. The science and art of midwifery . When the placenta passes the vulva the uterus is oftenfirmly contracted, and a considerable portion of the membranes arcstill within the uterine cavity. Hasty traction is then apt to tear offthe retained part of the membranes. It is well, therefore, at this pointto support the placenta until relaxation of the uterus has taken place,when the complete separation of the membranes is effected withoutendangering their integrity. There has been considerable discussion f late as to the true physi-ology of placental expulsion. Thus it has been maintained by Schnltz
. The science and art of midwifery . When the placenta passes the vulva the uterus is oftenfirmly contracted, and a considerable portion of the membranes arcstill within the uterine cavity. Hasty traction is then apt to tear offthe retained part of the membranes. It is well, therefore, at this pointto support the placenta until relaxation of the uterus has taken place,when the complete separation of the membranes is effected withoutendangering their integrity. There has been considerable discussion f late as to the true physi-ology of placental expulsion. Thus it has been maintained by Schnltzethat after the birth of the child the diminution of the placental areaduring a uterine contraction is followed by a central separation of theplacenta from the uterine walls and by a bulging of the separatedportion into the uterine cavity. The detachment takes place in thedecidual layer; the of uterine vessels are consequently openedup, and blood is aspirated into the retro-placenta] cavity. As, in point 222 Fig. 123.—Descent of the placentaaccording to Schultze. of fact, no uterine cavity exists during a contraction, Colin* modifiedthe Schultze theory by assuming that the central separation takesplace in fact as a consequence of uterine contraction, but that the hematoma follows upon the occurrence ofuterine relaxation. The further separa-tion of the placenta from the center to-ward the periphery is either the result ofthe increase in the amount of the effusedblood, or is effected during a contractionby the peripheral pressure exerted by theblood previously aspirated behind the pla-centa. According to Schultze, therefore,the placenta normally descends by its fetalsurface into the vagina, and a certainamount of haemorrhage is the regularconcomitant of placental expulsion. Dohrn,t accepting the views of Schultze,objects to Crede, that by his method a proc-ess which should develop naturally is disturbedby a comparatively brusque manipulation. Asa result of hasty
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