There is always profuse hemorrhage, which is usually concealed at first, but finally external. It is possible at times for a woman to bleed to death into her own uterus, when it is distensible. The mortality is about 50 per cent. for the women, and where there is concealed hemorrhage about 95 per cent. of the children are lost. A differential diagnosis is to be made to exclude placenta praevia, rupture of the uterus, extrauterine pregnancy, rupture of an appendical abscess, gall-stone colic, or intraäbdominal injury. If the child is viable it must be delivered as quickly as possible. If it is dead and the head is developed, craniotomy should be done to hasten extraction. When the abruptio takes place before the seventh month of gestation the fetus will die in about ten minutes, whether in the uterus or outside it; no matter what method might be adopted to empty the uterus, the child would be dead before delivery. The diagnosis would have to be made and instruments prepared, and this would take up more than the ten minutes of life left to the fetus. It is necessary to get the fetus out to stop the bleeding of the open sinuses by contraction of the uterus. The removal of the fetus here is not like an artificial abortion. In abortion the abortionist separates the placenta from the uterine sinuses and so kills the fetus; the removal from the uterus is secondary to that separation which kills. The common notion of moralists that death is caused in abortion by taking the child out of the uterus is inexact--tearing loose the placenta is the real cause. In a removal of the fetus after an abruptio placentae the death of the fetus is not caused by the physician at all, but by the force that effected the abruptio. As the child will be dead before sufficient dilatation of the cervix to deliver it can be attained, there is no objection to beginning the delivery as soon as the diagnosis is clear. CHAPTER IX ABDOMINAL TUMORS IN PREGNANCY