Some women with tuberculosis improve during the period of pregnancy, but decline after delivery. The disease may advance rapidly in such cases and the patient succumb very early.
There is great reluctance to terminate pregnancy in tuberculous patients, except in extreme cases as a last resort, to save the mother’s life, or when, after the child is viable, its chances for life would seem to be better if it were brought into the world, because of the mother’s possible death.
Certain it is that the care which is given to the non-pregnant tuberculous person is needed to an even greater degree by the expectant mother who is suffering from this disease. And under such care, it not infrequently happens that the patient will go through pregnancy safely, and if the care is continued after delivery, and her baby not allowed to nurse, her ultimate recovery does not seem to be retarded by the experience.
Tuberculosis is sometimes, though not frequently, transmitted from the mother to the fetus; but babies born of these mothers are not likely to be robust, particularly as they must be deprived of that bulwark of early infancy—maternal nursing.
Thyroidism in pregnancy has been, and still is, so widely discussed and studied that the nurse will do well to at least take cognizance of that fact, even though no definite conclusions seem to have been generally accepted.
The toxemias of pregnancy are so shrouded in mystery, and knowledge of the functions and inter-relations of the ductless glands is still so meagre, though it is known that one, the ovary, is inevitably concerned with pregnancy, that one is not surprised to find certain investigators considering these two problems together. Nor is it surprising that directly opposite views are held concerning the relation of thyroidism to toxemia.
Since the nurse will sometimes care for toxemic patients who are treated for thyroidism, either by means of gland therapy or operative procedure, she should understand the rationale of such treatment when she meets it.
Dr. Williams says, for example, “A considerable amount of work has been done in this direction, but the consensus of opinion is that abnormalities of the thyroid secretion play no part in the causation of eclampsia.”
On the other hand, it will be remembered that the thyroid gland is usually somewhat enlarged during pregnancy, and in this connection Dr. Edgar observes that “The normal enlargement of this organ in the gravida has been wanting in certain cases of eclampsia.”
Dr. Edward P. Davis summarizes his opinions on the subject as follows: “Hyper-thyroidism in pregnancy produces a toxic condition in the mother, which exposes her to the danger of the toxemia of pregnancy and her child to the dangers which accompany that condition. During pregnancy, the patient has a rapid pulse, often with high tension, and attacks of breathlessness and syncope, and intense nervousness. When uterine contractions begin, the action of the heart becomes exceedingly rapid; there is difficulty in breathing and the patient is brought into great distress. It is often necessary to give prompt assistance in labor, and this may require the performance of cesarean section. The child is exposed to the risks of rapid delivery, although, if section be performed, the risk to the child is reduced to the lowest point. When the placenta is examined, it is found that certain changes have taken place in its structure which interfere with the circulation of the blood through the placenta, and may indirectly bring about the death of the fetus. The child is also subject to the same toxic conditions which the mother has had and may die from failure of the liver and kidneys or in convalescence.