On uterine haemorrhage, with particular reference to a case of partial presentation of the placenta / by John Renton.
- Date:
- [1838?]
Licence: Public Domain Mark
Credit: On uterine haemorrhage, with particular reference to a case of partial presentation of the placenta / by John Renton. 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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![that a portion might be disrupted. I took his place, and made an effort with the funis to withdraw it. Disappointed in this, I introduced my hand into the uterus, and found a considerable portion of the placental mass adhering to its anterior parietes, about three inches above the cervix ; but by far the greater portion was detached, and lying in the way which Mr. Ingleby has described, partly within and partly without, but not re- tained by the os uteri. I withdrew the whole en masse, and administered a large dose of solid opium. We watched the case for two hours, and neither hsemorrhage nor any untoward symptom supervened. The progress of her recovery was very much retarded by a severe at- tack, on the third day after delivery, of pneumonia, and subsequently of phlegmasia dolens. From her extreme exhaustion, Mr. G. despaired of her being able to stand the antiphlogistic treatment he found necessary to adopt for the removal of these complaints. Under his management, however, she was restored to her usual state of health in the course of three or four months. I have been induced to allude to the particular cause of the detention of the placenta, because it is of rare occurrence, and corroborates the re- marks which Mr. Ingleby has made on the dangerous rule laid down by Dr. Gooch, in regard to the force which he recommends for the extrac- tion of the placenta, when it is felt in the upper part of the vagina.* 1 have had occasion too often to have recourse to manipulation in the removal of those preternatural attachments by which the placenta is sometimes connected by small portions of its mass, and at other times throughout its whole bulk, to the uterine surface, to be possibly mistaken in this case, as to the nature of the adhesion. Uterine contraction had detached a much larger portion of placenta than had been removed be- fore delivery, as the very different appearances on its surface afterwards indicated ; but the remaining portion, which I gradually separated with my fingers, was too intimately connected to be w^ithdrawn by any other method than the one I adopted. Had the cause of detention been mis- understood, and forcible attempts at extraction been made by pulling the funis, or that portion of the placenta which was without the os uteri, a considerable portion must have been left within the womb, and would probably, in the almost exsanguined condition of our patient, have pro- duced fatal effects. Dr. Burns observes,-]- that irregular action of the uterine fibres may be spasmodic; a state in which the circular fibres of the cervix are general- ly affected. On this condition we can explain the colic or cramp pains, as they have been expressly termed, with which Mrs. R. was so much distressed before the commencement of labour. But the chief and particular cause which retarded its progress consisted in the undeveloped band of the cervix uteri. At the same time, while such a primary agency is admitted in the production of the inefficient state of uterine action, it would be improper, while we take into account all the circumstances of the case, to overlook the co-operations of those accessory causes which I have described as arising from superabundance - Vide Ingleby's Treatise on Uterine Haemorrhage, p. 202. t Vide Burns' Principles of Midwifery, 8th edit. p. 419.](https://iiif.wellcomecollection.org/image/b21957332_0010.jp2/full/800%2C/0/default.jpg)
