Obstetrical Nursing / A Text-Book on the Nursing Care of the Expectant Mother, the Woman in Labor, the Young Mother and Her Baby

by Carolyn Conant Van Blarcom

“A minute discussion of the subject would be occupied largely by the question of exactly what are the poisons which cause this condition, and this question has not yet been definitely answered.

“So far as neutralizing the results of excessive action of the thyroid, it is best accomplished by rest, a diet from which meat and other heavy proteins are excluded, regulation in the action of the bowels and the avoidance of nervous excitement or undue exertion. If the action of the heart is excessively disturbed, those drugs which control cardiac action must be used. In extreme cases, morphine and atropine are given.”

Pyelitis is a fairly common, and sometimes a very painful and serious complication arising during the latter half of pregnancy. It is an inflammation of the pelvis of the kidney, most frequently the right, caused by a damming back of urine, because of pressure of the enlarged uterus on the ureter where it crosses the pelvic brim; and by infection, which may travel up from the bladder or be conveyed by the lymph and blood streams, frequently from the intestines. The colon bacillus is the commonest offender, though the streptococcus, gonococcus or even the tubercle bacillus may be the cause.

Frequently the patient will be entirely well, aside from a slight irritability of the bladder causing frequent micturition, and suddenly have paroxysms of acute pain in the region of the kidney, which may be swollen and very painful on palpation. She will have fever and sometimes chills and a catheterized specimen of urine will contain pus and bacteria. The kidney may suddenly empty itself of pus after which the pain and swelling will subside, only to recur when the pus accumulates again.

The treatment is rest in bed, a bland diet and an abundance of milk and water to drink. As the infection is often of intestinal origin, drugs are usually given to prevent intestinal fermentation and keep the bowels moving freely. Sometimes, though rarely, when the patient does not improve under treatment, pregnancy is terminated to relieve the pressure on the ureter and thus drain the diseased kidney by permitting an unobstructed flow of urine.

The tendency of the disease is to subside spontaneously, but sometimes it is necessary to incise and drain the kidney, or even to remove it; while in others the infection is so virulent that the patient dies of septicemia.

Gonorrhea during pregnancy may cause great discomfort in the shape of irritation and itching of the vulva, or even excoriation of the mucous membrane, and sometimes abscesses of the vulvovaginal glands. Occasionally the infection reaches the decidua and causes an abortion. But the chief danger in gonorrhea is that, after delivery, if the disease has remained uncured, the organisms may travel up from the vagina to the uterine cavity and tubes, and there set up an inflammation, or possibly cause a general postpartum infection. The greatest danger to the child is that its eyes may become infected during the passage of the head through the birth canal. This is the reason for the very great care that is taken of the eyes of the newborn, which will be described in a later chapter.

It is very important, therefore, for the sake of both mother and child, that gonorrhea be discovered early, for treatment started at this stage is often attended by very gratifying results, as the disease may be entirely cured before it is able to invade the uterus and tubes. This is because the closure of the internal os, by the membranes, converts the vagina and cervix into more or less of a cul-de-sac, to which the infection is restricted. Being thus localized, it may often be eradicated with relatively little trouble.

The yellow vaginal discharge, characteristic of gonorrhea, may become profuse and purulent. It is removed by means of low, very gently given douches. Tampons and vaginal suppositories are sometimes used, while abscesses and abrasions are given appropriate surgical treatment.

The nurse must observe the strictest technique while caring for these patients because of the danger of infecting herself and others with the discharges. She should wear a gown and rubber gloves when giving douches or dressing diseased vulva, and because of the possibility of contamination by splashing fluids, she should hold her head well to one side in addition to protecting her eyes with goggles. All utensils for each patient should be isolated and they should also be washed and boiled after each time that they are used.