104 



OBSTETRICS. 



the membranes and allowing the liquor amnii to escape. As soon as 

 this is done, the uterus contracts, compresses the orifices of the 

 bleeding vessels, and thus arrests the hemorrhage. 



Should the contractions not come on, the organ may be stimulated 

 by the administration of ergot, and friction over the abdomen. The 

 OS uteri is generally so relaxed by the hemorrhage as to be very 

 dilatable. It has also been proposed, if all these fail, to introduce 

 the hand, turn the child, and thus terminate the labour. 



The placenta is usually expelled immediately after the child ; if 

 it be not, it is much better to extract it, and secure a firm contraction 

 of the uterus, than to allow the hemorrhage to continue. 



If the patient's strength is much exhausted, stimulants should be 

 used, and nutritious articles of diet exhibited. It is generally con- 

 sidered advisable to keep down the reaction that succeeds excessive 

 hemorrhages, by the administration of opium, combined, if necessary, 

 with some stimulants. The patient should be kept in a strictly hori- 

 zontal position till all danger of a recurrence is past. 



UNAVOIDABLE HEMORRHAGE. 



Placenta prcevia ; 'placental presentation. — The hemorrhage 

 which results in this case is the necessary and unavoidable conse- 

 quence of the dilatation of the os uteri, by which the connexion 



between the placenta 



Fig. 37. 



and uterus is separated ; 

 the greater the separa- 

 tion, the greater the 

 hemorrhage, as the la- 

 bour advances. The 

 placenta may be situa- 

 ted partially, or entirely 

 over the os uteri. (Fig. 

 37.) The cause of the 

 hemorrhage is the sepa- 

 ration of the placenta 

 from the cervix uteri, 

 and the consequent ex- 

 posure of the mouths 

 of the bleeding vessels. 

 Symptoms. — The 

 first discharge generally 

 occurs from about three 

 to five weeks before la- 

 bour commences; the 

 amount varies, but is 

 generally slight at first 

 and unaccompanied by 

 pain. It returns again 



