COMPLICATED DELIVERY OF PLACENTA. 545 



SECTION 2. 



Complicated Delivery of the Sfter-hirth. 



Inertia, hemorrhage, convulsions, syncope, the rupture of the 

 cord, preternatural adhesions, an encysted state of the placenta, ex- 

 cessive size of it, and a spasmodic contraction of the os uteri, con- 

 stitute a number of accidents which sometimes complicate the de- 

 livery, and require that we should hasten or protract the term of its 

 exclusion. 



1181. Inertia of the womb, after delivery of the child, is more 

 particularly observed to happen in women who are weak and ex- 

 hausted by flooding or the fatigue of a protracted labor; it is also 

 met with after too sudden a delivery of the child, and in these dif- 

 ferent cases it requires a caution which is peculiar in each. Some- 

 times the proper remedy is a little good wine, sometimes a little 

 light and analeptic aliment, at others rest; but it is always useful to 

 excite the womb through the hypogastrium, by rubbing and pressing 

 it with the ends of the fingers, and even by compressing it with a 

 certain degree of force, alternately from above downwards, from 

 side to side, and from before backwards, as if with a view to m.ass 

 it, and oblige it to contract its dimensions. Pulling at the cord, if 

 attempted previously to the cessation of the inertia, would hazard 

 the production of an inversion of the womb, less perhaps, in conse- 

 quence of any remaining adhesions of the placenta, than from the 

 direct pressure of the abdominal viscera upon a soft and contracted 

 bag; transmitted to the internal surface of the gestative organ, they 

 might, also, invite an affluxion of blood to it, and give rise to hemor- 

 rhage. They must therefore be dispensed with, unless some d'erious 

 accident obliges us to act otherwise. Thus, inertia of the womb 

 ought to be classed among the complications which retard the de- 

 livery of the placenta. 



1182. The volume of the after-birth is in some instances the only 

 cause that retards its expulsion. But this excess of size is often 

 more apparent than real, and depends on the blood being amassed 

 behind the membranes. Where the placenta is really too large, 

 moderate and skilful tractions almost always suffice; if not, we must 

 wait, and the natural retraction of the uterus at last renders its ex- 

 traction easy. In the second case, which is the most common, if 

 the contractions of the womb and force carefully exerted upon the 

 cord are inefficacious, the membranes may be torn, or the placenta 

 itself perforated with the fingers, and a passage made for the fluids 

 behind them. 



