Hemorrhage of late pregnancy.

Rupture of the uterus, cesarean section and uterine atony were the major causes of maternal death associated with hemorrhage of late pregnancy for the five years 1945 to 1949 in New York County. Shock occurred earliest in rupture of the uterus and cesarean section, while in uterine atony there was some delay before shock was evident. Placenta previa was preceded by an initial small hemorrhage, and the time interval before shock was relatively long. It appeared that in cases of retained placenta, manual removal of the organ and hysterectomy were unduly delayed. Ten per cent of the maternal deaths reviewed were associated with severe transfusion reactions. Early recognition of a serious situation, rapid blood replacement and hysterectomy might have salvaged most of the patients.