US 3062215 A
Description (Le texte OCR peut contenir des erreurs.)
Nov. 6, 1962 o. s. HEYNS METHOD AND APPARATUS FOR FACILITATING THE PROCESSES OF PARTURITION 5 Sheets-Sheet 1 Filed Sept. 2, 1959 m w w m 00 5973 HEV/VJ Nov. 6, 1962 o. s. HEYNS METHOD AND APPARATU Filed Sept. 2, 1959 S FOR FACILITATING THE PROCESSES OF PARTURITION 3 Sheets-Sheet 2 Nov. 6, 1962 o. s. HEYNS METHOD AND APPARATUS FOR FACILITATING THE PROCESSES OF PARTURITION 3 Sheets-Sheet 3 Filed Sept. 2, 1959 United States Patent Gfitice W292 Patented Nov. 6, 1952 METHOD AND APPARATUS FOR FACILITATING THE PROCESSES OF PARTURITION Ocirert S. Heyns, Medical School, Hospital St, .i'ohannesburg, Transvaal, Republic of South Africa Filed Sept. 2, 1959, Ser. No. 819,323 Claims priority, application Republic of South Africa Jan. 14, 1956 9 Ciaims. (Cl. 128-361) This is a continuatio-n-in-part of the application filed on January 9, 1957 under Serial No. 633,335, new Patent No. 2,981,255.
The process of parturition is naturally divided into three stages, in the first of which the cervical orifice of the uterus is caused to open preparatory to the explosion of the foetus, while in the second stage the foetus and the uterus, opened during the first stage, are displaced towards the pelvic floor for the foetus to be expelled through the gap in the floor constituted by the vaginal canal. In the third stage the placenta is expelled.
The movements of all stages are produced by muscular contractions of the uterus induced automatically, and by movements of the abdominal diaphragm produced consciously.
The first and third stages and most of the second take place in the abdominal cavity, by which is meant the body cavity the walls of which are defined from above by the abdominal diaphragm, from below by the pelvic floor and at the sides by the abdominal walls. It has been ascertained that the pressure within the cavity is somewhat above atmospheric. The pressure is, of course, variable in that it is dependent upon the movements of the diaphragm, which, in the processes of parturition, is projected downwardly to promote or to induce the progress of the stages.
It is primarily but not exclusively the first stage with which this invention is concerned. The main object is to facilitate childbirth in the sense that the pain commonly associated with the process (which in the first stage endures on the average for 14 hours) is lessened and also in the sense that the duration of the first stage of labour is in a significant number of cases shortened.
To assist in understanding the invention, reference is made to the accompanying drawings in which:
FIGURE 1 is a diagrammatic section of the internal feminine organs during the first stage of labour,
FIGURE 2 is a similar view during the second stage,
FIGURE 3 is a side view of a bed with a patient seated on a decompression chamber during the second stage,
FIGURE 4 is a perspective view of part of the bed shown in FIGURE 3,
FIGURE 5 is a side view of a patient in the first stage of labour, using a decompression dome,
FIGURE 6 is an underplan view of the decompression dome,
FIGURE 7 is a perspective view of a patient in the first stage, using a decompression suit,
FIGURE 8 is a side view, partly in section of FIG- URE 7,
FIGURE 9 is a perspective view of a harness used inside the suit,
FIGURE 10 is a perspective view of a backing plate used with the suit, and
FIGURE 11 is a side view, partly in section, of another form of suit.
In FIGURES 1 and 2 of the drawings the abdominal cavity 10 is shown, defined from above by the abdominal diaphragm 11, from below by the pelvic floor 12 and at the sides by the flanks 13, the posterior wall 14 and the anterior wall 15.
In the advanced stages of pregnancy the cavity 10 is for the greater part occupied by the uterus 16.
During the first stage of labour, the spasmodic movement of the uterus 16 imposed by its own muscular structure as well as by conscious displacement of the diaphragm 11 can cause no significant displacement of the pelvic fioor 12 or of the flanks 13 or of the posterior wall 14 of the abdominal cavity; and the forces due to the intermittent changes from ellipsoidality to spheroidality of the uterus are therefore predominantly imposed upon the anterior abdominal wall 15. This is illustrated in FIG- URE 1 where the uterus is shown in dotted lines when it is spheroidal. Unless that wall is freely distensible, there is evidence that its resistance to these formal changes of the uterus causes severe pain.
If there be no conscious relaxation of the anterior wall 15, so that the wall is rigid, the whole process of labour is inefiicient and results in great sufiering. If such relaxation can be achieved, pain is relieved and the progress of the first stage of labour facilitated, but this is not always possible to achieve and, even if it is, the anterior wall 15 is normally distended by the changing uterus 16 beyond the natural stretch of the muscles of the abdomen.
In the method of the invention as applied to the first stage of labour the external pressure on the anterior wall 15 is reduced.
One way in which this is done is to apply to the exterior of the Wall 15 a decompression chamber such as the dome 19 illustrated in FIGURES 1, 5, and 6 in communication with a vacuum pump 17 (FIGURE 5) through a pipe 18.
It is pointed out that it is of the highest importance that the suction be applied to the abdominal region and not to the lower limbs. If the lower limbs be subjected to suction, as would be the case if the patient were placed in a box which is partially evacuated, circulation of blood within the limbs is seriously impaired. This is due to the inability of the vessels in the limbs to return blood to the heart, causing congestion or pooling of blood in the extremities because of reduction of pressure head. The result is akin to the mechanism occurring in the Valsalva experiment, and will induce ischacmia of the brain and unconsciousness and perhaps, if not immediately detected, will cause death.
The dome 19 is satisfactory since it acts to apply the suction only to the abdomen and not to the extremities, so that the Valsalva effects cannot occur.
A second way is to encase the patient in a flexible suit as in FIGURES 7 et seq. The suit is in the form of a sack 50 made of flexible material such as PVC or polyethylene and with an airtight lighting fastener 51 or like device extending longitudinally, which enables the suit to be opened up for the patient to don it. The suit is closed at the lower end, and has a hem 52. at its month which, when the fastener 51 is pulled up, and suction is applied to the suit, is pressed into sealing engagement with the patients chest and back.
The suit is maintained spaced from the patients abdomen by means of a harness 53 associated with a backing plate 54, against which the wings 55 of the harness rest. The harness and plate constitute a frame that surrounds the medial zone of the patient and is spaced from the abdomen; and which supports the suit.
The harness has a nipple 55 that registers with an aperture 57 in the suit.
To the nozzle there is connected a suction hose 157 comprising a valve 58 that is controlled, through a cable 59, by the patient to set the degree of vacuum in the suit; and a pressure gauge 69 to show the degree of vacuum at any moment.
In use, the woman dons the suit and is ensconced in a chair 61 in which she reclines at an angle such that the foetal axis is more or less vertical. She decompresses the suit to the extent necessary to relieve pain but not enough to cause discomfort. Between bouts of pain, the patient may restore atmospheric pressure in the suit.
The suit, being flexible, collapses save where the harness 53 holds it away from the abdomen, and presses against the limbs 62, which are therefore kept at atmospheric pressure, so that blood circulation is not impaired.
The suit of FIGURE ll is like that shown in FIG- URES 7 and 8, but instead of a harness the suit is kept away from the abdomen by pressure fiuid contained within an annulus 63 formed in the medial zone of the suit. The fluid-filled annulus keeps the suit spaced from the abdomen, as shown in FIGURE 8.
The posture of the patient during the decompression operation may be of some moment. Experiments indicate that while decompression is taking place the beneficial effects may result if the foetal axis is more or less vertical, so that gravity plays a part. The patient is therefore placed in a reclining attitude on a chair 20 the back 21 of which is inclined to the correct angle for this purpose; and the back 21 may be made adjustable so that the obstetrician can tilt his patient backwards in order to make it easier to listen to the foetal heart.
Under the effect of the suction the anterior wall 15 distends and is conditioned to distend further when acted on by forces due to intermittent changes of form of the uterus 16. Without conscious effort, therefore, the anterior Wall 15 yields, to avoid or to relieve pain and to hasten the progress of the first stage of labour.
The extent to which the external pressure on the anterior wall 15 is decreased is such as to promote the result discussed above, while avoiding undue discomfort.
It is a feature of the invention that the magnitude of the vacuum amounts to a negative pressure of at least 20 mm. of mercury and preferably over 40 mm. of vacuum. In normal cases a vacuum of the order of between 40 and 50 mm. may be very suitable. In some cases a vacuum of 100 mm. or even 150 mm. may be expedient. In the latter case it may be convenient to arrange matters so that as a contraction occurs the vacuum is raised to a high level, say 100 mm., and after a short interval, say 20 seconds, allowed to drop to a lower level of say 20 mm. Under these conditions, the duration of the first stage of labour in the majority of cases has been found to be reduced to several hours with less pain than is normal.
The applicant has amassed a great deal of experience on the effects of decompression on the first stage of labour, since the invention was reduced to practice. He has established that decompression stimulates labour even when early and while the contractions are still very weak. This is probably due to a reduction of the forces resisting the change of shape to spherical form, since, when contracting, a uterus always endeavours to change its flattened ellipsoid shape to round.
Thus spurious, tardy and inertia labours are typically altered to progressive by decompression, but as soon as decompression is stopped labour ceases or is markedly slowed down. The spectacular results are, however, obtained with the ideal irrevocable type of labour.
Results show that 98% of parturients are helped. In 50% the pain of labour and the amount of it is so trivial as to have become negligible.
When the two factors of duration of the first stage and pain relief are taken together, analysis shows the following achievement:
The first stage is reduced to half or below the average time in over 70% of primigravidae. There is substantial pain relief in over of labours.
Even in these few cases where there is seemingly no substantial pain relief applicants observations indicate that the parturients are indeed spared suffering, even it, because of the human factor, they do not admit to it.
Dealing now with the second stage, the wall across which the pressure differential is set up is the pelvic floor 12 composed of the levatores ani 22 (FIGURES 1 and 2) gapped at 23, as stated above, by the vaginal canal 24.
It will be appreciated that the pelvic floor 12 constituted by the levatores ani 22 differs from the anterior abdominal wall 15 in that its exterior surface is internal, and also in that it is not continuous but is gapped by the vaginal canal 24. The application of suction to the pelvic floor 12 up to the late first stage of labour will normally not be made although it might be in cases of uterine inertia; but as the second stage proceeds the gap 23 (as shown in FIGURE 2) becomes occluded by the foetal head and the application of suction then permits a pressure differential to be built up across what remains of the floor 12 after enlargement of the gap 23 by the foetal head; and this pressure difference acts to facilitate the passage of the foetus through the gap 23, a passage which may be further facilitated by a pressure difference across the anterior abdominal wall 15, in its lower regions at least, to minimize resistance by the wall to muscular movements of the uterus 16 and the diaphragm 11.
The exterior surface of the pelvic floor 12 not being readily accessible from without the body, suction is imposed on it by way of the vaginal canal 24 and the surrounding soft tissue. In this connection it is pointed out that the tissues surrounding the canal 24 and underlying the floor 12 are spongy and pervious and that suction applied to the canal should lower the pressure within the tissues and beneath the floor 12.
During the application of suction, it is advisable that the patient be seated in a reclining position, so that gravity assists the passage of the foetus along the birth canal. In the method of the invention, the patient, when the second stage of labour begins, may leave the chair 20 and be transferred to an apparatus which enables her to sit herself upon a decompression chamber formed with a port that in use is closed by her body.
The apparatus illustrated in FIGURES 3 and 4 consists in a bed 25 the head end 26 of which is pivoted to be capable of being raised to form a back rest, as shown in FIGURE 3. The foot end 27 is inclined downwardly and can be raised to horizontality and clamped there by a stay 28. Thus when the head 26 is raised and the foot end 27 lowered the bed is transformed into a-chair. The head end may be raised and lowered by a leadscrew and nut device 29. The medial portion 30 'of the bed is fixed. It is formed with a hole 31. Underneath is situated the upper end of a cylindrical decompression chamber 32, the top of which is gapped at 33 to form a port preferably of kidney shape with a soft rubber or .rubberlike rim 34.
With the head end 26 of the bed raised,'the patient sits upon the decompression chamber, and the rim 34 of the port 33 causes the chamber to be sealed with her body around the pelvic outlet 35 (FIGURES 1 and 2).
The decompression chamber 32 is connected by a pipe 36 to a vacuum pump 37.
Suction is applied to the pelvic outlet 35 more or less in synchronism with the uterine spasms which accompany the second stage of labour; that is to say for periods of between 30 and 60 seconds, at intervals of say 60 seconds.
The pulsations of suction are continued until the delivery is imminent. To enable this point to be ascertained the chamber 32 is provided with a window 39, and an electric lamp 40 is mounted within the chamber.
The head end 26 of the bed is then lowered to bring the patient to a recumbent position, a shutter 41 is slid into place over the hole 31 and delivery is effected.
Experience has shown that the results of the method of the invention during the second stage of labour, are remarkable. The patient need not bear down, but the time taken for the foetus to move down the birth canal is materially reduced, if she does. Indications are that some births requiring instruments will proceed normally, and that some caesarean operations will be rendered unnecessary.
The handling of the third stage of labour is akin to that of the second since again the method of the invention is to apply a difierential pressure across the pelvic floor to assist in the extraction of the placenta. After delivery the shutter 41 is withdrawn, the head end 26 of the bed is raised and the foot end 27 lowered, to bring the patient into a sitting posture on the port 33, and suction is applied. It is found that by the method of the invention the third stage of labour is in most cases reduced to a period of the order of one to three minutes, after the placenta has separated.
A highly important feature of the invention is that, after extraction of the placenta, the suction applied tends to cause strong contraction of the uterus and thus to avoid post-partum haemorrhage. Experience has shown that even where haemorrhage has occurred the effect of suction is to stauch the flow of blood and that it has not been necessary to administer oxytoxics.
It is scarcely necessary to say that in practice the dome 19, or suit 5% and the chamber 32 are each one of a set, to cater for women of different sizes. in the case of the chamber 32, the upper part containing the rim 34 may be replaceable by any one of a set to vary the size of the rim.
1. A method of relieving pain during the process of parturition comprising the steps of applying suction to the entire abdominal zone of a parturient in a reclining position during the first stage of labor thereof so as to distend the abdominal wall outwardly, and maintaining the remainder of the body of the parturient including the lower limbs at substantially atmospheric pressure.
2. The method of claim 1 in which the suction is applied intermittently.
3. The method of claim 2 in which the suction is applied while the parturient is so reclining that the foetal axis is substantially vertical.
4. The method of claim 2 in which the suction applied is above 20 mm. Hg.
5. The method of claim 4 in which the suction applied is to the order of 150 mm. Hg.
6. The method of claim 2, followed by the steps of applying pulsations of suction to the pelvic outlet during the second stage of labour, substantially synchronously with the uterine contractions; and continuing such pulsations substantially up to the point of delivery.
7. The method of claim 6 followed by the steps of applying suction to the pelvic outlet, after delivery to extract the placenta.
8. Apparatus to relieve pain during childbirth comprising a flexible suit defining a sack having a cavity therein and provided with a mouth to receive the body of a parturient up to and under the arms thereof, fastener means extending longitudinally of said sack to provide ingress and egress of said parturient therein as well as providing an airtight seal, means disposed at said mouth to seal same around the back and chest of said parturient, rigid frame means medially disposed within said sack to maintain said suit spaced from the abdomen of said parturient to form a cavity therebetween, said frame means including a harness having wings and a backing plate having an angular disposition, said wings of said harness having an angular configuration corressonding to that of said backing plate so that said harness snugly abuts against said backing plate, the angular disposition of said backing plate being such that when the parturient is in a reclining position the foetal axis is substantially vertical, and suction means operatively connected to said suit to apply suction to said cavity to distend the abdomen of the parturient while the part of said suit around the parturients legs collapses therearound during the application of suction to maintain the legs at substantially atmospheric pressure.
9. Apparatus according to claim 8 in which said suction means includes hose means communicating with said cavity, valve means disposed in said hose means, and manual operating means operatively connected to said valve means which is controlled by the parturient to apply the desired amount of suction in dependence upon the amount of pain.
References Cited in the file of this patent UNITED STATES PATENTS 1,498,430 Doerfler June 17, 1924 2,490,395 Wilm Dec. 6, 1949 2,917,050 Kenyon Dec. 15, 1959 FOREIGN PATENTS 565,434 Germany Nov. 30, 1932 952,782 France May 9, 1949
Citations de brevets