Post-Partum Haemorrhage.

Post-partum haemorrhage is defined as being "excessive bleeding from any part of the genital tract after the birth of a child." Some authorities make a hair-splitting definition and describe intra-partum haemorrhage when excessive bleeding occurs before the placenta has been delivered, and confine the term post-partum haemorrhage to excessive bleeding after the completion of the third stage of labour. As practically all serious cases occur before the placenta is delivered, the more commonly used definition will be used throughout this article. The word "excessive" is subject to differences of opinion in its interpretation, many authorities state that a loss greater than 20 ozs. is excessive. It is exceedinglv difficult to measure the loss with any accuracy. In some clinics special fitted trays have been used, draining direct into a bottle under the bed, in which it is hoped to collect all the blood; but even this method is not accurate, as frequently, especially in the more severe cases, some liquor amnii is retained in the uterus after the child is born, and is expelled with the blood, and so makes the reading inaccurate. Further, it is not very rare to express some urine from the bladder during manipulations designed to control the bleeding, which again will make the reading inaccurate. In order to get over this difficulty, some authorities have suggested that the criterion of excessive haemorrhage should be when the woman shows signs and symptoms of loss of blood, but again we are faced with great difficulties, as the previous manipulations to effect delivery may have caused a rise in pulse rate, which is the main symptom to rely on to diagnose excessive bleeding. In this article a rough estimate of an excess of 20 OZS. will be used as the definition, and it is suggested that it is unnecessary to try and be academically accurate. The different varieties of haemorrhage: (i) Traumatic post-partum haemorrhage due to the laceration involving an artery or arteries. (2) Atonic bost-partum haemorrhage, due to insufficient contraction and retraction of the uterine muscle. and these varieties may be further subdivided into: (a) Primary, occurring within 24 hours of delivery. (b) Secondary, occurring any time up to three weeks after delivery. The serious cases are all cases in Group 2., and as this group of atonic bleeding is going to take up most of this article, we will deal shortly with the other two groups …