COMPLICATED DELIVERY OF PLACENTA. 559 



tracted without detaching the other, not that this practice must in- 

 evitably occasion an inertia of the womb or bring on flooding, as 

 has been supposed by some persons, who found the opinion upon 

 the false notion that certain large orifices would remain, through 

 which the blood flows into the uterine cavity, but because it is al- 

 ways dangerous to destroy the organic relation of the foetus witli its 

 mother, unless it be on the point of expulsion itself. One single 

 circumstance might permit us to depart from this rule: it is when 

 the after-birth of the first child presents spontaneously at the orifice, 

 before the birth of the second, and then care should be taken not to 

 destroy the adhesions of the one that remains. 



In general, the delivery of the placenta after the birth of twins, 

 is longer in taking place than in the common case, provided it be 

 not provoked by the accoucheur; which depends upon the uterus 

 having rather less tendency to contract, and perhaps also, upon the 

 fact that the size of a double placenta, is necessarily greater. 



In order to assist it we may take hold of one of the cords, or 

 one of the placentae, and draw down the two after-births, one after 

 the other; but it is better, more prompt, and safer to twist the two 

 cords round each other, so as to make one siring of them, and then 

 act as in a simple case. The placentae, being almost never at the 

 same level in the organs, present at the orifice in succession, and not 

 both at once; besides, if the contrary should happen to be the case, 

 and their escape rendered difficult, it would be too easy to over- 

 come such an inconvenience for it to be necessary for me to enter 

 into any long explanations concerning it.* 



1208. After an abortion, the delivery of the placenta is generally 

 not so easy as it is after a labor at full term; in the first three months 

 of pregnancy the ovum is almost always expelled whole, and there 

 is therefore no delivery, properly so called; but after that period, this 

 expulsion in mass becomes more and more rare and difficult. The 

 foetus escapes first; its involucra remain and are not expelled until 

 sometime afterwards, sooner or later. The cervix recovering its 

 original form and length, soon resists the necessarily feeble efforts of 

 the uterus; the after-birth having scarcely changed its relations to the 

 ■ organs in which it is contained, cannot clear its orifice and fall into 

 the vagina, but with great difficulty. On the other hand, the cord 



* Let not the student be led, from the above paragraph, to expect to find two 

 distinct placentae in all cases; on the contrary, most of the cases of twins are ac- 

 companied with a single oblong or oval placenta, the two cords springing from 

 the eccentric points. — In a case of triplets, under my care, there was one very 

 long oval placenta, with the three umbilical cords in a line, distant near two 

 inches from each other. — M. 



