Or in those cases in which the hemorrhage becomes truly alarming, before the full times has come, or before labor has actually set in, it will become necessary to induce labor. This can most safely be accomplish, by using the “Essex Enema Syringe, or any other syringe, by which a quantity of water shall be thrown directly upon the so and neck of the uterus, or, of the so be sufficiently dilated the membranes may be ruptured at once. See Induction of premature Labor, page 549.
UNAVOIDABLE HEMORRHAGE-PLACENTA PRAEVIA-Occurs when the ovule had descended in the early days of pregnancy and has become fixed to some spot near the internal so, so that the placenta become developed either very near the so uteri;l over a portion of it; or covers it completely, centre for center.
In these cases it is very evident that as the uterus develops from above downward to the internal so, the disproportion between the placenta and the internal os must become very great after the sixth month of pregnancy; hence a rupture must take place and the hemorrhage occur more or less of attachment becomes separated.
Unavoidable haemorrhages seldom occur till after t the sixth month; and then they come suddenly, without and admonition or apparent provoking cause,.. The the hemorrhage may start while the patient is quietly sleeping in bed; sitting at her sewing at the piano or yet in church or the subsequent attacks. And the flooding is always liable to become more and more profuse are every attack. for the disproportion between he placenta and development of he lower segment of uterus becomes grate and greater as the time for delivery approaches.
The treatment proper to be pursued when these haemorrhage occur is to keep the patient as quiet as possible, and to prescribe such remedies as are recommended of Uterine Haemorrhages, till the patient sees quiet well again. The course is pursues from time to time, till the arrest of the the haemorrhage in this manner seems to longer possible. If we now make an examination per vaginal, we shall usually find the os uteri more or less upon; and if the placenta be entirely over the os, the lips will be thicker than usual; or if the pleasant covers one side of the os only, the lips corresponding to the attachment will be thickest, owing to the increased growth from the attachment of the placenta. The finger will so remained us of the presence of a spongy mass, quite unlike the smooth surface of the membranes. We could only mistake this for a cauliflower excrescence; and not thickness, if the placenta is over the entire os and it is impossible of introduce the finger within the curiosity of the uterus on account of the close adhesion all around just within the circumstance of the os. If the placenta but partially covers the os uteri, then, only one lip or side will be thickened; and the condition will the shown by the inability to carry the finger up within the uterus on hat side; and the condition will be shown by the inability to carry the finger up within the uterus on that side; and by the ability to carry to cup on the other side and to feel there the smooth membranes. Add to the above condition the face, that if there are labour pains, the haemorrhage will always be worse during the pains, stance is this: the object of the pain, or contraction of uterus, is to dilate the os so as to complete the first stage of labor; and of course he more the os dilates the more its adhesions will the placenta will be break up; and as it cannot expel a nag of membranes full of water, so the great the pains the greater the hemorrhages during their continuance.
Now the only safe plan for deliverance is to draw off the liquor amnii, though the placenta, thus the bulk of the uterus is send, it contacts upon itself and the hemorrhage ceases at once. As the connection now takes place, the os is dilated without tearing up the adhesions to the placenta. And as dilation is effected, the placenta separates between its cotyledons and the presenting portion portion of the child follows and passes through its centre. And as dilation is effected, the placenta separates between it cotyledons, and the presenting portion of the child follows and passes through it centre, And the placenta itself is finally delivered after the birth of the child as in ordinary cases.
The time and more of operating in this matter, are as follows: When it becomes apparent that the hemorrhage is no longer controllable, and the woman’s life is tin danger from further loss of blood, the finger must explore a sulcus between the cotyledons of the placenta, and with the same hand a female catheter, previously concealed in. the palm, must be forced through the membranes during a pain. the liquor amnii now passes off freely through the catheter;l the bulk of the uterus begins at once to shrink and the haemorrhage ceases. The ginger may be sue door the pursue of rupturing he membranes between the sulci, as in ordinary cases. But much care is needed in this event in order that the waters do not discharge themselves stood rapidly and thus produce atony from too sudden relief, for then that the haemorrhage would not cease, The liquor amnii must flow slowly; and as surely as it thus flows, so surely will the haemorrhage cease. After the water has pretty much escaped. the finger may take the place of the catheter, and aid entering the orifice larger, so that the presenting part can descend. If the shoulder is found penetrating, any other malpresentation, the hand must be introduced through the placenta; and the presentation corrected as in ordinary cases.
By this method of procedure, not a single mother was ever lost; and the child is almost invariably saved. No pain is inflicted upon the mother in tearing off the placenta as is recommended in the usually practice; but she rallies as if by magic, immediately after the picture. Even severe and either months children are saved in this manner. But it must be remembered to evacuate the liquor amnii very slowly every accoucheur knows the bad effect of emptying he uterus rapidly under such circumstances; the atony thereby produced is more to be dreaded than the former state.
When the placenta is only partially over the os, or even down to the edge, the same principle and practice hold good. We have not space to contrast the old and the new practice in these cases. Surface it so say that in the method formerly pursued dreadful pain is inflicted in forcing the hand between the adherent placenta and the uterus. Another and still more important objection to the usual course of procedure, is the careful mortality both of mothers and of children.
