DISEASES OP THE PLACENTA 133 



certain cotyledons are often equalized by the remaining healthy 

 cotyledons. The termination of diseases of the placenta may 

 become of great importance from an obstetrical point of view. 

 Diseases of the placenta may be divided into three groups : 

 hemorrhage, inflammation and tumors. 



The simplest form of hemorrhage is capillary apoplexy. 

 It is caused by a rupture of capillaries, and in consequence of 

 the extravasated blood the adhesions between single villi of the 

 chorion and corresponding villi of the maternal placenta are 

 destroyed. In cases of more serious hemorrhage or extravasa- 

 tions, the blood mixes with the uterine milk, forming a choco- 

 late-colored fluid (Franck). 



Sequelae. — Limited hemorrhages and separations of a few 

 cotyledons do not influence the foetus materially, as sufficient 

 collateral circulation exists. The extravasated blood is absorbed 

 and only a little pigment remains, which maybe seen later upon 

 the chorion or placenta materua of pin-head or pea size. Such 

 small hemorrhages do not give rise to clinical phenomena, 

 as the cervix uteri is closed and the process an aseptic one. 

 Nevertheless, another termination is possible — the formation 

 of connective tissue. Out of the small amount of connective 

 tissue in the villi cell tissue may be formed ; in this case the 

 extravasation is resorbed and adhesions between the placenta 

 follows. Greater hemorrhages, the result of rupture of blood 

 vessels, is accompanied by an accumulation of blood between 

 the chorion and uterine mucosa. This may lead to extensive 

 separations of the foetal placenta. Here the life of the foetus^ 

 is endangered by asphyxia, when the blood supply becomes, 

 insufficient. In such a case, often a limited dilatation of the 

 cervix uteri is seen, permitting the discharge of some blood 

 from the vagina; this also occurs occasionally in very small 

 hemorrhages. This phenomenon is known as hemorrhage from 

 the uterus, or metrorrlmgia. 



Symptoms. — The attendant's attention is first attracted by 

 the flow of blood from the vulva. Small hemorrhages are 

 characterized by a little coagulated blood now and then, more 

 extensive ones by the discharge of liquid blood. The general 



