OBSTETRICS.
Case of Placenta Prcevia. By W. F. Vidal, M. R. C. S., Ave-
ley, Essex, late House Surgeon to the London Hospital.—Emma T.,
aged 37, wife of a waterman, a woman of a full habit, being pregnant
for the ninth time, wished to be attended by me in the event of her
sending, as she felt very unwell, and at the same time stated, that the
previous morning, and also three times before, she had a profuse
discharge of blood, the first time being about the third month of utero-
gestation, which gradually ceased on lying down. I recommended
quietude, the recumbent position as much as possible; there being no
haemorrhage at that time, objected to an examination per vaginam, and
as she was at the full period of her time, desired, that if a similar
attack returned, to send without delay.
I heard no more of the case until five days after, when I was sum-
moned at about half-past five, A. M., to go immediately to my patient,
as she was in a very low state. I promptly attended, as, from the
previous losses of blood, my suspicion was a case of placental presenta-
tion. On entering the room, I found her in the seini-erect posture in
the bed, with wet napkins applied to the pubis, and in a very low state ;
countenance pallid, pulse rapid and extremely feeble ; the bed, &c.,
was saturated with blood. On inquiry, I learnt that she had an attack
similar to the first the same day after she had spoken to me, and also
symptoms of approaching labor, both of which continued in a slight
degree for three days, when the discharge ceased, the pains remaining,
but less severe. On the following day, she exerted herself all day in
her household duties, and felt great heaviness for sleep during the day,
which increased at night; she went to bed, and, after a short time, all
pains left her and she fell into a sound sleep and continued to do so
until five o’clock the following morning, when she awoke with a feeling
of faintness and general debility, and lying in a pool of blood, which
grearly alarmed her, and immediately I was sent for. After some
trouble I got her to the foot of the bed, as she dreaded to move from
her position, and, on an examination per vaginam, found the thick mass
of the placenta situated over the os uteri, and almost completely
detached, with the exception of a small portion near the left side of the
womb. The mouth of the latter dilated to an extent sufficient to allow
nearly the introduction of the hand, and inclining to yield. During
my examination a gush of blood took place, which immediately
induced me to separate the remaining adherent portion of the after-
birth, and endeavored to find the feet of the child, which I soon
managed, and, in the act of turning, a sudden return of hremorrhage
occurred, which drove the placenta, together with some clots of blood,
by my arm externally ; I ligatured the cord by the assistance of the
nurse, deeming it might be of some object to the infant, although, from
all appearances, “ dead,” as there was no pulsation in the cord, and a
quantity of meconium passed ; and also what might be expected from
the small quantity of nutrition received, if one may judge from the
proximity of the placenta, in this instance, being so slight to the
uterus.
As soon as the operation of turning had been accomplished the
woman seemed so exhausted that I thought further proceedings would
have been attended with great hazard, and therefore waited for a time
until she rallied, at the same time keeping my hand in the mouth of the
uterus as a plug, and I gave slight stimuli ; after a short time she re-
gained her strength, pulse rose, and she expressed herself better. My
wish was then to empty the uterus as soon as possible, which was
done with comparatively little difficulty; after which, to mv surprise,
“ there being no haemorrhage at the time,” she became perfectly insen-
sible, and remained in that state for some minutes, when consciousness
gradually returned, but not the power of articulation ; the pulse ex-
tremely low. I ordered an egg beaten up with brandy, which seemed
to have the effect of restoring, in part, the vital functions. The uterus
contracted steadily and firmly, and no return of the flooding, which I
attribute greatly to the syncope after the delivery. I remained some
time with her, and left her as comfortable as possible after so severe a
trial, and gave an anodyne mixture of tincture of opium and camphor
mixture to be taken every three hours, and on visiting her in the
evening, was pleased to find that she was perfectly composed, pulse
tranquil, slight fever, and she had slept. My patient did well, and is
now in perfect health.
My success in this case I impute to prompt and active measures,
which, in one so severe, is, in my opinion, the sole hope of a favorable
termination. At the same time, a constitution so good as that of my
patient tends much to ultimate recovery.—Lancet.