560 DELIVERY OF THE PLACENTA. 



is so weak that it will bear only slight pulling, and notwithstanding 

 retention of the placenta after abortion is scarcely a less serious 

 matter than after labor at full term. 



As inertia, and inversion of the womb are not to be dreaded in 

 this case, the wisest course in my opinion is to make haste to effect 

 delivery before the cervix has had time to close, either by pulling 

 moderately at the cord, or by getting hold of the placenta with the 

 fingers if possible. But when we have waited too long, or have 

 been called too late, we are compelled to wait still longer and confine 

 ourselves to endeavors to promote the contraction of the uterus. 

 Should any accidents supervene, the hand could not be carried up as 

 far as the placenta, on account of the resistance of the cervix, and 

 the smallest extractive force would soon rupture the cord. I pre- 

 sume this would be the proper case to try the injections recommend- 

 ed by Dr. Mojon. If, however, the placenta should appear at the 

 orifice, or could be felt with the finger, and the tractions or the hand 

 should prove insufl[icient to extract it, an attempt might still be made 

 to bring it down with the pince a faux germes. Otherwise, its ex- 

 pulsion is to be left to the natural powers, and we must take care to 

 prevent the occurrence of accidents, or if they do occur, to combat 

 them as soon as they make their appearance. We may resort to 

 blood-letting, opiates, and baths, general and local; emollient or de- 

 tergent injections may be thrown into the vagina, and even into the 

 womb, so as to neutralise the effects of putrefaction; the woman is 

 to be confined to a strict diet, and as soon as the os uteri becomes 

 somewhat open, such portions of the after-birth as may present 

 themselves are to be removed. 



Sometimes all these precautions are of no avail, provided the os 

 uteri has closed soon after the escape of the foetus, and the placenta 

 may remain in the uterus for a longer or shorter period without pu- 

 trefying; cases have been seen where the women in some sort forgot 

 it, did not discharge it until after the lapse of one or two years, when 

 they even became impregnated again, proceeded to their full term, 

 and then discharged it together with the new placenta. But the pla- 

 centa and membranes are most commonly expelled either piecemeal 

 or in one mass, in the course of the first week after the miscarriage, 

 or they are gradually discharged along with the lochia, or by means 

 of injections. It will be understood, further, that these difficulties 

 become more frequent and numerous in proportion as the abortion 

 takes place nearer to the middle period of gestation; that they are, 

 on the contrary, less severe, and more easy to overcome, the nearer 

 they occur to the natural period of parturition. 



