Clinical history of three cases of placenta praevia, in which podalic version was performed / by D. Lloyd Roberts.

  • Roberts, D. Lloyd (David Lloyd), 1835-1920.
Date:
1861
Catalogue details

Licence: Public Domain Mark

Credit: Clinical history of three cases of placenta praevia, in which podalic version was performed / by D. Lloyd Roberts. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    7/10 (page 5)
    a.m., a messenger arrived with the intimation that my attendance was again requested, and I was soon at the bedside of the patient. The pains had com- menced. and the flooding had returned, blood oozing away through the plug. I at once removed the tampon, and found the os uteri in the same state of dilatation as on my previous examination, but more dilatable. By carefully dilating the os uteri with three Angel's (introduced seriatim) of my right hand, I succeeded in insinuating my hand into the uterus; the pains were much increased by my manipulation, and I had great difficulty in seizing a foot. I hooked my finger into the popliteal space of the child; more than the ordinary amount of tractive force was requisite in bringing the body externally. As the head was firmly retained within the os, as the haemorrhage had now stopped, and as the funis had ceased to pulsate, I kept up gentle traction only, prefer- ring that expulsion should be effected by the natural powers, rather than any risk of laceration should be incurred by the use of forcible traction. The usual dose of tincture of opium and Indian hemp was administered when the delivery was completed. She recovered slowly, her convalescence being retarded evidently by the effects of loss of blood. Remarks.—lsZ. The foregoing cases are demonstrative of the fact, that turning may be performed with safety to the mother when the os uteri is only dilated to the size of a shilling, provided only rigidity be absent; and that if we wait, as some obstetricians recommend, until it has attained the size of half-a-crown, the powers of the patient may in the meantime be so exhausted as to render recovery next to impossible. 2d. That the administration of full and decided doses of laudanum with Indian hemp, is beneficial in preventing the syncope which so often occurs after severe haemorrhage. 3c?. That where the child is dead, and version has been performed, and in cases where the os uteri is not sufficiently dilated to permit of the head passing easily, I would prefer keeping up gentle trac- tion, and trusting to the natural powers, rather than making forcible attempts at extraction, and running any risk of lacerating the cervix uteri; as by the former means the head is brought to press more continuously upon the open vessels, thus preventing any further haemorrhage. MURRAY AN!) OIBR, PRINTERS, EDINBURGH.