Abortion, as the term is used by physicians, in its widest sense is the ejection or extraction of a fetus from the womb at any time before term. The word is popularly contrasted with miscarriage, where the fetus is ejected through disease or accident; abortion in the lay sense supposes artificial, and commonly criminal, extraction of the fetus. Abortion (from aboriri, to perish) etymologically has an association with destruction of life, but the name is given by physicians to a removal of any premature fetus, even if it is viable. Strictly, however, abortion is an interruption of pregnancy before the fetus is viable, and premature labor is such an interruption after the fetus is viable. Throughout this chapter the words are used in this sense.
Abortion as a medical and moral consideration may be considered from several points of view.
First, involuntary pathologic and accidental interruptions of pregnancy are to be averted, if it is possible to do so, to save the life of the child; and when the abortion is inevitable the treatment has moral qualities which involve the physician and the mother.
Secondly, voluntary and therapeutic abortion has peculiar moral and medical qualities arising (a) from the period of gestation or the viability of the child; (b) from the truth or error in the diagnosis as regards the necessity for interference, and the advantage or damage resulting from the interference.
Thirdly, the technical skill or ignorance of the physician, and the methods he employs may in themselves in any case avert or cause the death of the mother or grave injury to her, and in the forced delivery of premature infants may save, kill, or maim the child.
Fourthly, voluntary criminal abortion has a special malice of its own, which makes it somewhat more criminal than the therapeutic removal of an inviable infant.
Fifthly, there are positive canonical and civil penalties against abortion as it affects the inviable infant.
Pathologic abortions, and those arising from accident or carelessness, are extremely common. Hegar estimated that there is one of these abortions to every eight normal parturitions, and specialists in obstetrics find as many as one abortion to four deliveries at term. These abortions are most frequent from the eighth to the twelfth week of gestation, because the ovum is then not firmly attached to the uterus, and it readily succumbs to external influence. Moreover, the woman is not certain she is pregnant and neglects precautions. Many women, again, are under the error that there is no moral evil in getting rid of the ovum before quickening, and they think quickening occurs only when they feel the fetal movements. Others, erroneously again, fancy that abortion in the early months is not dangerous or injurious to themselves.
The causes of pathologic and accidental abortion are very numerous and often interactive. They may arise from the fetus, the mother, the father, or from violence. The death of the fetus, or diseases of the fetus itself or of its appendages, cause abortion. Weakness of the fetus from alcoholism in the parents, anemia, carbon monoxide and lead poisoning, tobacco poisoning in women who are cigar-makers, and similar conditions in one or both parents, will bring on abortion. Monsters rarely go on to term. Acute or chronic affections in the mother, as typhoid, malaria, smallpox, cholera, scarlatina, measles, tuberculosis, and the like, and syphilis in the mother or father, effect abortion. Other abnormal states that bring on abortion are low blood-pressure in maternal anemia, shock, syncope; hemorrhages into the placenta in maternal nephritis; hemorrhages between the placenta and uterus from diseases of the placenta and decidua, or from traumatism, which detach the placenta; sun or heat stroke; sudden high temperature in fever; toxemias, as in some forms of hyperemesis gravidarum, eclampsia, chorea, hepatic autolysis, and impetigo herpetiformis.