Every labour is accompanied with a certain quantity of bloody discharge from the womb, but the hemorrhage sometimes bursts forth in such fearful quantities, that the patient's life is suddenly placed in the most extreme peril. In order thoroughly to understand the cause and the treatment of uterine hemorrhage, it is necessary to bear in mind the connexion which is established between the foetus and the mother by means of the placenta, wad the peculiar manner in which the circulation through the maternal portion is carried on.
The human placenta is formed of two separate portions; the one the production of the foetus, which is vascular, the other the product of the uterus, which is cellular; and hence it is divided into the foetal or vascular, and the maternal or cellular portions. Between these two parts there is no direct communication, the circulation through each being perfectly distinct. In the arrangement of the fetal blood-vessels, there is nothing peculiar; the arteries terminate in the veins, as in other parts of the body; but, if the maternal structure be examined, it will be found to be widely different; for here the arteries terminate by open mouths into the cells, from whence, also by open orifices, the veins arise; the communication between artery and vein being kept up by the intervention of this cell. The blood brought by the uterine artery (for, in order to make the subject more clear a single vessel will be selected,) must be deposited in this cell before it can be taken up by the returning vein: if, then, by any accident, the cell be torn away from the sides of the womb, {and this must always take place in a separation of the placenta,) it must necessarily have the effect of destroying the communication between artery and vein. The blood, therefore, brought to the uterus by the former vessel, cannot be returned by the latter, but is poured from the open mouth of the artery into the uterine cavity; and when the extraordinary size of these vessels at the full period of gestation be considered, and the free communication that exists between the cells of the placenta, it will not be at all surprising that the hemorrhage should be alarming, even where the separation has not occurred to any great extent. As the size of the blood-vessels increase in a ratio corresponding to the period of gestation, it follows a female has approached her full time, the greater will be the danger to be apprehended from uterine hemorrhage; although, even in the very early months, blood is frequently effused in alarming quantities, owing to the great number of vessels (although of small size) by which the ovum and the uterus are connected together.
Hemorrhage may occur at any period of the labour, before it has begun, or after it has been completed; and, although the general principles of treatment are the same, it will be found convenient to describe it under two heads.
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From Charles Waller
Elements of Practical Midwifery: Or, Companion to the Lying-in Room, 1829
