FLOODING-UNAVOIDABLE HEMORRHAGE-PLACENTA PRAEVIA.
THE hemorrhage that may occur in non-pregnancy women has already been considered. (See page 287 of he present work.) That which arises in pregnancy at any time previous to the latter months of gestation, has been discussed in connection with Abortion, with which it tends to result. Puerperal hemorrhage, our present theme, includes the flooding which occurs just previous to labor, during its progress, or subsequent to its conclusion. No complication of labor will be more dreaded by the young practitioner, since there is non capable of proving more rapidly fatal unless promptly arrested. Nor indeed can this indispensable result be produced unless he physician so completely remains his presence of mind in the most trying the moments as to be able to ascertain the cause of he mischief; institute the requisite procedure where direct interference is not called for.
In the natural course of labor the child is delivered while the placenta still retains, more or less perfectly, its connection with the uterus. In such cases little or no hemorrhage takes place up to this time. But with the fist pains which occur after the expulsion of the child from this moment, until the uterus has considerably contracted upon itself after the discharge of the placenta begins to separate from its adhesion to the uterine parietes; and from this moment, until the uterus has considerably contacted upon itself after the discharge of the placental mass, there is sometimes considerable loss of blood sometimes almost none at all. Where all goes well, and the placenta is delivered, as it usually is, within fifteen or twenty minute after the birth of the child, the hemorrhage that does take place proves beneficial rather than injurious to the mother, by relieving the engorgement of the uterus and enabling the system in general, more readily to adapt itself to the new conditions.
But just in proportion as this hemorrhage becomes prolonged it becomes more and more dangerous, whether it arise from causes which hinder the progress of the labor in the first instance; or prevent the subsequent contraction of the uterine parties. hence in order to be able intelligently to employ the requisite means, it is absolutely essential to learn what are the efficient causes of he flooding in each individual case. This knowledge is to be obtained from the history of thatches; from the conditions and symptoms obviously present; and from digital examination.
The haemorrhage which occurs during the last month of gestation threatening to bring on labor, and what which appears at the commencement for labor itself, results from the influence of one of he classes of causes dependent upon the relative situation of the placenta. That has been termed :accidental hemorrhage, which arises from the partial and accidental separation of he placenta occupying its usual position. While that has been termed “unavoidable hemorrhage,
which result from the placenta being placed partially or wholly over the so uteri-(Placenta praevia.) Unavoidable, since the dilatation of those must necessarily detach the after birth. Thus each successively pain t the same time increases the dilation;l the separation of the placenta from its adhesions, and a fortiori, the unavoidable flow. the hemorrhage, often not very severe, which occurs during the progress of the labor, arises, also from he premature, and either partial or complete separation on placenta before the expulsion of the foetus will allow the uterus to contract upon itself so off essentially s to prevent the abundant flow of blood into its veins, and close the open months of it sinuses. While the flooding which occurs after delivery of the child, may be occasioned by the retained placenta, either still adherent, or even when separated, by its present ant the uterus presenting he necessary reduction of that organ. Or it may result from want of tone and contractility of the uterus itself, and from the consequent total absence of the after pains by which alone the uterine veins and open-mouthed sinuses might be effectually obstructed. In some of the worst cases of Puerperal hemorrhages these causes are successive and cumulative; the previous loss of blood so debilitating the system as to deprive the nervous energies of all power of contracting the walls of he uterus,. and thus pr preventing the flow from still continuing. In such cases so vast and numerous are the exposed vessels of the uterus, and consequently so rapid and enormous is the haemorrhage, that the fainting by which nature in the instances seeks to save life, by diminishing the force of the flow from still blood, comes stood late; and the patient unless otherwise rescued, become so thoroughly depleted as to be incapable of subsequent restoration, even if she does not perish at once.
ACCIDENTAL HEMORRHAGE occurs when from any cause a portion to the placenta becomes detached from the uterus. the hemorrhage in this event may remain internal for a while; but at length its flow will descend between the uterus and the epichorion and appear externally. In these cases the haemorrhage continues constantly every moment, day and night, more or less profuse, unless there is pain, when it ceases during the contraction In cases of hemorrhage of this kind the immediate cause of the flooding is the separation of some portion of the placenta, and the laceration of its vessels; since these cannot be closed by the contraction of the uterus while it is still full. This separation of the placenta may result from shocks or blows, or violence of any kinds fatigue, overexertion, straining from lifting or otherwise. In some constitutions, plethoric or susceptible the slightest influences suffice to bring on the haemorrhage, m and the certain cases it seems to arise, as it were spontaneously in the course of labor. the flow is not necessarily external; since, as already stated the blood may be retained within the womb. In these cases the existence of the hemorrhage must be determined from the constitutional symptoms; these are, rigors, tension and sensation of fullness and weight in the abdomen and faintness. When such symptoms appear in. the course of a labor, they should always exact strong suspicion of internal hemorrhage; and the state of the pulse may confirm he suspicion, especially if weak, or sinking. “When the flooding its is internal during labor, none may escape till after the expulsion of the child or placenta, and the characteristic symptoms are gradual diminution or cessation of the pains with fainting which may possibly by mistaken for symptoms of laceration, but differing from this latter accident in the gradual cessation of he pains nd the absence, or recession of the head. At length, with or without pain, the discharge commences, varying in amount from a few ounces to a quantity sufficient to compromise the patient safety.
Churchill.
The diagnosis of accidental from unavoidable haemorrhage is essential to it proper treatment; and it may be determined by means of the four following distinctions:
I. Accidental hemorrhage before labor, or in it first stage, usually result from some definite and ascertained external cause.
II. In accidental haemorrhage, the discharge takes place freely in the interval between the pains; but it is arrested by the pains themselves during their continuance, while in unavoidable hemorrhage, from placenta praevia, the conditions are exactly opposite the flow occurring during the pain which expander the so uteri.
III. In accidental hemorrhage, the so uteri is free and closed by the membranes only;while in other cases, the presence of the placenta may be detected, over or near the so, the digital examination.
IV. By means of the stethoscope, the situation of the placenta and its presence in the fundus or body of the womb, or elsewhere, may be positively determined.
The treatment of ceases of accidental hemorrhage, e in Homoeopathic practice, is at once simple and in almost all instances perfectly successful. It consists in maintaining he patient in a state of perfect quiet in body and in mind in sustaining her strength with nourishment suitable to the occasion and in the existing symptoms and conditions. Since seen he exact cause of the mischief, as in cases of the mischief, as in cases of flooding resulting from a flow or strain, will often direct to the proper remedy. And the utmost care should be taken, and indeed the greatest pains will sometimes be necessary to arrest this kind of hemorrhage, which is usually very persistent. the remedies which will be require it cases of accidental haemorrhage will be found described already under the head of uterine Hemorrhage, in previous chapter of the present work. Neither tampons, nor any injections will be needed to arrest the haemorrhage, if the above rules are observed and the proper remedy selected.
When there are pains, or when it is evident that delivery alone can be expected to finally arrest the hemorrhage, remedies suited to the existing conditions in. these respects must be selected, remedies which will render available such desultory and inefficient pains as may be present, or bring on actual labor pains when these latter are entirely wanting. In these case the haemorrhage softens the cervix uteri, and disposes it to yield more readily to the pressure of the head. And when the flooding is prose and the danger in eminent, the membranes may be ruptured in. the usual manner; then the pains will increase and the haemorrhage diminish as the labor advances, The happy result comes from the fact that the bulk of the uterus being diminished by the evacuation of the liquor amnii, its walls more effectually contact upon the placenta, at least temporarily arresting he flow from the uterine sinuses, and a the same time facilitating the expulsion of the foetus.
