. An American text-book of obstetrics. For practitioners and students. ccasionally one and rarely both placentae may be expelled after thebirth of the first child. In a case of the writers the placenta of the first child,prolapsing in front of the second, necessitated a difficult forceps operation forthe extraction of the second. On account of the frequent and extensive anas-tomoses between the vessels of the placentae in unioval twins it is a necessaryprecaution to tie the cord of the first child with a double ligature and to cutit between the ligatures ; otherwise the second infant might ble
. An American text-book of obstetrics. For practitioners and students. ccasionally one and rarely both placentae may be expelled after thebirth of the first child. In a case of the writers the placenta of the first child,prolapsing in front of the second, necessitated a difficult forceps operation forthe extraction of the second. On account of the frequent and extensive anas-tomoses between the vessels of the placentae in unioval twins it is a necessaryprecaution to tie the cord of the first child with a double ligature and to cutit between the ligatures ; otherwise the second infant might bleed to death. The prognosis of twin labors is always doubtful. There are so many possibledangers for both mother and children that multiple labors must be regardedas distinctly pathological. Albuminuria in the mother is the rule in multiplepregnancies, and eclampsia is ten times more frequent than in single births.*There is a disposition to inertia uteri during and after birth from distention* Of 627 cases of eclampsia, sixty-nine were multiple pregnancies (Winckel).. Pig. -Twins, head and breech (modified fromHunter). 570 AMERICAN TEXT-BOOK OF OBSTETRICS. of the cavity, and consequently a likelihood of post-partum hemorrhage. Someoperative interference or intra-uterine manipulation is called for in about 25 percent, of cases, and this, in addition to the frequency of kidney insufficiency, pre-disposes to sepsis. Finally, there may be insuperable obstruction in labor iflocked twins are not managed properly, and the woman may die of ruptureduterus or of exhaustion. The maternal mortality in the Budapest Mater-nity was four times as great as in the single births, and Kleinwiichters statis-tics give a mortality of 13 per cent. For the children there is greater dangerthan for the mother. Twin pregnancy is almost always prematurely inter-rupted, and even if it is not the children are, as a rule, under the normal sizeand weight. There is always the possibility that the developme
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectobstetrics, bookyear1
