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January 2, 1954


JAMA. 1954;154(1):60-61. doi:10.1001/jama.1954.02940350062017

Severe uncontrollable hemorrhage associated with nonclotting of the blood is a dreaded complication of certain obstetric conditions, particularly premature separation of the normally implanted placenta. Attention was first drawn to this condition in 1901 by DeLee, who described it as a temporary hemophilia. Since then, various investigators have sought to determine the nature of the coagulation defect. In 1915, Williams likened the hemorrhagic lesions in abruptio placentae to those seen after poisoning by certain varieties of snakes and suggested that a toxic substance circulating in the blood led to changes in the vessels that permitted escape of blood into the tissues. Willson in 1922 suggested that in abruptio placentae there was liberation from the placenta of a hemorrhagic toxin that exerted its maximal effect locally in the form of retroplacental bleeding and thus led to the placental separation. He further suggested that, when this toxin was absorbed into the maternal

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