. Obstetrics for nurses. blood escapes intothe tissues and produces a hema-toma. Unless the torn vessels areeffectively compressed by the devel-oping clot, the hematoma slowly in-creases in size, and, in so doing,splits the decidua along the line ofleast resistance. This usually takesplace toward one edge of the pla-centa and later extends between themembranes and the uterine wall, sothat the blood finally escapes throughthe external os. In the rare casesof concealed hemorrhage, the mem-branes do not peel off so easily, andthe retroplacental hematoma so in-creases in size that the placenta be-
. Obstetrics for nurses. blood escapes intothe tissues and produces a hema-toma. Unless the torn vessels areeffectively compressed by the devel-oping clot, the hematoma slowly in-creases in size, and, in so doing,splits the decidua along the line ofleast resistance. This usually takesplace toward one edge of the pla-centa and later extends between themembranes and the uterine wall, sothat the blood finally escapes throughthe external os. In the rare casesof concealed hemorrhage, the mem-branes do not peel off so easily, andthe retroplacental hematoma so in-creases in size that the placenta be-comes detached and the uterine wallsbecome distended by the accumulated l)lood. Occasionally, it escapes into the amniotic cavity through a rentin the meml)ranes, but more usually a passage is eventually dissectedthrough the decidua vera and a part of the blood escapes from the cervix. It should be rememl)ered that the bleeding tends to continue untilthe uterus is emptied of its contents and is able to contract down upon. Retro-placentalhemorrhage Fig. 113.—Premature separation of nor-mally implanted placenta—concealedand external hemorrhage. (Diagram-matic.) 266 TEXTBOOK OF OBSTETRICS FOR NURSES and thus compress the bleeding vessels. The developing hematoma com-presses the adjacent placental tissue, and, by interfering with the cir-culation through its villi, renders it functionless. When the area ofcorhpression and separation is extensive, the fetus receives a deficientsupply of oxygen and finally dies from asphyxiation. In most cases of premature separation, there are no demonstrablelesions in the uterus, and the only evidence of its occurrence is affordedby the presence of a depressed area on the maternal surface of the after-birth corresponding to the location of the clot. In the more severecases, characteristic changes develop in the uterine wall, which aredesignated as uteroplacental apoplexy. In this, the extravasation ofblood involves the muscular wall of the uter
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectobstetrics, bookyear1
