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.
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![I ami in no instance ont of 912 ciuseK tliat lio lias onlluctud lias ( death (wcurred before the seventh niontli. Now, though a seven I months' child has not a very great chance of living (except it be a : first brtbv, which it is notorious does excellently well), still its chances of life are not increased by the frequent floodings that are likely to occur before its birthj^ which will in all probability be premature, and it appears to mc stands as good or a better chance by being delivered then, than by allowing pregnancy to con- tinue, for let us consider what is the mortality of children in I placenta prajvia according to different authors :— Schwar/! 75 per cent. Hecker 67 per cent. Biinies G4 per cent. Miiller 64 per cent, (average of 2,360 Cii.sesi. Fritsch 60 per cent. Spiegelberg 50 i)er cent. Brauu 50 per cent- Now these numbers refer mostly to the question whether the child was boni with life, not whether it remained alive, which is a very different matter. For example: Behm had 78 per cent, boru with life, but of these only 29 per cent, lived, so that instead of having 78 per cent, of children that lived, he had in reality only 22 per cent. Kuhn followed the fate of the childi'cn in 4(3 cases of placenta prscvia, and found that two months after birth only two of them were alive. And Miiller states a placenta prsevia child has only three chances out of ten of being born alive; and as Virchow shows that nearly one ont of every three children boru under all circumstances in Berlin die within the first year, its remaining chances would be almost gone before even its time came for measles, whoo]jing cough, scarlet fever, and the various other dis- eases that we may almost regard as its necessary trials, before it reaches a time when the value of its life may be in any way compared to that of its mother; so that as far as we can at present manage the treatment of placenta pra5via the chances of saving the child need not prevent us from inducing premature labour. Therefore I would strongly urge that jiveniature labour he brought on as soon as we knov; that we are dealing with a case in luhich the 2}lacenta presents afte)- the seventh nu/nth of jyregnanci/, and even before then should the Ueedinf/s be serious, frequent, or continuous. Before discussing the best means of inducing labour in these cases, let us consider some of the principal methods of ti-eatment recommended for placenta i)ra)via, the point l)cing to effect deUvcry with as small a loss of Ijlood as ])ossible, and with the least risk to mother and cliild. Tlic older writers, even as far back as Uiftard and Portal, knew tliat the i)lacenta might be implanted over the OS, or (as tlicy thought) attached to the cervix; and some of their instructions for treatment are botli (luaint and curious, thou'di](https://iiif.wellcomecollection.org/image/b22294375_0007.jp2/full/800%2C/0/default.jpg)
