An improved method of managing the third stage of labour : with a criticism of the theory that the placenta is then separated by the uterine pains / by D. Berry Hart.

  • Hart, D. Berry (David Berry), 1851-1920.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: An improved method of managing the third stage of labour : with a criticism of the theory that the placenta is then separated by the uterine pains / by D. Berry Hart. 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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    By Contraction I understand that the uterine muscle diminishes in bulk, that the uterine area the muscle subtends diminishes, and that the muscle and area resume their condition prior to con- traction when the contraction ceases. In Retraction the greater part of the diminution in bulk and area is retained, but not all. < Dr Barbour’s definition does not coincide with clinical evidence, and would make labour “ tonic,” which it is not. Consequently I hold that a certain amount of relaxation after retraction takes place normally. Dr Barbour’s papers have seemed to me most valuable in many respects, but his conclusions only demonstrate the futility of the attempt to explain separation as the result of diminution of placental site. As to the Third Stage being a “ labour in minia- ture,” I see no advantage in the comparison, more especially as in the Third Stage we have separation and expulsion, whereas in the First and Second stages it is merely a question of expulsion if we leave out of account the separation of the membranes over the lower uterine segment. The view I advocate is a consistent one, explains all separations by one law, .and gives clear indications for management. The management based on Dr Barbour’s view should be to get the uterus to retract as much and as quickly as possible, so as to diminish the placental site and separate the placenta. Such a method would be in every way dangerous, would tend to partial expulsion of placenta and membranes, with all the dangers attendant on such a course. On this ground alone I would strongly condemn his view. Literature. Barbour, A. H. F.—“ Sectional Anatomy of Labour,” Edin. Med. Jour., 1887. “Labour: a Criticism of Papers by Cohn, Champneys, and Hart,” Edin. Med. Jour., 1888. Hart, D. B.—“ A Contribution to the Anatomy of the Post- Partum Uterus, with special reference to Placenta Prsevia,” Edin. Med. Jour., 1887. “Note on the Mechanism of the Separation of the Placenta during the Third Stage of Labour,” Ibid. PRINTED BY OLIVER AND BOYD, EDINBURGH.