The Brooklyn Medical Journal. Vol. II. No. 2. Aug., 1888Various
Science
The Brooklyn Medical Journal. Vol. II. No. 2. Aug., 1888
Various
Medicine -- Periodicals
Fehling (Sammlung Klin. Vorträge, No. 308) compares the views and
practice of authorities in the treatment of the third stage of labor.
The various methods of placental delivery that have been advocated by
different writers are recounted. The reaction against Credé in favor of
expectancy, first started by Dohrn and Ahlfeld, has resulted in proving
the inferiority of the latter plan, and in a return to more active
methods. In a large number of German clinics, the uterus is allowed to
rest immediately after the expulsion of the child, without friction.
When the placenta lies detached in the lower uterine segment, which is
generally the case after fifteen or twenty minutes, nothing is to be
gained by longer waiting. The author is favorably disposed toward the
practice of Credé, which as he says, has never been shown by its
adversaries to be capable of harm when properly conducted. With
reference to the mechanism of placental separation, both theoretical
considerations and clinical observations favor the views of Duncan, yet
the question is not settled. Retained membranes may be removed with the
aseptic hand. Yet Credé and Olshausen consider the retention of even the
whole chorion free from danger, and clinical experience has shown better
results by the expectant plan in case of retained membranes than by
interference. These results, the author thinks, in the light of
Döderlein’s researches, are explained by the fact that the hand may
transport the peccant germs from the vagina into the uterus. The active
plan, with a preliminary vaginal disinfection and a vigorous asepsis
throughout, should yield better results than expectation. Interference
with these precautions is, at least, justified in case of atony and
hæmorrhage or fever, including, if need be, the use of the curette and
subsequently ergot. Dührssen’s method of tamponing the uterus in
post-partum hæmorrhage with iodoform gauze is favorably mentioned.
In the event of cervical tears causing troublesome hæmorrhage,
Kaltenbach, Schroeder and Leopold practice immediate suture. The author
thinks the vaginal tamponade is generally to be preferred. Yet, in
certain cases the suture may also be required, or the application of the
perchloride of iron on cotton pledgets to the bleeding surfaces.
Credé (Arch. f. Gyn., B. 32, H. 1) again discusses and defends his
method of managing the placental delivery which he prefers to call the
external method.
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