On the prevention and treatment of post-partum hemorrhage / by Thomas More Madden.

Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: On the prevention and treatment of post-partum hemorrhage / by Thomas More Madden. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    Despite all our efforts, however, she sank rapidly and died within an hour’s time, from the effect of the hemorrhage she had suffered before the reposition of the uterus. The complication of labor with uterine fibroids is another occasional cause of post-partum flooding. The following case is a fair example of the instances of this kind which have come under my observation: I was sent for by Dr. Boyle, of Eathgar, to see a lady some distance from Dublin, and, on my arrival, finding that she had been for a considerable time in the second stage, delivered her with the short forceps. Hemorrhage set in during the third stage ; and, the placenta being morbidly adherent, on introducing my hand to remove it, I found a large fibroid tumor growing from the fundus uteri. After the removal of the placenta, the hemorrhage became still more profuse than before, so that the flooding saturated the bed and floor of tlie room, and having re- duced the patient to a])parently the last extremity, was at last arrested by the ]ierchloride of iron and firm pressure on the uterus. Eupture of the uterus, although generally the most fatal, as well as one of the rarest complications of childbirth, may be possibly recovered from as far as the shock of the accident is concerned, and yet may cause death from the accompanying hemorrhage sifter delivery, smd hence must be referred to in con- nection with the subject of this paper. A table, elsewhere published, which I compiled from the Reports of the Rotunda Hospital, shows that in (>1,814 cases of hiboi-, there were 92 in- stances of rupture of the uterus, of which only 5 occurred in primiparous patients. Of these cases, 86 proved fatal. In my own experience, four cases of rupture of the utenis have occur- red, and of these, in only one did the patient recover.. In that csise, which I saw in consultation with Dr. Dudley White, of Dublin, rupture of the uterus resulted from arrested delivery in a transverse presentation, and had occurred before any medical assistance was sought. When we arrived,the patient was in a state of collapse, and on delivering her by version, we found a large rent in the anterior wall of the uterus, extending from the cer- vix up to the fundus. From this laceration, and from every }>art of the uncontracted uterus, profuse hemorrhage was pouring into the peritoneal cavity as well as externally. As it would have been impossible to inject the percliloride of iron in the ordinary way, in such a case, without sending the injection into the ab- dominal cavity; and as the woman was obviously dying from the effect of unarrested hemorrhage, as well as from the shock of the