UTERINE HEMORRHAGE. 103 



head has descended, and the parts are in a favourable condition, it is 

 better to use the forceps. If the woman has had children, the pelvis 

 is roomy and the soft parts dilated, and the presenting part not 

 descended too low, the child may be turned. Should the cord have 

 ceased to pulsate, we need not interfere. 



UTERINE HEMORRHAGE. 



There are three varieties of hemorrhage treated of by obstetrical 

 writers, viz.: accidental; unavoidable ; QluA hemorrhage after delivery. 

 The first generally occurs before or during labour, and arises from 

 a partial and accidental separation of the placenta, which is gene- 

 rally in its usual position. 



The immediate cause of the flooding is the separation of some 

 portion of the placenta from the womb, and laceration of its vessels ; 

 the remote cause may be undue muscular exertion ; blows ; falls ; 

 mental excitement ; straining at stool ; general plethora, &c. 



Diagnosis. — This variety of hemorrhage is distinguished from 

 that which depends on implantation of the placenta over the cervix 

 uteri by these circumstances : the os uteri may be felt on examination 

 to contain nothing but the bag of waters ; that the hemorrhage 

 occurs during the interval of the pains, and is arrested by the uterine 

 contractions ; and that we can generally make out some definite 

 cause for accidental hemorrhage, and its occurrence is irregular. 



When the blood which is poured forth from the uterine vessels 

 on the separation of the placenta, is at once discharged externally, 

 the nature of the case is clear. But it may happen that the blood 

 may be poured into the bag of membranes, or between the mem- 

 branes and the womb, without appearing externally, and may thus 

 prove fatal, without the practitioner being aware of the danger. 



This condition of things may be suspected, if, towards the end of 

 pregnancy, the patient is subjected to any of the above causes that 

 may produce hemorrhage, and if she complain of dull aching pains 

 in the back, tenderness of the womb, with, perhaps, obvious swelling 

 at some part of it, together with faintness, and the constitutional 

 signs of loss of blood. 



Treatment. — If the patient has not arrived at her full time, the 

 hemorrhage is not profuse, and the os uteri undilated, there is no 

 immediate danger. She should be placed in a horizontal position 

 on a hard mattress, and lightly covered ; cold applications to the 

 pubes, or cold enemata, should be used. Internally, the infusion of 

 rose leaves and aromatic sulphuric acid, or acetate of lead and opium, 

 should be administered. 



Should these measures not succeed, recourse may be had to the 

 tampon. It should be remembered, however, that this instrument 

 should never be employed when the uterus is empty ^ as the blood 

 might collect within the cavity till the woman perished from the loss. 



Should these means fail, there still exists another, viz. : rupturing 



