Obermann (Arch. f. Gyn., B. 32 H. 1.) discusses the treatment of
placenta prævia by version with the results obtained in sixty-four cases
at the Leipsic clinic. The method, which has become known as Hofmeier’s
method, he states as follows:
Perform bimanual version with deliberate extraction in case of much
hæmorrhage. The podalic extremity of the child makes an effectual
tampon. Massage of the uterus during extraction is advised to aid
expulsion. Iodoform gauze tampon may be used in case of hæmorrhage in
the early months. The colpeurynter is recommended in case of hæmorrhage
with a closed cervix. Alcoholic stimulants are given early and often.
The results in the sixty-four cases were eighty-nine per cent. of the
mothers and forty-seven per cent. of the children saved.
Nordmann, of Dresden, condemns early resort to operative procedures as a
routine measure, a more expectant plan of treatment being competent in a
certain proportion of cases.
Robt. Barnes (Br. Med. Jour., March 3d, 1887) sums up his views
substantially as follows: The hæmorrhage in placenta prævia proceeds
from so much of the lower zone of the uterus as is laid bare by
separation of the placenta during canalization. This comprises all that
portion of the uterus that lies below the equator of the fœtal head.
When canalization is complete the hæmorrhage is almost invariably
arrested spontaneously by retraction of the lower zone thus freed. Until
canalization is completed flooding is liable to persist, but after that
process is accomplished the case becomes practically a natural labor.
The too prevalent idea that the hæmorrhage is unavoidable and must go on
till delivery is erroneous and mischievous. Enough placental attachment
usually remains after complete dilatation to preserve the life of the
child. The fœtal life is not necessarily compromised except in certain
extreme cases of complete central placenta prævia. His views of
treatment follow as a corollary. Expedite the first stage, avoiding
violence or precipitation. His caoutchouc bags accomplish this
indication and control hæmorrhage. Detach the placenta with the finger
from the zone below the equator of the head, thus permitting retraction
and arrest of flooding. Rupture of the membranes and the use of the
binder meet the indications in certain cases. The vaginal plug may be
used in occasional instances if carefully watched. The os uteri
moderately expanded and the placenta separated from the lower zone,
hæmorrhage having ceased, wait. With sufficient dilatation, deliver, if
necessary, by forceps, version, or craniotomy. Dr. Murphy’s success by
this plan has been unexampled. [Dr. Barnes does injustice to version in
placenta prævia, since he appears to assume that immediate extraction
and violence to both mother and child are a necessary part of the
procedure. The success of that plan he attributes in great part to the
fact that, in carrying out the operation of turning, the placenta had
probably been detached from the lower zone. These criticisms certainly
cannot apply in case of external or bipolar version. With reference to
Barnes’ bags, it is safe to say, “the German teachers” are not the only
practitioners who have found them, in many cases, more or less
impracticable.]