A textbook of obstetrics . he retention ofplacental masses after labor, he must attempt their removal. Thisis usually not difficult. The hand—the only trustworthy instru-ment under the circumstances—is inserted into the uterine cavity,the placental substance is felt for, caught by the fingers, andremoved ; if the placenta is adherent, the tip of the finger mustbe gently inserted, wherever most practicable, under the edge,and the whole organ gradually peeled off. If the uterine muscleis too firmly contracted to allow the introduction of the hand, the 1 Zur Frage der Behandlung der Placental*-Re
A textbook of obstetrics . he retention ofplacental masses after labor, he must attempt their removal. Thisis usually not difficult. The hand—the only trustworthy instru-ment under the circumstances—is inserted into the uterine cavity,the placental substance is felt for, caught by the fingers, andremoved ; if the placenta is adherent, the tip of the finger mustbe gently inserted, wherever most practicable, under the edge,and the whole organ gradually peeled off. If the uterine muscleis too firmly contracted to allow the introduction of the hand, the 1 Zur Frage der Behandlung der Placental*-Retention, etc., Zeitschr. , xvi, pp. 292, 594 PATHOLOGY OF THE PUERPERIUM. resistance must be overcome by firm, gradual pressure, first in-serting one finger, then two, and so on until dilatation is accomplish the dilatation it is often necessary to administeran anesthetic. If puerperal hemorrhage occurs, the presence of membranesor placental fragments within the uterus should be suspected,. Fig. 453.—Stratas section of a primipara, who died from hemorrhage with fattyheart within an hour after delivery: internum;c, uterovesical reflection of peritoneum ; if, bladder; e, symphysis pubis; j\ urethra;;?, promontory of sacrum ; //, pouch of Douglas ; /. posterior fornix ; /, os externum. and their removal should be attempted unless some other con-dition is clearly seen to be the cause of the bleeding. To reachthe uterine cavity after involution and retraction have made someprogress, it is often necessary to dilate the cervical legars bougies will be found the safest and most convenientinstruments for the purpose. Branched dilators, unless used PUERPKRA I. ffEMORRH. 1GES. 595 with the greatest care, are dangerous in the puerperal rarely, however, the cervical canal remains patulous in con-sequence of a foreign body in utero ; in this case access to theretained mass and its removal are easy. Displacements of the Uteru
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