The Treatment of Ante-Partum Haemorrhage

Kai Tiaki : the journal of the nurses of New Zealand, Volume XIV, Issue 1, 1 January 1921, Page 39

The Treatment of Ante-Partum Haemorrhage

In reading the accounts of the conjoint meeting of the Section of Obstetrics and Gynaecology of the Royal Society of Medicine with the North of England and Midland Obstetrical and Gynaecological Societies, one is left with the profound conviction that there is no rule of thumb method in the treatment of ante-partum haemorrhage, that each case must be dealt with individually and symptomatically, and that the procedure adopted must depend to some extent on the facilities for operative treatment and the experience of the attendant. Let us briefly review the opinions of the experts. Dr. Hastings Tweedy advocated plugiging the cervix and vagina tightly, and application of a tight abdominal binder. He urged that the plug acted by impeding the circulation in the uterine vessels. Dr. Fletcher Shaw (Manchester) said that in cases of haemorrhage due to marginal placenta praevia, the routine treatment was to rupture the membranes, put on a binder, and give ergot. He thought the results were equal to those obtained by the use of the vaginal plug. Dr. Williamson (London) said that at St. Bartholomew's no local treatment had been necessary in 58 per cent, of the cases of accidental haemorrhage, 'and in 16.6 per cent, of the cases of placenta praevia. In other cases, either bi-polar version, dilatation of the cervix, De Ribes' bag, or Caesarian section (three times) were the methods employed. In 18 cases the vagina was plugged. He was of the opinion that in the majority of cases lnvmorrhaige tends to be arrested by its proper use. He did not, however, believe That the plug compressed the uterine vessels. In the toxaemic variety of accidental haemorrhage he considered Caesarian section the only treatment. Dr. Herbert Spencer (London) found plugging had giiven very good results in placenta praevia. He condemned the general employment of Caesarian section for such cases. Dr. Blair Bell (Liverpool) thought plugging a valuable asset to treatment,

but attributed its success to stimulation of uterine contractions. Dr. Fothergill was perfectly sure that most 'obstetricians, if they had seen what he personally had seen, would not teach students to pack at all for any condition of obstetric haemorrhage. The constant occurrence of sepsis after packing was quite enough to restrain him from saying anything about packing to students. He considered the practice obsolescent, if not already obsolete. He thought it was a matter of extreme importance for teaching purposes that a definite treatment should be formulated to be used by midwives. Dr. Fitzgerald (Manchester) was a rigid adherent of the plug, but since its use did n ; ot save the child, he thought Caesarian section must be considered. Dr. Eden (London) thought it was a matter of the greatest importance that students and midwives should be taught ■exactly how to plug the vagina. If this were done the dangers of the method would to a great extent disappear. Mr. Gordon Ley (London) had discarded plugging, because he had met with one case of rupture of the uterus following this method, due to necrosis of the uterine muscle. In mild cases he preferred to follow a course of inactivity. If haemorrhage was getting w'orse he did not hesitate to open the abdomen. Dr. McKerron (Aberdeen) was of opinion that the plug offered the best method of treating severe accidental haemorrhage. He thought the mortality attached to placenta praevia was due not to the method of treatment but to delay in its adoption. Personally, he preferred version to the use of De Ribes J bag. Professor Munro Kerr (Glasgow) was in favour of external version in placenta prama. He thought delivery should not be hurried. In connection with accidental haemorrhoge, he agreed with Dr. Tweedy in all that he had said about the plug. He also thought, with Dr. Gordon Ley, that the use of pituitrin after the

rupture of the membranes was a good alternative method to plugging the vagina. Dr. Tweedy said that he thought every nurse and student should be taught to plug. It was the one treatment that was available to nurses in bad cases 'of haemorrhage where a doctor was not at hand. In dozens of cases in outlying parts of Ireland and Scotland a nurse was left to herself while her patient was almost dying. His experience was that midwives knew their work a great deal better than the students. He re-emphasised that the efficient plug controls the uterine artery ; this he believed from practical observation. On the wh'ole then, the experts are in favour of packing the vagina in accidental haemorrhage, provided it is carried out with surgical cleanliness, and done efficiently. In many slight cases no obstetric

interference is necessary ; in others external version, plugging the cervix with the half-breech, or rupturing the membranes, applying a tight binder, and giving ergot or pituitrin, will secure good results, with diminished risk of sepsis. Caesarian section, as a line of treatment, is only practicable where a hospital or good nursing home is available ; in certain cases the experts consider it the best method of delivering the patient, and it secures a living child. Only in a few exceptional instances is hysterectomy necessary. — From the "Nursing Times," October 9th. [Note. — The above interesting paper, we hope, will call forth from the medical officers of our St. Helens Hospitals, and also from the matrons, some expression of their experience and views on the treatment of <ante-partum haemorrhajge.]