It is impossible to distinguish between eclampsia and nephritic toxemia during an attack, but this is of no importance at the time, as the treatment of the two diseases is the same.
Chart 2.—Chart showing persistence of high blood pressure and of albumen in the urine, after delivery, in nephritic toxemia with convulsions.
But during the puerperium, the differential diagnosis may be made, for in eclampsia the blood pressure falls rapidly to normal and the casts and albumen disappear from the urine in from two to four weeks. In nephritic toxemia, on the other hand, although the blood pressure falls somewhat, and the albumen decreases in amount as the patient’s general condition improves, by the end of the puerperium the blood pressure is still elevated and casts and albumen are still present in the urine.
In eclamptic cases that come to autopsy, there is a typical, peripheral necrosis of the liver, but in nephritic toxemia there is no liver lesion.
Acute Yellow Atrophy of the Liver is one of the grave but very rare toxemias of pregnancy and though it may occur at any stage it usually appears during the latter part of pregnancy or during the puerperium. This complicating condition is not peculiar to pregnancy alone, although from forty to sixty per cent. of the cases which occur are in pregnant women.
The symptoms, which sometimes come on suddenly in a woman who previously has been entirely well, may suggest phosphorus poisoning. They are abdominal pain, headache, vomiting, and diarrhea followed in some cases by coma and convulsions, and in others by violent delirium. With these symptoms are jaundice and a diminished amount of urine, which contains albumen, casts, and usually a good deal of blood. The picture is practically that of pernicious vomiting plus jaundice and pain.
Little is known of the ultimate cause of the disease, but it produces rapid atrophic and degenerative changes in the liver, and though mild cases sometimes recover, the outcome is usually fatal. It was formerly thought that the termination of pregnancy virtually cured the condition, but the present belief is that delivery produces little or no effect. The tendency now, therefore, is simply to employ the same kind of eliminative treatment that is used in eclampsia.
Among the more serious complications of pregnancy, which are not due to that condition, but which it is important to recognize and treat early, may be included syphilis, heart lesions, pulmonary tuberculosis, thyroidism, gonorrhea and pyelitis.
“Syphilis is one of the most important complications of pregnancy,” in the opinion of Dr. Williams, “as it is the most important single cause of fetal death.”