SIGNS OF DELIVERY 301
is bright red (lochia rubra) consisting of pure blood mixed with large clots.
It becomes serous and paler in colour (l&chia serosa) during the next four
days. About the ninth day the colour becomes yellowish-grey or slightly
greenish (lochia alba or green water), and gradually diminishes in quantity,
till it disappears altogether from the second to the third week.
From the above signs taken collectively it will scarcely be difficult to
diagnose a case of recent delivery for the first fourteen days after parturi-
tion. These signs are more characteristic of a full-term delivery than of a
premature one. They are likely to disappear within a week or ten days or
even at an earlier date in a strong and vigorous woman, especially if she
happens to be a multipara.
II. SIGNS OF RECENT DELIVERY IN THE DEAD
The diagnosis of recent delivery in the dead hardly presents any
difficulty. In addition to the signs described above, the uterus is found
flabby and nine to twelve inches long, containing large clots of blood, and
its inner surface is lined by the decidua if necropsy -is held on the body, of a
woman who has died soon after delivery. The uterus in course of time
becomes more and more contracted. In the first two or three days after
a full-term delivery it is about seven inches long and four inches broad. At
the end of a week it is between five or six inches long and about an inch
thick. At the end of a fortnight it hardly exceeds five inches in length, and
returns to the normal size in about six weeks. Soon after delivery the
uterus weighs about twenty-eight ounces, twelve ounces at the end of a
week or ten days and about one and a half ounces by the end of a month.
The site of the placental attachment is of a dark colour. The openings
of its vessels are well marked, and recognizable for two or three months.
The ovaries and the Fallopian tubes are usually congested, but may
become normal in a few days. A large corpus luteum is usually found in
one of the ovaries.
IH. SIGNS OF REMOTE DELIVERY IN THE LIVING
1. Abdomen.—The abdominal wall is relaxed, and marked with white
silvery streaks, called the lineae albicantes, which result from overdistension.
These lines also occur from ascites, ovarian tumours, etc.
2. Breasts.—These are soft and pendulous, marked with linese albi-
cantes. The areolae are dark. The nipples are prominent and larger than
usual, unless the woman has not suckled her child.
3. Vagina.—The labia are more or less separated from each other. The
vagina is somewhat capacious, its rugae are absent, and its walls are
relaxed, especially in a multiparous woman. The fourchette and posterior
commissure are destroyed, and the perinaeum may be found ruptured. The
hymen is absent, or may be seen as separate nodules in the form of
4. Cervix.—The cervix is cleft transversely with ragged and irregular
margins. The os is wider.
Most of the above signs may possibly be simulated by the passage,
large fibroid tumour per vaginam. Again, most of these
disappear in a woman who had had only one delivery short of the :
several years ago, and it is possible for the vagina and utegiisY 4
normal appearances""as observed in a nulliparous woman.