Licence: Public Domain Mark
Credit: The treatment of placenta praevia / by James Murphy. 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.
11/18 (page 13)
![IS uf an oxpoctant nature. A ([uick extraction made now would cause rupture of the cervix, and fatal post ])artuni hfeniorrhage. Wait, therefore; give the patient time to rally her powoi-s; wait until pain sets in, tiud then assist nature by exerting slow and gentle tractions; if the child is in dangsr during this time, let it run its risk, let it die if necessary, but do not endanger the mother by quick extraction. Cervical laceration is always a dangerous thing—it is particularly dangerous in ])lacenta prajvia, on account of the great vascularity of the tissue of the cervix and its liability to rupture. Atony of the uterus is also a disagreeable complica- tion, especially in cases of placenta praivia, when there generally is not too much blood to lose-; but these dangers may be got rid of by an expectant treatment. After turning, pains generally set in quickly, the cervix distends rapidly, and the child is born generally between one and two-and-a-half hours after turning. He then discusses the method imder five heads:— 1. How should we treat cases of flooding occuiTing during preg- nancy? and states that his cases have not proved to him the necessity of bringing on premature labour, but goes on to say, when strong hfeniorrhage occurred in pregancy, we use the tampon and examine a few hours later, to sec whether the cervix was sufficiently dilated to allow one finger to be passed, and to permit of turning to be performed. In this sense, he confesses, his method may be counted perhaps among the proceedings having the object to induce prematm'e labour in placenta prfevia, and further says operators who have lately followed this plan have had very good results, paying me the compliment of quoting me as an exponent of it, say- ing that my cases show that the adoption of active measures early is the right thing for placenta prsevia. 2. Is bi-manual turning an easy operation? To which he answera in the affii-mative—in which all who have practised the method frequently will concur—and recommends chloroform to be freely given in all cases. 3. Can we rely on hscmoi-rhage ceasing after turning? Keplying, that notwithstanding all views to the contrary, that it is a matter of fact that hajmorrhage does cease. 4. How long must we wait for the child to be born by natural powers ? That delivery takes place in from one to two-and-a-half hours. Behm generally allows the children to be born quite spon- taneously, and had to wait from half-an-hour to four hours, and in one case for eleven houi's. 5. Ought the method of rupturing the membranes in head pre- sentation be abandoned altogether ? He says circumstances must decide. When the placenta is only felt marginally, when the head has entered the pelvis, when pains are strong and haemorrhage not very profuse, then rupture of the membranes seems to be the right](https://iiif.wellcomecollection.org/image/b22294375_0013.jp2/full/800%2C/0/default.jpg)
