A nurse's handbook of obstetrics . s ofectopic gestation. Hemorrhage occurring late in pregnancy may be due to pla-centa praevia, to the accidental detachment of a normally situatedplacenta, or to the rupture of an ectopic gestation sac. Bleed-ing due to placenta prsevia is termed unavoidable hemorrhage,because, from the very nature of the case, it is bound to occur, 253 254 A NURSES HANDBOOK OF OBSTETRICS. sooner or later; while that caused by the accidental separationof a normally situated placenta is called accidental hemor-rhage, since it need not necessarily have occurred except forthe ac
A nurse's handbook of obstetrics . s ofectopic gestation. Hemorrhage occurring late in pregnancy may be due to pla-centa praevia, to the accidental detachment of a normally situatedplacenta, or to the rupture of an ectopic gestation sac. Bleed-ing due to placenta prsevia is termed unavoidable hemorrhage,because, from the very nature of the case, it is bound to occur, 253 254 A NURSES HANDBOOK OF OBSTETRICS. sooner or later; while that caused by the accidental separationof a normally situated placenta is called accidental hemor-rhage, since it need not necessarily have occurred except forthe accident that caused the detachment of the placenta from theuterine wall. Unavoidable hemorrhage (that due to placenta praevia) isalways external, and the first symptom of this complication isthe sudden gush of bright-red blood unaccompanied by pain anddependent upon no discoverable exciting cause. The mere posi-tion of the placenta at or near the internal os uteri is sure tocause bleeding either at or before the beginning of Fig. 123. — Concealed hemorrhage. The blood has collected between the placenta and theuterine wall, and the patient may bleed to death inside her own body. Accidental hemorrhage may be either external or concealed,and is accompanied by severe tearing pain at the site of theplacental separation. In the concealed type the uterus merelybleeds into itself (Fig. 123), and the condition can only be recog-nized by the severe pain in the uterus and the general symp- TTEMORRIT.\(; E. 255 tonis of hemorrhage,—namely, collapse, extreme pallor, feeble,rapid pulse, disturbances of sight and hearing, excessive thirst,and air hunger. Hemorrhage due to the rupture of the sac in ectopic gesta-tion is always concealed, the blood escaping into the abdominalcavity and the patient suffering from pain of an excruciatingcharacter on the affected side, accompanied by collapse and thegeneral symptoms of hemorrhage mentioned in the precedingparagraph. The gestation sac in
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