | July, 1963 DYSTOCIA—PARKER 283 station 2 plus with contractions, tightly stretching the septum. The septum could not be displaced to either side. The patient was taken to the delivery room where the septum was divided close to the posterior vaginal wall. The end of the septum was ligated and the defect in the posterior vaginal wall sutured. She was placed on her side while the vertex slowly rotated to position ROA during the next hour. When the vertex crowned, she was placed in the lithotomy position again and catheterized. A mid-line episiotomy was done, and she was delivered of a 7 pound 1 ounce normal girl by outlet forceps. The membranes and placenta were delivered three minutes later. The recently sutured posterior vaginal wall was examined and found intact. Most of the vaginal septum was then excised, but not flush with the anterior vaginal wall so as to avoid endangering the sub-lying urethra and bladder. The anterior defect was sutured and the episiotomy repaired. 'CONGENITAL LONGITUDINAL ^ PAGINAL SEPTUM All sutures were of 000 chromic catgut. No packs or drains were used. Estimated blood loss was 200 cc. Cystitis (found on culture to be due to Proteus vulgaris) developed one day post partum, possibly from catheterization prior to delivery. It cleared promptly on being treated with Azo-Gantrisin. There was no infection, drainage, or discomfort related to excision of the vaginal septum. The patient was discharged on the sixth postpartum day. Urinalysis was normal two weeks post partum. The patient was re-examined at five weeks and again at six months post partum. Urinalysis was normal and there were no genitourinary symptoms. The vaginal walls and the episiotomy healed well, with no narrowing of the vagina. The posterior vaginal wall was flush. Anteriorly there was a small asymptomatic soft ridge of tissue where the septum had not been trimmed off completely flush. No dyspareunia remained. She was most appreciative of this change, saying: "I had just taken it for granted that I was supposed to hurt like that when I had relations." Comment In this case the septum actually obstructed the vagina, prevented delivery, and thus caused vaginal dystocia. The bladder was endangered by traction on the bladder base as the descending head stretched the vaginal septum. The septum was divided during labor, because only then was incision obviously necessary. Prenatally it had been hoped that the septum would be displaced to one side at delivery. It would have been prudent to explore the uterine cavity after delivery and to have obtained an intravenous pyelogram. Discussion Symptoms While a longitudinal vaginal septum may be asymptomatic, it usually causes dyspareunia and possibly dystocia. The septum itself does not cause infertility, although infertility may result from associated anomalies. |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-024.pdf |
Document Sort | all; nchh-17 |
Article Title | Dystocia Resulting from Acongenital Vaginal Septum |
Article Author | Talbot F . Parker |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-024 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
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