| dc.description.abstract | A placenta, the implantation of which encroaches
upon that part of the uterus which will afterwards
become the lower uterine segment, is termed Placenta
Praevia. Of this, there are three varieties:
(a) Central, where the placenta completely covers
the os; (b) Marginal, where the placenta reaches the
margin of the internal os; (c) Lateral, in which the
edge of the placenta dips into the lower uterine
segment. The two last are often grouped together as
Partial Placenta Praevia, on account of the arbitrary
nature of the words lateral and marginal, which, by
different observers, are respectively used to denote
different degrees of praevia, at unstated degrees of
dilatation of the internal os. It may here be observed
that such terms may be misleading unless at
the same time the size of the os is stated, for it
follows that a placenta which may be felt to cover the
os completely when it is dilated to admit one finger,
may only partially cover it by the time the os has
reached the size of a teacup. The words Central
and Partial will here be employed to describe the
situation of the placenta, as it would be recognised
Clinically with the os dilated to one finger. Often
when the patient is first seen the os is further
dilated, and in these cases the relationship between
the placenta and the cervix at a "one finger" dilatation
has to be assumed.
That placenta praevia is a serious condition for
both mother and child is shown by the mortality
figures obtained by taking the average of 20 observers,
the maternal mortality being 10.e% and the foetal
mortality 50%. The incidence amongst hospital cases
is approximately 1.2%.
Whilst the variety of praevia, the amount of
blood loss, and the general condition when first seen,
have considerable bearing upon the prognosis for the
mother, judicious treatment is undoubtedly an import_
ant factor. It is to this side of the subject that
most attention will be directed in this paper, in
the hope that further light may be shed upon the
right choice of method of treatment under varying
circumstances. With this in view, the findings of a
number of observers will be compared with the findings
resulting from an analysis of 192 consecutive cases,
which have been admitted to the Edinburgh Royal
Maternity Hospital, during the past 5 years 1923 -27,
inclusive. | en |
