Accouchement Force

ACCOUCHEMENT FORCE, forced delivery, a concept which should be understood as a series of surgical interventions directed toward the rapid and artificial dilation of the cervix and subsequent removal of the fetus per vias naturales. For this purpose, there are several methods. - The instrumental method: dilation of the cervix is performed with a special Bossi instrument, which consists of metal rods bundled together, which, after being introduced in a folded state into the cervix, are spread apart, thereby stretching the cervix; this method is not safe and therefore has not become widespread. - Manual dilation of the cervix has several variants: 1) one finger is introduced, which, sliding along the edge of the cervix and pulling it to the side, massages the cervix, causing stretching; 2) two fingers are first introduced, with which the cervix is stretched sufficiently to introduce the next finger and then the thumb; then further dilation of the cervix is performed until it becomes passable for the entire hand; 3) dilation is performed bimanually, with the index and middle fingers of each hand being introduced into the cervix and stretching it to the sides. - Dilation with the aid of forced metreurysis: the metreurine, after its introduction into the cervix, is left in constant tension. - At present, A. f. has little practical value, since in cases where immediate delivery is truly required without cervical dilation, the aforementioned methods are dangerous due to the possibility of cervical rupture. The A. f. method has now been replaced by the method of operative delivery—either by incision of the cervix and removal of the fetus per vias naturales or by extraction of the fetus by the abdominal route by means of cesarean section (see Obstetrical Operations).