A textbook of obstetrics . ard theclose of pregnancy. Symptoms and Diagno-sis. — Accidental hemor-rhage, especially if con-cealed, should be recog-nized without delay. Theaccident usually occurs be-fore labor begins or in thefirst stage. The uterinecontractions become weakand finally cease, being re-placed by persistent andsevere pain, usually at theplacental site. There isshock, the signs of internalhemorrhage become moreand more apparent, and theuterus is distended by the accumulation of blood within it. Feeble but persistent contrac-tion of the upper part of the uterine muscle maybe felt. I
A textbook of obstetrics . ard theclose of pregnancy. Symptoms and Diagno-sis. — Accidental hemor-rhage, especially if con-cealed, should be recog-nized without delay. Theaccident usually occurs be-fore labor begins or in thefirst stage. The uterinecontractions become weakand finally cease, being re-placed by persistent andsevere pain, usually at theplacental site. There isshock, the signs of internalhemorrhage become moreand more apparent, and theuterus is distended by the accumulation of blood within it. Feeble but persistent contrac-tion of the upper part of the uterine muscle maybe felt. Ifthere is a retroplacental effusion, a localized bulging at theplacental site may be made out by abdominal palpation. The symptoms resemble somewhat those of rupture of theuterus. In both there are hemorrhage, shock, and perhaps sud-den excruciating pain. But in rupture of the uterus the accidentoccurs late in labor, the membranes are broken, the presentingpart recedes, the uterus is well contracted, and perhaps its con-. Rectum. Fig. 408.—Premature detachment of theplacenta occupying its normal site. Frozensection of an undelivered woman dead ofeclampsia. A blood-mass under the placenta(after Winter). THE PATHOLOGY OF LABOR. tents arc evacuated into the peritoneal cavity ; while in accidentalhemorrhage the detachment of the placenta occurs early in labor,the membranes are not ruptured, the presenting part does notrecede, and in concealed hemorrhage the uterus is distended bythe accumulated blood. In frank accidental hemorrhage thediagnosis rests between detachment of a normally situated pla-centa and placenta praevia. The presence or absence of the latteris determined by a careful internal examination. In exceptional cases a frank accidental hemorrhage appears as early in pregnancy as the Upperend_ojrdot Jlemtr-. fourth month. Abortion usu-ally follows, but I have seentwo cases in which the bleed-ing continued uninterruptedlyfor weeks, a large blood-clotformed between the
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Keywords: ., bookcentury1800, bookdecade1890, bookidtex, booksubjectobstetrics
