- The point of the procedure is to prevent exsanguination (severe blood loss) in pregnant patients with placenta previa.
Season 1, Episode 1: Method and Madness
In the surgical theatre of The Knick, Dr. J.M. Christiansen attempted to perform an early version of this procedure on a pregnant woman with placenta previa (the placenta blocking the neck of the uterus, thus interfering with birth).
During the procedure, Thackery states that the fetus is trapped in the umbilical cord, but despite this he is able to deliver the baby. The pregnant mother continues to bleed excessively, and Christiansen locates the source of the bleed and closes it. However, the patient does not survive the procedure and neither does the baby who was delivered. J.M., who is unable to cope with the failure, goes to his office and ends his life with a bullet to the temple.
Season 1, Episode 6: Start Calling Me Dad
Thackery explains to Bertie that the old placental repair of Christiansen's was wrong conceptually. Despite Christiansen's closure of the blood tear, the patient died due to excessive blood loss. Therefore, the procedure will work so long as they can slow the loss of the blood as much as possible.
He helps reveal and teach Bertie that they can accomplish their patient dying more slowly by adding pressure on the tear in the womb to slow the bleeding—except now from the inside rather than the outside. Thackery shows Bertie his invention, a sheath that allows the bladder to keep its correct shape for insertion.
- They test the procedure by inserting the invention into payed prostitutes. However, the prostitutes are not pregnant so difference of the size of the uterus and lack of dilation of the cervix cause a slight change in the final results of the experiment.
- Bertie helps Thackery realize that they can fill the sheathed bladder with water instead of air, giving the invention more weight and conforming better to the patient's anatomy.
- A woman at Bellview Hospital with a thickened lower uterine wall and a placenta out of place appears to be the perfect candidate for Thackery and Bertie’s new procedure. They successfully deliver the healthy baby and save the mother’s life at The Knick, in front of an audience.
Surgical Procedure Edit
The surgical procedure for treating pregnant patients with placenta previa and thus delivering a healthy newborn is as follows:
- Insert the sheathed deflated bladder (sheathed so that it can keep the shape small) up into the vaginal canal, up into to the uterus, and leave an airway trailing to the outside.
- Fill the tube that leads to the deflated bladder with water until full. Attach weights to the tube for added pressure. The bladder should expand and harden against the source of the bleed, slowing the blood loss to a trickle. This gives the physicians more time to deliver the baby.
- Make a vertical incision and perform the Caesarean procedure, successfully delivering the newborn baby and saving the mother's life.
- Close the patient up with proper suturing technique.