US2592959A - Obstetrical instrument - Google Patents

Description

April 15, 1952 A':'L.' SICHIOFIELD, ,959

OBSTETRICAL INSTRUMENT FileaDeC. 2, 1950 2 SHEETS--SHEET*2 INVENTUR ALAN L. SCHOFIELD BY Patented Apr. 15, 1952 2,592,959 ensrsrnros insrnoiusnr Alan L. Sclioiield, Lowell, Mass.

Applica-ticn fiecernbcr 2, 1959, Serial No. 198,840

This invention relates to an obstetrical instrument or device for protecting a prolapsed umbilical cord during childbirth, so as to avoid the death of the child and a stillbirth to cutting off the blood supply to the child.

The conditions which may be met such as are shown by the illustrations and described in the Principles and Practice of Obstetrics by Joseph B. De Lee, A. M., M. D., fifth edition, published in 1928, on pages 672 to 686, and also as shown and described in The Management of Obstetric Difficulties by Paul iitus, M. D., second edition, published in 1940, on pages 733 to 744.

However, the cord is always in the form of a loop with two branches either of which or both of which may be compressed and the two branches may be entwined or twisted together, thus causing a constriction which is dangerous and should be rectified.

The object of this invention is to provide a laterally flexible, longitudinal, expansible and contractible casing, sufficiently rigid to resist great pressure and made up of a series of rigid interlocking split rings, each of which is turnable with reference to each other, whereby the split in the rings may be aligned to form a slot which extends the entire length of the instrument and at the same time to have enough longitudinal clearance to permit the casing to bend to a certain extent.

One or more of the rings can be turned so that the slot is substantially closed, thus preventing the branch of the cord from escaping.

As part of the instrument, I provide a removable holding guide, serving also as a carrier and is formed of two parallel arms, eacnhaving on the outside a lengthwise groove, each made to fit over the opposing ends of a ring at each side of the slot, whereby all of the rings can be held in alignment to form a slot which extends from end to end, while the casing is put in place and a single branch of the cord, or in some cases both branches, can be put in place, whereupon the guide is removed to allow th loop to pass around i an open end of the casing.

The guide then can be replaced and by manipulation, turning circumferentially ha .1 and forth, alternate rings or certain rings, starting at the inside, can be turned to wholly on partially close the slot.

Also, preferably, I provide a handle in 'the form of pivoted tongs with finger and thumb holes at one end and teeth at the other end to serve as an extension of the guide'and to hold 3 Claims. (Cl. 128-361) it firmly when it is inside and also for convenient handling when outside the patient.

Inthe drawings,

Fig. 1 is a plan view of the complete instru ment, including the flexible casing, the guide and holding member, and the handle member.

Figs. 1 to 4 show the casing slot open.

Fig. 2 is an elevational view of the complete instrument shown in Fig. 1.

v Fig. 3 is a plan view of the casing, the guide and holding member and a loop of the umbilical cord, as one branch is being introduced into the slot between the arms of the guide and holding member and into the casing.

' Fig. 4 is a view similar to Fig. 3, with the guide and holding member removed and one branch of the cord inside the casing, the loop extending out therefrom and another loop along the outside of the casing.

Fig. 5 is a view similar to Fig. 4, after the guide and holding member has been re-introduced and has turned some of the rings to partly close the slot.

Fig. 6 is a diagrammatic view of a certain number of the casing rings closed, the umbilical cord in position, and curved to conform with the head.

Fig. 8A is a diagrammatic view, showing how the end rings of two casings can be interlocked to form one casing.

Fig. 7 is a longitudinal sectional view of an end ring of the preferred head type at the entering end of a casing.

Fig. 8 is a sectional view as on the line 8--8 of Fig. '7; Fig9 is a sectional view as on the line 8-9 of Fig. 1; Fig. 10 is an enlarged cliagrammatic longitudinal sectional view on part of the line lillfl of Fig. 2; and Fig. 11 is a view similar to Fig. 10, of a modification of the ring construction.

Fig. 12 is a plan view of the end of a guide and holding member with a block, both of the preferred construction for use with the prefer-red type of handle member or tongs.

Fig. 13 is a diagrammatic view illustrating how the ends of the arms at the block end of the guide and holding member can'be used to aline the ends of the rings of the casing to form a slot with straight sides.

. Fig. 14 is a longitudinal section of the adjoining parts of the block end of the guide and holding member and the contacting ends of the handle member or tongs.

Fig. 15 is an illustration of the position of the loop at the end of the cord with the casing closed around it, the loop being held in place by a piece of gauze.

Fig. 16 is a view similar to Fig. 15, of the loop at the end of the cord being pulled into the casing, and Fig. 17 is a diagrammatic view showing one position of the head, the pelvis, the umbilical cord and the casing.

Fig. 18 is a plan view similar to part of Fig. l of a modification of the block of the guide, its arms of the handle or tongs.

In the drawings C represents the casing as a whole, made up of interlocking split rings B, each of which in cross section is formed of S-shape with substantially square corners with an inwardly projecting radial leaf 2, an outside leaf 3, inwardly projecting leaf 4, inside leaf 8, and outwardly projecting leaf 9, Fig. 10.

As is clearly shown, the radial leaf 2 enters between leaves 4 and 9, thus interlocking and leaving the leaf 3 on the outside and the leaf 8 on the inside. At one end there is an end ring P which is so shaped as to serve as a head for introducing the assembly and this has an inside leaf l and a radial leaf which interlocks with adjoining leaves 2, 3, and 4 of the adjoining ring. Each ring R; and head 5 is split, leaving adjoining ends 6, 6, which, when aligned, form a straight slot I with parallel sides 48 and M, Fig. 4.

G represents a guide and holding member with parallel arms and-30, each being formed with a groove 3! and a rounded free end 32, its other end 34 also being rounded and curved at 35, the arms 39, 39 being held apart and at the right distance so that the ends 6, 6, of rings R, R, can be held apart and the slot i kept open with straight parallel sides 40 and 41.

Preferably the block B which holds the ends 35 and arms 35 in place, has sides 39, 39 and a curved channel 33, in extension of the grooves 3!, 3i, and a web 36 forming a recess 31 through which web is a tusk hole 38 to receive the tusks 28 and 28 of holding tongs T as will be described. See Fig. 14.

Preferably the block B, and, ends 35 with grooves 31, 3| and channel 33 are formed as a plough whereby this closed end of guide C can be pushed or worked in at H between the ends 8, 6, of the rings R, R, at the slot 1 as shown in Fig. 13 to align the sides 49 and M of the slot 1; or the free ends 32, 32 can be worked in or out as shown in Fig. 5. 4

The tongs T are formed of two crossed members 29, 29 pivoted at 24 and having, on one side of pivot 24, arms 22 and 22, each having at its free end a finger or thumb hole 23, and on the other side of the pivot jaws 2!, 2|, each with teeth 25, and preferably each with a tusk tooth 23 to enter hole 38, whereby as shown in Figs. 1 and 2, the casing C, held straight by guide G, can be carried around and inserted in the vagina and uterus or the tongs T and guide G can be released and the casing C left in the hand of the operator or the tongs T alone can be released and the casing C with guide G kept together as shown in Fig. 3, until one branch 12 of the umbilical cord A is dropped into slot 1 with its loop [4 extending around the end of casing C at 19 and the other branch I3 passed along the outside of easing C as shown in Figs. 3, i, and 17- The positions between the childs head H and the mothers pelvis F may be as shown in Fig, 1'7.

As shown in Fig. 5, the free ends 32, 32 of guide G can now be inserted in slot 1 at 19 engaging ends 6, 6, of the casing C, until all are aligned and then by holding head 5 and turning all the other rings R, R, by guide G, the slot 1 can be sufficiently closed to keep the branch 12 of cord A in casing C until guide G is removed.

The casing C can be so manipulated that it can bend, as shown in Fig. 6, branch 13 being passed along outside and, if that is necessary, between the curves of the head H, pelvis F, and casing C, as shown in Fig. 17.

As shown in Figs. 15 and 16, in some cases both branches l2 and I3 can be dropped down through slot 7, Fig. 15, or pulled through it into casing C as by a rubber tube L, known as a Penrose drain, Fig. 16, passed through loop [4 and the branches I2 and i3 kept from winding on each other as by a piece of gauze K, as shown in Fig. 15.

As explained, the main purpose of this device is to protect the umbilical cord from pressure and also to avoid kinks and twists. In the hands of a skilled operator it is possible to use the casing alone, preferably with the finishing ring, first aligning the split rings by the fingers so as to form a continuous slot such as i, then introducing the easing into the vagina or the uterus, if necessary, and usually dropping one branch of the cord through the slot.

For convenience, in aligning rings to form a continuous slot with straight edges, as shown in Fig. 13, the end of the guide and holding member with its plough shaped end, can conveniently be used for lining up the rings to make a straight slot or the free ends of the arms can be pushed in to line them up, as shown in Fig. l.

The manipulation of the casing can be done by a skilled operator to turn certain rings with the fingers after they have been lined up by the fingers or by the guide and holding member, after that member has been withdrawn, but in most cases this member is kept in place, holding the slot open with the rings on each side, until the cord is put in place, one branch extending over the holding block until enough rings have been turned either by the fingers or by the guide to keep it in place until the rings have looked the parts in place, as shown in Fig. 5.

The method of operation in turning the rings is preferably to start with the inside, either turn the inside finishing ring to lock the branch of the cord or the cord itself in place, then either by using the free ends of the arms, turning the whole assembly, successively, leaving the next inside ring in place, then moving alternately to the next or some other ring, leaving one or more in the new position, turning the rest back, then moving outward, leaving one or more in position, turning the next, leaving them, turning back, leaving more, and so on, until the last outside ring is rested in place, whereupon if the guide and holding member is used, the loop of the cord or the whole cord, as the case may be, is dropped into position, as shown in Figs. 3, 4, 5, 5, and 15.

The rings can be lined up by hand to form the receiving slot and the whole manipulation done with the fingers, but it is of great advantage to have the aligned arms to position the rings for the slot and then to use this guide in turning the rings to lock the device, moving it as described, in such a way that certain rings partly close the slot as shown in Fig. 5.

In many cases, depending on the conditions, the rings are lined up by the guide with the finishing member at the inside and the block member at the outside end and in many cases, this outside end can be grasped by the tongs so that the device can be held outside the body by the right hand while the left hand is used inside to guide the device as a whole and to manipulate the cord.

The principal feature of this device is a series of interlocking split rings, each with radial leaves connected by circumferential leaves, in which the adjoining radial leaves arev far enough apart or have clearance enough to allow the whole assembly to bend.

As shown in Fig. 6A, the material should be so springy that the end ring 90 of one assembly and the end ring 91 of another assembly can be so bent axially that a radial leaf at one side of a slot can be passed behind another radial leaf at the other side of a similar slot and by turning these end rings circumferentially the two assemblies can be connected so as to remain together as a single assembly.

As shown in Figs. 2, 3, 4, 5, and 6, the finishing ring 5 can be merely rounded at the end and otherwise substantially cylindrical, but as shown in Fig. '7, the preferred type tapers somewhat. Instead of an S-shape for the cross section of each ring, such as shown in Fig. 10, I may, as shown in Fig. 11, use two sets of interlocking rings, the inner ones being indicated by D and the outer ones by W, the outer rings W each having two inwardly projecting radial leaves 10, 10, and an outside circumferential connecting leaf 14, while the inside ring D has outwardly projecting radial leaves 12, 12, and an inside circumferential connecting leaf such as 13.

It is also understood that as shown in Fig. 18, the teeth 25 may be dispensedjwith as well as the tusk tooth 28, and the tusk hole 38 in the web 36 forming part of the block B in a recess 36.

The tongs may merely have friction clamping jaws 80, 8|, and the block 82 of the guide and molding member which holds the arms 83, 84 may be formed at 85 in'spade shape, while the ends of the arms 83, 84 are rounded but do not curve towards each other.

relatively turnable and axially movable with reference to each other to so register as to provide a slot the entire length of the instrument to "permit a branch of the cord to be placed in and to extend through the entire length of the casing or to partially close the slot to retain such branch of the cord in said casing; in combination with a removable guide and holding member including a block fixed to and from which project two parallel arms each having an outside lengthwise groove, the free ends of each to fit between the ends of the split rings whereby the slot can be kept open for the insertion of the cord or part of the rings can be successively turned to close the slot.

2. A device such as described as the subject matter of claim 1, in which the fixed ends of the arms of the guide and holding member are connected by a block, the sides of the free end of the block and the grooves extending from the arms curving towards each other.

3. A device such as described as the subject matter of claim 1, in which the fixed ends of the arms of the guide and holding member are connected by a block including a web forming a recess, the sides of the free end of the block and the grooves extending from the arms curving towards each other and towards the recess.

ALAN L. SCHOFIELD.

REFERENCES CITED The following references are of record in the file of this patent:

UNITED STATES PATENTS Number Name Date 421,781 Stoughton Feb. 18, 1890 2,402, 97 Johnson June 18, 1946

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