Placenta

“ As the placenta is non-contractile it cannot accommodate itself to this decreased area of attachment, and so is literally squeezed from its moorings. It is then gradually forced down into the lower uterine segment where it may be located by the distension of the abdominal wall which it produces just above the symphysis. After the separation of the placenta is complete the uterus rises in the abdominal cavity until the fundus is felt above the umbilicus. The placenta, finally, may be completely expelled spontaneously, or expressed by slight pressure made upon the fundus by the accoucheur. ”

“ The placenta thus has a two-fold function in acting both as an organ of circulation and of respiration. It is through the walls of the villi that this interchange of gases and fluids takes place; nourishment and oxygen passing through them to the fetus, and carbonic-acid gas and waste materials passing through them to the mother. There is no direct communication between the fetal and the maternal blood. The placenta, normally, is attached to the contractile part of the uterus, and on its separation the blood-vessels are closed by the contractions of the uterine wall. ”

“ After the child is breathing properly and the cord is cut, the mother may receive your attention. If the placenta is not expelled spontaneously, place one or both your hands over the uterus, and by friction, squeezing and pressure there, you will probably cause enough contraction of the womb to start the placenta from its attachments. You may then make slight traction on the cord, pulling only gently, and it will probably come down; as it emerges from the vagina gently twist or turn over the afterbirth, and you will secure the removal of the membranes. ”

“ The first time was in a placenta from the garbage can. We had been culturing polio viruses in human placentas (very interesting personalities viruses are, too) and I'd been sent a whole placenta more than I needed. What can a mother tell a placenta which has been doing its work and is still in excellent shape, just like that civilization in the Phoenix Nebula some two and a half millennia ago? Does she say, 'There's nothing more for you in time or space; the baby is born, I abandon you to utter nothingness'? Very rarely. And even then she doesn't mean it. But the life does go out of the cells. ”

“ When the placenta is examined, it is found that certain changes have taken place in its structure which interfere with the circulation of the blood through the placenta, and may indirectly bring about the death of the fetus. The child is also subject to the same toxic conditions which the mother has had and may die from failure of the liver and kidneys or in convalescence. ”

“ In order to explain the formation of the placenta it is necessary to encroach to some extent on the domain of physiology. Before each menstrual period, during the child-bearing age of a woman, the mucous membrane of the uterus hypertrophies, and, at the period, is cast off and renewed, but if a fertilized ovum reaches the uterus the casting off is postponed until the birth of the child. ”

“ We have seen that after the first month of pregnancy the placenta serves the fetus as a combined respiratory and digestive apparatus, not alone in supplying the oxygen and nourishment requisite for life and growth, but also in excreting the broken-down products of fetal life. ”

“ Its shreds when expelled are of diagnostic importance, and in early abortions its massive thick tissues, changed by disease, often cause greater trouble than the ovum itself, forming, alone or with the membranes proper of the ovum, what is so commonly but erroneously called the placenta in abortion. ”

“ The placenta is, for the most part, a highly developed portion of the chorionic membrane, which became specialized simply because it happened to receive the best supply of blood. At the time of birth the placenta measures nearly an inch in thickness, is as large around as a breakfast-plate, and generally weighs a pound and a quarter, that is, approximately one-sixth of the weight of the child. ”

“ For some embryos have a more perfect structure provided for them, such as that fleshy substance mentioned above, which in some is altogether wanting. In some, also, the placenta is observed to be thicker, larger, and more loaded with blood; whilst in others it is more spongy and white, like the thymus or pancreas. But there is not more variety found in the placenta than in the mamma or viscera generally: for instance, the liver in some animals is red and filled with blood, in others, as is the case with fishes and some cachectic persons in the human species, it is of much paler hue. ”

“ It seems probable, from Bischoff’s and Kölliker’s observations, that the subzonal membrane in the area of the placenta becomes attached to the uterine wall, by means of villi, even before its fusion with the allantois. In the later periods of gestation the intermingling of the maternal and fœtal parts of the placenta becomes very close, and the placenta is truly deciduate. The cavity of the allantois persists till birth. Between the yolk-sack, the allantois, and the embryo, there is left a large cavity filled with an albuminous fluid. ”

“ As you will see later, it is through this mass of branching blood-vessels that the baby virtually eats and breathes and gives off waste materials during the nine months of his life within the uterus. The doctors refer to the mass as the placenta but you have heard it called the “afterbirth,” because it is expelled after the baby is born. ”

“ Not much is definitely known about the cause of placenta prævia, but it is evident that multiparity is a factor, since the condition is found about six times as frequently among women who have borne children, as it is among those who are pregnant for the first time. A diseased uterine lining is probably the fundamental cause, and this may explain why the trouble is found more frequently among the poorer classes, since such women as a class have less skilled medical attention than those in better circumstance. ”

“ Some patients with defective uterine lining will have slight bleeding for a long time, possibly throughout the entire period of pregnancy, because a small area of the placenta has separated, leaving, however, a sufficiently large attached area to nourish the fetus. Such women should, of course, be under a doctor’s care and sedulously avoid all shocks to the uterine musculature, for the separated area may very easily be increased to such a size 170that the fetus will be unable to secure adequate nourishment, and die as a result. ”

“ The placenta can generally be seized by two fingers and removed; but if persevering efforts are necessary, they should not be relinquished until the safety of the mother is assured, which cannot be while the ovum, or membranes, or placenta remain in the uterus separated from their connections.
But it should always be considered especially important to PREVENT THE ABORTION. If a woman is prone to miscarry, she ought, as soon as she is pregnant, to lie down a great part of the day; she must keep her mind calm and unruffled, and must live on plain diet ”

“ When the whole conception come away at once, the pain and discharge usually go off; but, if only the fœtus come away, all the symptoms either continue and increase till the placenta come away, or, if they be for a time suspended, they are sure to return, except in early miscarriages of ten or twelve weeks pregnancy, when sometimes the fœtus is expelled separately, and the placenta comes immediately after, but the latter frequently remains several days. ”

“ If there is no hemorrhage, or other cause of alarm, there is no more reason for giving assistance to deliver the placenta than if only one child had been present; we ought either to wait for the spontaneous operation of nature, or, at most, give very little assistance, precisely as we would in a case of single birth. ”

“ Blood is the only nourishment the child has while it is in the mother’s womb. Hence it would be manifestly improper to rob the child of any portion of the fluid coming from the mother to it.
The ancients not only waited for the expulsion of the after-birth before tying the cord, but if the child was at all feeble or dead at birth, the placenta, when expelled, was laid upon its belly as a comforting and restoring application. ”

“ But one of the most dangerous varieties of uterine hemorrhage is that which follows the expulsion of the placenta, or its removal from the uterus by art. Sometimes the blood escapes in great quantities from the uterus immediately after the removal of the placenta, and the pulse ceases at the wrist, and consciousness is entirely lost in a few seconds. There is no symptom before labor has commenced, or during its progress, to warn you of what is about to take place. ”

“ The placenta is, in fact, a portion of the child incorporated in the tree. A caul, which is as much a portion of the child as the placenta, and which, unlike the latter, is easy of preservation, was formerly regarded in this country as an index of the health of the person who was so lucky as to be born with it. While he remained alive and well, it was firm and crisp; if he sickened or died, it became flaccid and relaxed.33.1 Any fragment of a human being may, indeed, become his life-token. ”

“ The separation and extrusion of the placenta, on the contrary, are apt to be imperfect when pregnancy ends in the early months, and medical attention is necessary to determine whether the uterus has been emptied completely. ”

“ If the reader can procure a placenta which has been thrown off immediately after the birth of the child, without any effort, and cleaning it of all coagula from off the surface which lay next to the uterus, by careful maceration and washing, he will afterwards introduce a small quill or pointed tube into one of the arteries of the navel-string, and blow strongly into it, he will find that the air raises upon that surface, to various degrees of puffiness, a very delicate pellicular covering, through which none of the air can escape, unless through an accidental laceration. ”

“ Whatever part of the womb the ovum attaches itself to is stimulated to intense activity, to growth. Numerous bloodvessels begin to grow and that part of the lining membrane with its numerous bloodvessels constitute the placenta, or as it is commonly called afterbirth, because it comes out after the birth of the child. From the placenta there is also reflected a membrane over the ovum, so as to give it additional protection. That membrane forms a complete bag over the fetus ”

“ I usually instruct some one else to make strong and firm pressure upon the uterus, and I pass two fingers of one hand into the vagina, and learn thereby when the placenta descends, and if necessary assist in its removal. Although we should never hurry in removing the afterbirth, I believe that it always is easily removed if we make the effort very soon after the child is born, and if it is necessary for you to pass your hand into the uterus you can do so then better than at any other time. ”

“ In a case of ventral aberrant fœtation, which had proceeded to the end of the sixth month, before it destroyed the patient, a vascular and tomentous membrane had been formed on the xviisurface of the peritoneum, to which adhered the regular placenta and chorion of the fœtiferous ovum. This membrane resembled in every respect the decidua, at six months—it was thicker, and more red and vascular where the placenta was adherent than any where else. ”

“ These fanciful beliefs, however, are sometimes serious matters to the young woman who is traveling, day by day, toward a great and mysterious event, and they should not be laughed to scorn, but explained away seriously and with sympathy. She may be told quite simply, that after conception she gives her baby only nourishment; that the baby’s connection with her body is through the cord and placenta, in neither of which are there nerves ”

“ The art of turning does not appear to be known, neither 19 is blood-letting practised in their obstetrics. We heard of no case of retention of the placenta after parturition, nor of the affection of longing, or of nausea of the stomach during pregnancy. ”

“ A new human being is the ultimate result of conception, but the chorion, amnion, placenta and umbilical cord must also be created to serve as aids in building and protecting the developing child during its uterine life. The part played by these accessory structures is so vital, in spite of being temporary, that it will be well for us to look into their origin and functions before considering the fetus itself which they serve. ”

“ If the fundus is above the umbilicus something is wrong. Painful contractions of the uterus follow and cause a squeezing off of [Pg 181] the placenta. There is a flow of blood, the placenta follows, passes out of the vagina, dragging the membranes after it. The fundus sinks, and the uterus, hard, contracted and firm, lies in the pelvis. In some cases it becomes soft, rises up and then relaxes. If it becomes too soft, the relaxation which follows may induce hemorrhage. The uterus should be carefully massaged until it hardens. ”