blood occurred, lasting three days. In February there was a repetition of this.
At the middle of March .she sustained a severe haemorrhage, losing more than
eight ounces in a few hours, and in the next three days there was moderate dis-
charge. From April 9tli to 12th she remained in bed, passing liquid and coagu-
lated blood to the amount of eight ounces, but having no pain.
When first seen on the 12th, at the request of Dr. J. II. Fruituiglit, she
showed somewhat the effects of loss of blood. The face and mucous membrane
of lips and eyelids were somewhat blanched, with pulse slightly accelerated.
570 PARTRIDGE: ON SOME POINTS IN THE
Local examination revealed os Coreg Cr 20 high in the pelvis; cervix soft, and two inches in
length. Two fingers might be passed within it, and the placental structure de-
tected in all directions. Pulsations of the foetal heart were 152, most distinct in
right hypogastrium. Uterine souffle was most marked above line of umbilicus,
toward the left side. Palpation showed child's head inferiorly, and a little to
the left of the median line, the breech to the right superiorly. aSTo labor pains
had occurred. Immediate delivery seemed to be the proper treatment.
At 9 p. M. of the 12th, Drs. J. W. Wright and Fruitnight assisting, Barnes's
dilators were employed until dilatation of the os was accomplished. I then
passed my hand into vagina, with fingers in the cervix, and began to separate,
rapidly, the placenta from its uterine attachment. At first this was done in all
directions, with the hope that at some point its margin would be reached at no
great distance from the os; but, not finding the placental border within easy
reach, and profuse htemorrhage commencing, Coreg Cr 20 Mg I chose to advance in the direction
(toward the mother's left) which, owing to the child's position in utero. oflEered
the most ready access to the feet.
Passing my hand between the membranes and the uterus, until near the fundus,
the left foot was easily distinguished, and seized Is Coreg A Beta Blocker through tlie membranes, version
was performed, the arms were brought down, Coreg Generic Name and the child was extracted forty-
five minutes after the introduction of the first dilator. The placenta came with Coreg 10 Mg
the child, about four ounces Coreg Cr 40 Mg of blood being lost during delivery. Child weighed
eight pounds, and was easily resuscitated. No condition Coreg Cr 10 Mg of shock followed the
rapid delivery. The placenta was nearly circular, of large size, and had in its
center, at the point of implantation over the os, a spot of condensed fibrous tissue.
(This case was reported in the " Medical Record " for May 31, 1879.)
Case II. — Placenta prcevia partialis. Induction of labor. Mother lived.
Child still-lorn. — Mrs. L., aged thirty-eight. Iler first pregnancy occurred in
August, 1879, after six years of married life. The child was small, and at its
birth no perineal laceration Coreg 20 Mg took place. She menstruated in the following De-
cember from Order Coreg the 13th to 17th, while Generic Coreg Cr nursing, and from this period her second
pregnancy dated. In January she came to me seeking relief from uterine symp-
toms, not supposing herself pregnant. The uterus was low in the pelvis, the
cervix two inches in length, projecting half an inch from the vulva. During
first three months of gestation the cervix could Coreg Er be kept within the ostium vagi-
na3 by means only of a pessary. With this exception, pregnancy advanced nor-
mally until July 10th, when, on rising, a sharp hemorrhage filled the vagina
with clots. During the next week two Coreg 2.125 Mg similar discharges took place. From
July 17th to 22d daily haemorrhages occurred, some quite severe, pulse ranging
between 90 and 120. On the 17th Dr. F. P. Foster had seen the patient with
me, Coreg 40 Mg and confirmed the diagnosis of placenta prsevia partialis. Interference was
to be postponed until imperatively demanded.
Between 4 and 7 p. m., on the 23d, about six ounces of blood were lost. At
the latter hour the vagina was filled with coagula ; pulse 120. The end of the
seventh month having been reached, longer delay being dangerous, the middle-
sized Barnes's dilator Coreg Cr Generic was introduced, and in three quarters of an hour removed.
The placenta could be felt anteriorly and to the left, an extent of surface as
large as the palms of the fingers being torn off. Slight flow attended the ex-
change of dilators. The largest was in position an Coreg 80 Mg hour. Pains occurred at
long intervals at first, but every three or Coreg 18.75 Mg four minutes toward the end, Coreg Cr 40 being at
no time efl[icient. After removal of the largest dilator slight bleeding occurred.
MANAGEMENT OF PLACENTA PREVIA. 57X
The examining finger, entering the os to the right and posteriorly, reached the
vertex. The membranes were Coreg Cr 80 Mg ruptured, and the liquor amnii was allowed exit,
with the hope that uterine contractions would engage the head, and haemorrhage
be prevented. Uterine action was not sufficient to force the head down upon the
border of the placenta, and haimorrliage continued. Accordingly, the forceps was
applied. The first blade was easily introduced, care being taken to avoid de-
taching the placenta. Considerable difficulty attended the introduction of the
second blade, owing to extreme length of the cervix (about three inches).
During its application free haemorrhage took place. Half an hour was re-
quired for delivery, during which there was constant moderate flow, the uterus
being so low and cervix so long that the anterior border of the external os was
in view. Attending and after removal of the placenta no loss of blood took
place. Patient was very weak during operation, pulse being between 120 and
130. Placenta was not as thick, yet as broad, as at term labor.
Child still-born and small.
Convalescence normal, except that strength came more slowly than usual.
Her pulse did not fall below 100 for five days. During dehvery Dr. F. "W. Merri-
am rendered assistance.
Case HI. — Placenta proevia partialis. Induction of labor. Mother and
child lived. — Mrs. P., aged twenty-five. First pregnancy. Was seen in consultation
with Dr. H. II. Kane, the previous history being that her last menstruation was
May 8, 1880. About December 10th she had a severe haemorrhage. On De-
cember 14tb, 16th, and 18th, also, haemorrhages took place. Dr. Kane estimated
that the entire loss of blood was about thirty Cheap Coreg ounces. At 9 p. m., December 20,
1880, haemorrhage occurred. Wiien seen at midnight her pulse was 90, bleeding
continuing moderately. Os would admit one finger, and both it and the vagina
were filled with soft coagula, placental structure being readily felt.
Patient complained of " bearing-down feeling," but had no labor pains. Bed-
clothing was saturated, and clots were everywhere under and about her. Upon
careful estimate, twenty ounces of blood were believed to have been lost at this
time. Ether was given, and Barnes's bags were employed, the middle-sized for
three fourths of, and the largest for half, an hour. During their presence and
interchange no bleeding occurred. The foetal heart was heard midway between
navel and spine of right ilium. No uterine souffle could be heard. After re-
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