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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![of the liquor amnii,* its confinement above the fcetal head in the upper part of the uterus, and the disordered state of the digestive organs.-]- It would be, perhaps, refining too much on causes to assign to each its particular share of power in retarding or counteracting labour; but if I might be permitted doing so, I would say in this case, comparing the pains with the resistance made, that the imperfection and insufficiency of the labour originated in the constriction of the cervix uteri and over- distension of the uterine parietes, and its irregularity in the fits of nausea and sickness. Of the particular cases in which the plug may be advantageously era- ployed it does not become me to speak, having had no experience in its use. I have a general dislike to it in the latter months of pregnancy, on the ground that when hsemorrhage, either from accidental or unavoid- . able causes, occurs, procrastination becomes, in every sense of the word, ' the thief of time, and deferred hope in no circumstance is more apt : to make the heart sick, not only of the patient, but of the practitioner. Dr. Burns says, As long as the os uteri is firm and unyielding—as 1 long as there is no tendency to open, no attempt to establish contraction, : it is perfectly safe to trust to the plug, rest, and cold. But I must parti- . cularly state to the reader, that the os uteri may dilate without regular ; pains, and in almost every instance it does, whether there be or be not I pains, become dilatable. t)id I not know the danger of estabhshing posi- I live rules, I would say that as long as the os uteri is firm, and has no ' disposition to open, the patient can be in little risk, if we understand the ■ use of the plug ; we may even stuff the os uteri itself, which will excite I contraction. But if the patient be neglected, then, I grant, that long : before a tendency to labour or contraction be induced she may perish. It is evident when the uterus has a disposition to contract, and the os : uteri to open, delivery must be much safer and easier than when it is still inert, and the os uteri hard. He adds, In some instances we shall find I that by the plug alone we may secure the patient. In these circumstances, ' who would propose to turn the child and deliver it ? Who would not I prefer the operation of nature to that of the accoucheur ? To determine iin any individual case whether this shall take place, or whether delivery : must be resorted to, will require deliberation on the part of the practitioner. ;If he have used the plug early and effectually, and the pains have become brisk, he has good reason to expect natural expulsion, and the labour tmust be conducted on the general principles of midwifery. But if the I uterus have been enfeebled by loss of blood—if the pains be indefinite 1 if they have done little more than just open the os uteri, and have no dis- ! position to increase—then he is not justified in expecting that expulsion ^shall be naturally and safely accomplished, and he ought to deliver. 'When he dilates the os uteri, he excites the uterine action, and feels the rmembranes become tense. But he must not trust to this; he must finish i what he has begun. ,Denman has an excellent section on the too great distension of the uterus Vide Introduction, &c. 7th Edit. p. 223. + In Burns' Principles, p. 418, an attempt is made to account for this, '• bv «b;niRes ni the action or condition of the origin of the nerves supplying the uterus. -T Vide Burns'Principles, p. {326. e](https://iiif.wellcomecollection.org/image/b21957332_0011.jp2/full/800%2C/0/default.jpg)
