A treatise on the science and practice of midwifery . rule, as it givesample time for the complete detachment of the placenta, and the co-agulation of the blood in the uterine sinuses. Mode of Effecting Expression of the Placenta.—During this inter-val the practitioner or nurse should sit by the bedside, with the handon the uterus to secure contraction and prevent distension; but notkneading or forcibly compressing it. When we judge that a suffi-cient time has elapsed, we may proceed to effect expulsion. Forthis purpose the fundus should be grasped in the hollow of the lefthand, the ulnar edge
A treatise on the science and practice of midwifery . rule, as it givesample time for the complete detachment of the placenta, and the co-agulation of the blood in the uterine sinuses. Mode of Effecting Expression of the Placenta.—During this inter-val the practitioner or nurse should sit by the bedside, with the handon the uterus to secure contraction and prevent distension; but notkneading or forcibly compressing it. When we judge that a suffi-cient time has elapsed, we may proceed to effect expulsion. Forthis purpose the fundus should be grasped in the hollow of the lefthand, the ulnar edge of the hand being well pressed down behindthe fundus, and when the uterus is felt to harden, strong and firm pres-sure should be made downwards and backwards in the axis of thepelvic brim. If this manoeuvre be properly carried out, and suffi-ciently firm pressure made, in almost every case the uterus may bemade to expel the placenta into the bed, along with any coagula thatmay be in its cavity (Fig. 103). The uterine surface of the pla- Fig. Illustrating Expression of the Placenta. centa is generally expelled first, as is represented in the diagram, thecord being within the membranes; whereas the foetal surface, androot of the cord, are the parts which appear first when the placentais removed by traction (Fig. 102). If we do not succeed at the firsteffort, which is rarely the case if extrusion be not attempted toosoon after the birth of the child, we may wait until another contrac- MANAGEMENT OF NATURAL LABOR. 281 tion takes place, and then reapply the pressure. I repeat that, aftera little practice, the placenta may be entirely expelled in this way,in nineteen cases out of twenty, without even touching the cord,and the bugbear of retained placenta will cease to be a source ofdread. Management of the Membranes.—Should we fail in causing theuterus to expel the placenta, a vaginal examination may be made,and, if the placenta be found lying entirely in the vagina, it ma
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Keywords: ., bookcentury1800, bookdecade1870, bookidtre, booksubjectobstetrics
