37

P O S T P A R T U M H A E M O R R H A G E , (R.C.O.G. TABLE 25)

DR. ROSEMARY JORDAN

Summary : ~" Booked ---- 94

106 J Unbooked --~ 12 (a) Total number of cases . . . . . . . . . ] ,Primipara -~40 ~Mult ipara ----66

Incidence against total deliveries 28 weeks maturi ty and over (4,909,) . . . . . . 2-1 per cent.

(b) Maternal mortality . . . . . . . . . Nil

(c) Number of patients transfused with blood

(d) Number of cases in which shock developed

In some instances ~6Jcondit ions other than v ] P . P . H . influenced the

transfusion. 9

T Y P : ~ s o F H A ] ~ M O R R H A G E AND ESTIMAT]~D C A U S E :

Primary (66) : (a) Atonic . . . . . . . . . . . . . . . . . . 42

Associated with A.P.H . . . . "'" "4 Associated with retained placent'a ::: ::: ::: 6

(b) Adherent placenta . . . . . . . . . . . . . . . . . . 2 (c) Traumatic . . . . . . . . . . . . . . . . . . . . . . . . 16 (d) Ruptured uterus . . . . . . . . . . . . . . . . . . . . . J (e) Clotting defect . . . . . . . . . . . . . . . . . . . . . 1 (f) Retained cotyledon . . . . . . . . . . . . . . . . . . 4

. ~

Secondary (40) : (a) Retained products of conception (b) Vulval haematom~ . . . . . . (c) Sacculation of lower uterine segment

. . . . . . . . . 37 . . . . . . . . . 9,

. . . . . . . . . ].

COMMENT

T h e decrease in t r a u m a t i c p o s t p a r t u m h a e m o r r h a g e recorded las t y e a r (1962) has n o t been m a i n t a i n e d . S ix of these cases fol lowed s p o n t a n e o u s d e l i v e r y a n d 3 were easy low forceps de l iver ies a n d t h e cause in each case was v a g i n a l l acera t ions . I t is difficult to a c c o u n t for t h i s increase u n l e s s a m o r e s t r i n g e n t e s t i m a t i o n of b lood loss has b e e n m a d e . The r e m a i n i n g 7 cases of t r a u m a t i c h a e m o r r h a g e fol lowed difficult ope ra t i ve del iver ies .

T w o cases r equ i red h y s t e r e c t o m y a n d a re fu l ly descr ibed u n d e r t h e Le t t e rp r e s s " H y s t e r e c t o m y assoc ia ted w i t h P r e g n a n c y ", page 50, a n d a n o t h e r case of p a r t i c u l a r in te res t , No. 60369, is fu l ly descr ibed in L e t t e r p r e s s on Caesa rean sect ion, page 39.

M A N U A L R E M O V A L O F P L A C E N T A (R.C.O.G. TABLE 26)

DR. ROSEMARY JORDAN

Summary :

(a) Total number of cases . . . . . . . . .

Incidence against total deliveries 28 weeks maturi ty and over (4,902) . . . . . .

{" Booked =252 2 / Unbooked ---- 34

86~ Primipara =128 [. Multipara = 1 5 8

5.8 per cent.