A nurse's handbook of obstetrics, for use in training-schools . ondition unless thepresence of the after-birth in the uterus prevents firm contrac-tion of the womb and causes severe hemorrhage. Even in thesecases there is usually time to await the arrival of the physician,for it is assumed that he was summoned at the onset of labor,and it is not to be supposed that he will leave before the placentais delivered. Firm pressure is to be maintained on the fundus,which is to be kneaded vigorously whenever it shows signs ofrelaxation, and it is hardly probable that enough blood will belost to affect
A nurse's handbook of obstetrics, for use in training-schools . ondition unless thepresence of the after-birth in the uterus prevents firm contrac-tion of the womb and causes severe hemorrhage. Even in thesecases there is usually time to await the arrival of the physician,for it is assumed that he was summoned at the onset of labor,and it is not to be supposed that he will leave before the placentais delivered. Firm pressure is to be maintained on the fundus,which is to be kneaded vigorously whenever it shows signs ofrelaxation, and it is hardly probable that enough blood will belost to affect the patient seriously. If the bleeding becomesalarming, as shown by the amount of the flow and the generalcondition of the patient, and no physician can be secured, thenurse may, after the most careful disinfection of her hand, pass 214 A NURSES HANDBOOK OF OBSTETRICS. it gently into the vagina up to the cervix, grasp the placentafirmly in her fingers and remove it slowly and with a deliberatetwisting motion (Fig. 109). If it is still adherent to part of the. Fig. 109.—Manual extraction of the placenta. (Garrigues.) This must never be attemptedby the nurse, except for urgent reasons and after most careful aseptic precautions. uterine wall, two or three fingers are to be carried into thewomb, between it and the placenta, and the tissues separatedmuch as one would separate the sections of an orange. Whenthe entire organ has been detached in this way, it is to begrasped in the palm of the hand and withdrawn carefully. Ifall antiseptic precautions have been faithfully observed thismanoeuvre will do no harm, but it must be distinctly understoodthat it is a dangerous thing to do, and one never to be attemptedby the nurse except in the gravest emergency when no physicianat all can be obtained. Hemorrhage other than the type just mentioned may be dueto laceration of the cervix or to uterine inertia. Hemorrhage due to cervical laceration is almost invariablycaused by instrumental or
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