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Friday
May132011

1906 Placenta Previa Treatment

I have the most wonderful book, the 1906, "Obstetrics, Volume V of the Practical Medicine Series" by none other than Dr. Joseph B. De Lee (he spelled it separated). One of the moms that reads on the Navelgazing Midwife Facebook page has Placenta Previa and is scheduled for a cesarean in three days. It was her "case" that sent me looking at the old text, to see how they dealt with previa back in the olden days. Here, I'll write it out for you all.

"R. Warren summarizes a series of 94 cases of placenta previa with a mortality of 6 mothers, 6.3 percent; and of the 93 infants, 49 died, or 52 per cent. None of the primipara mentioned in the series died, although mortality in such cases is considerable. Twin labors occurred twice, three of the children and one mother dying. Prolapse of the cord occurred in 3 cases out of 54 in which de Ribes bag was not used and in 4 cases out of 40 where it was used. Postpartum hemorrhage occurred in 14 cases; in 4 the placenta was adherent, in 2 there was atony uteri. These last two mothers died. As regards treatment, in 27 cases watchful expectancy was followed in conjunction with various minor methods of treatment. Twenty-one cases were treated by internal version or extraction by the breech in podalic presentations. Of these, 5 mothers died; of the 22 children, 14 died. Forty cases were treated by the insertion of the de Ribes bag. None of the mothers died, but 25 children were lost. There was no case of complete previa in the series."

The book goes on discussing complete previas (Placenta Previa Centralis), Missed Labor with Placenta Previa Centralis, where the author gives the case study of a woman having labor then it completely stopped, re-starting two months later where she gave birth to an 11-pound stillbirth.

The standard of care was "tamponing," putting some sort of material (it doesn't say anywhere I can find) inside the vagina to put pressure on the presenting placenta until the mom is dilated completely, then the placenta and baby come out together once the mom is completely dilated.

"When the placenta is located over the os it is better to loosen it at one side until the edge is felt and then rupture the membranes than to bore through the placeta."

Eek!

Cesareans were extremely rare... unless they were vaginal cesareans. Yes, you read right. That will be the next post from this book. It's rather amazing. And looks horrid!

Reading about how many mothers and babies died at the doctor's hands... as they obviously practiced on women... just ghastly. I thank goodness for today's mortality rate; wish it was better, of course! But oh so glad it isn't like it was in 1906.