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Habitual Abortion with Prolapse of The Placenta
·HABITUAL ABORTION WITH PROLAPSE OF THE PLACENTA 0SCAR-FREDRIK GULDBERG,
M.D.,
STAVANGER, NORWAY
(From the Department of Obstetrics, Eogaland Hospital. Senior Surgeon: Roar Strpm, lrl.D.)
ROLAPSE of the placenta means the birth of the placenta before the Pfetus. This may happen both in cases of placenta previa and in cases where the site of the placenta is normal. Burezak2 has collected 46 cases of the latter type, 45 of the patients being multiparas while one was a primipara. Twenty-two of the infants were premature.
S. S., a 33-year·old gravida iv, para iii, was at term on Dec. 9, 1951. She had had two premautre deliveries and one term delivery previously. During her fourth pregnancy she was given intramuscular injections of Antefysin. No proteinuria or hypertension was noted during pregnancy. Two months before term on Oct. 4, 1951, at about 7 A.M., she suddenly fell ill with abdominal pain not resembling labor pains. There was an escape of liquor amnii, and she began to bleed per vaginam. On her admission to the hospital at 10 o'clock she was exhausted, almost in a state of shock. The placenta and membranes hung out of the vagina. At once she was given 500 e.c. of Macrodex, two blood transfusions, as well as penicillin. . No fetal heart sounds were audible. The presenting part could be moved above the symphysis. At 11:20 A.M. she was delivered spontaneously by breech presentation of a dead female fetus that weighed 1,820 grams. On admission there was a trace of albumin in the urine, which was normal at later examinations. The puerperium was normal, and the patient was discharged well. On J'uly 4, 1953, she was delivered spontaneously of a live female infant that weighed 3,210 grams.
Comment Probably a normally inserted placenta prolapsed in 1951. The diagnosis might have been confirmed by a histological examination of the placenta, and the demonstration of fibrinogenopenia during labor. However, by cesarean section it has been demonstrated that premature separation of the placenta may occur simultaneously with placenta previa. 1 • 3 • "· 6 The diagnosis consequently may be difficult. Kobes 4 searched for remains of the placenta and found its insertion in the fundus uteri. Palpation of the uterine wall is probably the only reliable method of deciding whether we are dealing with the prolapse of a normally inserted placenta or a placenta previa.
Summary A case of prolapse of the placenta is reported. Placenta previa and premature separation of the placenta may occur simultaneously, and it is not possible to decide with certainty which type of prolapse occurred in thi<~ case.
References J. }'lorida M.A. 32: 425, 1946. Burezak, N.: Zentralbl. Gynak. 58: 1829, 1932. Fleming, J. G., and Pierce, .J. M.: J. Med. 21: 170, 1940. Kobes, P.: Zentralbl. Gynak. 52: 2747, 1928. Rosenbloom, D.: AM. J. OBST. & GYNEC. 42: 1086, 1941. Roth, D. B.: AM. J. OBST. & GYNEC. 54: 137,1947.
1. Benbow, .J. 'l'.:
2. 3. 4.
5. 6.
TORFAEUSGT. 15 STAVANGER, NORWAY
451
M.D.,
STAVANGER, NORWAY
(From the Department of Obstetrics, Eogaland Hospital. Senior Surgeon: Roar Strpm, lrl.D.)
ROLAPSE of the placenta means the birth of the placenta before the Pfetus. This may happen both in cases of placenta previa and in cases where the site of the placenta is normal. Burezak2 has collected 46 cases of the latter type, 45 of the patients being multiparas while one was a primipara. Twenty-two of the infants were premature.
S. S., a 33-year·old gravida iv, para iii, was at term on Dec. 9, 1951. She had had two premautre deliveries and one term delivery previously. During her fourth pregnancy she was given intramuscular injections of Antefysin. No proteinuria or hypertension was noted during pregnancy. Two months before term on Oct. 4, 1951, at about 7 A.M., she suddenly fell ill with abdominal pain not resembling labor pains. There was an escape of liquor amnii, and she began to bleed per vaginam. On her admission to the hospital at 10 o'clock she was exhausted, almost in a state of shock. The placenta and membranes hung out of the vagina. At once she was given 500 e.c. of Macrodex, two blood transfusions, as well as penicillin. . No fetal heart sounds were audible. The presenting part could be moved above the symphysis. At 11:20 A.M. she was delivered spontaneously by breech presentation of a dead female fetus that weighed 1,820 grams. On admission there was a trace of albumin in the urine, which was normal at later examinations. The puerperium was normal, and the patient was discharged well. On J'uly 4, 1953, she was delivered spontaneously of a live female infant that weighed 3,210 grams.
Comment Probably a normally inserted placenta prolapsed in 1951. The diagnosis might have been confirmed by a histological examination of the placenta, and the demonstration of fibrinogenopenia during labor. However, by cesarean section it has been demonstrated that premature separation of the placenta may occur simultaneously with placenta previa. 1 • 3 • "· 6 The diagnosis consequently may be difficult. Kobes 4 searched for remains of the placenta and found its insertion in the fundus uteri. Palpation of the uterine wall is probably the only reliable method of deciding whether we are dealing with the prolapse of a normally inserted placenta or a placenta previa.
Summary A case of prolapse of the placenta is reported. Placenta previa and premature separation of the placenta may occur simultaneously, and it is not possible to decide with certainty which type of prolapse occurred in thi<~ case.
References J. }'lorida M.A. 32: 425, 1946. Burezak, N.: Zentralbl. Gynak. 58: 1829, 1932. Fleming, J. G., and Pierce, .J. M.: J. Med. 21: 170, 1940. Kobes, P.: Zentralbl. Gynak. 52: 2747, 1928. Rosenbloom, D.: AM. J. OBST. & GYNEC. 42: 1086, 1941. Roth, D. B.: AM. J. OBST. & GYNEC. 54: 137,1947.
1. Benbow, .J. 'l'.:
2. 3. 4.
5. 6.
TORFAEUSGT. 15 STAVANGER, NORWAY
451