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The physiology and treatment of placenta praevia
The physiology and treatment of placenta praevia Author:Robert Barnes Purchase of this book includes free trial access to www.million-books.com where you can read more than a million books for free. This is an OCR edition with typos. Excerpt from book: 35 LECTURE II. EXPOSITION OF THE PHYSIOLOGY OF PLACENTA PKVIA. The next question before us is one that embraces most of the points of cardinal interest... more » in the physiology, pathology, and therapeutics of Placenta Praevia. WHAT IS THE COURSE OF A LABOUR COMPLICATED WITH CERVICAL OR CENTRAL ATTACHMENT OP THE PLACENTA? It will be convenient to discuss, in the first place, several questions connected with the attendant haemorrhage. We have seen from previous quotations that the doctrines most generally inculcated are : that there is an essential difference between the circumstances attending the detachment of the placenta from adhesion to the fundus, and from adhesion to the cervix uteri; that this difference consists in the separation of the placenta from the fundus without haemorrhage, and from the cervix D 2 with haemorrhage; that, in the latter case, the haemorrhage is necessary, unavoidable, a condition inseparably dependent upon the nature of the process by which the mouth of the womb is opened. It is contended, in short, that contraction which, in the case of fundal attachment, secures against flooding; in the case of cervical attachment necessarily causes flooding. This proposition is, I shall show, physiologically erroneous ; and, being so, is the foundation of erroneous pathological and therapeutical doctrines. If we watch attentively a case of labour in which the placenta presents—I mean, of course, such a case as admits of simple watching, that does not call for obstetric interference—we shall observe that as soon as the longitudinal muscular fibres of the womb have begun to contract so as to pull back the lower segment from the central point represented by the os uteri internum, a certain amount of detachment of the placenta from the part nearest to th...« less