Remarks on placenta prævia : with a case / by Alexander Milne.

  • Milne, Alexander.
Date:
1867
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on placenta prævia : with a case / by Alexander Milne. Source: Wellcome Collection.

    7/14 (page 5)
    traded pretty well. A drachm and a half of liq. ergotse was, however, given by way of making u assurance doubly sure.” Mrs L—-has gone on well since ; and though her pulse is still rather quick and feeble, and she is somewhat blanched-looking, she is (March 24) gaining strength every day. The infant is also doing well. On inspecting the placenta soon after its delivery, we found it to be, as is common in these cases, thinner and of greater superficial extent than ordinary. It was slightly torn near the edge, where forcibly separated by the fingers, close to the perforation in the membrane. Remarks.—Perhaps I owe an apology for detailing this case at so great length, seeing that there is little of a novel nature either in its history or treatment, but I had a desire to^call attention to one or two points connected with the case and the subject generally; besides, a thoroughly successful case of placenta prgevia cannot be altogether uninteresting to the obstetrician. The first point I wmuld direct attention to is the early period at which the hsemorrhage appeared—the middle of the sixth month. On glancing at many recorded cases, I find that the first flooding happened generally somewhat later; but that it should appear so early seems not an unnatural feature to those who believe in the early expansion or distention of the cervix. This early distention, I may just remark in passing, is stoutly denied by such able observers as Weitbrecht, Stoltz, Matthews Duncan,1 and Cazeau; but I would ask, does not the flooding in placental presentation support the view that it does take place at an early date ? And if the cervix is thus expanded, it surely cannot occur without, but must involve a certain amount of development, which is denied by these authors. Of course this difficulty may be got rid of by adopting the view that the growth of the placenta, wherever situated, involves, or provokes, or generates a commen¬ surate increase at the part to which it is attached ; and if this be the case, then the early growth of the cervix is an abnormality, and the offspring of another abnormality, viz., the misplaced placenta. Whichever be the correct view—whether early develop¬ ment of the cervix be normal or abnormal—early growth or expan¬ sion is in these cases undeniable, and even indispensable, for did it not take place, the placenta would cease to grow : it would become a withered and stunted and blighted thing. Another point worthy of remark is the long period that elapsed between the first flooding and the advent of labour pains. Is it usual to find the hemorrhage going on at intervals for ten weeks, without inducing painful uterine contractions? I think not. Is it not rather usually found that the irritation due to the implantation of the afterbirth on the cervix, together with the flooding arising 1 See article in this Journal for September 1863, by Dr Matthews Duncan, wherein this subject is very ably discussed and illustrated.