Placenta praevia / by G.M.B. Maughs.

  • Maughs, G. M. B. (George Madison Brown), 1821-1901.
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: Placenta praevia / by G.M.B. Maughs. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Rarasbotham gives both the fact and the reason. He says: “ We may, perhaps, find her faint and cold and gasping, the uterus quite inactive, with its mouth widely open, and possess- ing that degree of unresisting flabbiness which, to an expe- rienced hand, is indicative of urgent danger; undef)- this condi- tion delivery icould indeed be easy, but it icould at the same time be followed by almost certain death, for, if we empty the uterus un- der syncope or deep and long-continued fainting, we cannot reasonably suppose it will take upon itself that degree of action necessary to close its vessels and insure permanent safe- ty ; our indication here would be to arouse the ])atient, to bring her to a certain point—stimulants are absolutely called for. Under such circumstances, although it is a maxim in obstetrics never to allow a patient to die undelivered, it should also be an- other maxim never to emj)ty the uterus during syncope, for it is not the mere extraction of the child, but to leave the woman in the best condition for recovery; but another danger (besides the woman dying of hiemorrhage) must be added. The sudden emptying the uterus of the whole of its contents nearly to- gether, and that, too, when the constitution, weakened by haem- orrhage, is easily aflfected by any depressing action. We well know the effects of suddenly evacuating the water in ascites, that the most hearty persons will sometimes falj into a state of syncope by the sudden removal of the pressure—the same con- dition exists when the pressure of the gravid uterus is re- moved by the evacuation of the liquor amnii and the extraction of the child at a time when the system is sufl'ering from de- pressing causes, and we cannot wonder that collapse occurs as a consequence, even though the delivery be perfected with but slight additional loss of blood.” The quotations will doubtless be accepted as sufficient to justify—fortify—our urgent advice not to hastily empty the ute- rus duringgreat exhaustion; let none forget or disregard the ad- monition, as the penalty for so doing is death. Well, what should be done in addition to what has been recommended in such cases, as in those more desperate still, where we cannot, dare not do even this ? To answer this question, we will suppose a case in the last extremity. The woman has had frequent haemorrhages, and falls in labor at full term with a fearful haemorrhage, faints, rallies, faints again, and is found by the accoucheur almost in artieulo moHis, pulseless, labored respiration, surface cold.