Diagnosis and Treatment of Ante-Partum Hæmorrhage

PROFUSE heemorrhage occuring prior to, or shortly after, the birth of a child, is always a dangerous, and often a fatal, complication, although with proper diagnosis and treatment the maternal death rate should be very low. Practically all varieties of ante-partum hemorrhage, with the exception of those originating from lacerations of the genital tract, are due to a partial separation of the placenta from its attachment to the uterine wall. This accident is an inevitable accompaniment of labour when the placenta is implanted in the region of the internal os-placenta proevia-but also occurs when the placenta occupies its normal situation, i.e., accidental haemorrhage. Our knowledge of the pathology, and our experiences of the treatment, of accidental haemorrhage, have made considerable advance in recent years, as a result of the work of several investigators, notably Professor F. J. Browne of London. In 1885, Winter first drew attention to the presence of albuminuria in patients suffering from accidental haemorrhage, and since then we have gradually come to recognise that the hoemorrhage is often merely a symptom, or result of a deep-seated systemic disease, producing effects in other parts of the body. Many conditions have been stated as being possible causes of accidental haemorrhage , e.g., syphilis, endometritis, etc., but none of these can be shown to be an important factor in any given series of cases. Albuminuria, however, is found in a large proportion of cases-eighty-four per cent. of obstetric cases in Ley's series, and almost one hundred per cent. in F. J. Browne's series of experimental cases of accidental haemorrhage. O'Donel Browne states that while not questioning "the accepted and proved knowledge that nephritis can produce utero-placental changes which can precipitate a woman into the critical condition of accidental hoemorrhage, individual patients show wide variations in the degree of albuminuria, and that these alterations did not appear to bear any relation to the amount of blood lost, but rather to the rapidity and facility with which its products were absorbed." Clinically it is a well recognised fact that a woman with albuminuria runs three great risks: 1. Eclampsia. 2. Accidental haemorrhage. 3. Death of the foetus in utero. And in Ley's series of cases of accidental haemorrhage thirty-four per cent. of them had eclampsia. Microscopical examination of the uterine muscle reveals a succession of degenerative changes extending to actual necrosis of the muscle bundles. Microscopically in serious cases the muscle fibres …