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

The termination of pregnancy before the expected time is termed an abortion, miscarriage, or a premature labor or birth, according to the stage to which the pregnancy has advanced, but there are wide variations in the accepted meanings of these terms, among both lay and medical people.

In the lay mind, abortions are usually associated with criminal practice and the term is seldom used, while miscarriage is a term which is loosely applied to all deliveries occurring before the child is viable, or before the seventh month. It is not uncommon, however, to hear the term abortion used to designate the termination of a pregnancy before the end of the fourth month; miscarriage, one which occurs between the end of the fourth and seventh months, and premature labor as one which takes place any time after the seventh month, but before the expected date of confinement.

Medical people, on the other hand, seldom use the term miscarriage, but designate as abortions all terminations of pregnancy which occur before the end of the seventh month; and premature labor, those occurring from that time until the estimated date of confinement. It is these meanings which will be intended when the terms abortion and premature labor are used in the following pages.

Abortions. In the nature of things, it is impossible to say how often abortions occur. They sometimes happen so early in pregnancy that the patient is unaware of the accident; or, if she does know of it, she may take no notice of it or regard it of so little consequence that she does not consult a doctor; while in many cases it is intentionally concealed because of having been criminally induced. But such information as is available suggests that at least one out of every five pregnancies ends in an abortion.

Since the ovum is insecurely attached to the uterus until the sixteenth or eighteenth week, an abortion is more likely to occur during this time than later, while of this period, the second and third months seem to be the most perilous.

Abortions are less likely to happen during first pregnancies than succeeding ones; they occur more often among women over thirty-five years old than in younger ones, and in all cases are most likely to take place at the time when the menstrual period would fall due were the woman not pregnant. Their frequency probably increases with the number of pregnancies, because of the tendency of multiparous women to have endometritis, which, as we shall see later, is a causative factor.

Causes. There is a variety of causes of abortions and miscarriages, some entirely unavoidable, but many which are preventable, and it is well for the nurse to be familiar with those which operate most frequently, as follows:

1. Certain abnormalities of the developing fetus are inconsistent with life, and are, therefore, a frequent cause of abortion. Dr. Mall, of Johns Hopkins University, showed after years of investigation that at least one-third of the embryos obtained from abortions were malformed and would have developed into monstrosities had they lived to term. It is often a great comfort to the expectant mother who loses her baby early in pregnancy to realize that had she carried her baby to term it might have been a monster, and that, therefore, she has not lost a beautiful, normal child. Just why these abnormalities occur is not known, nor is there any known method of preventing or correcting them. There also may be such defects in the placental development, that the fetus does not derive sufficient nourishment to continue its development, and dies very early as a result.

2. Abnormalities in the generative tract may cause abortions, the most common of these being inflammation of the uterine lining and a malposition of the uterus itself. Gonorrheal infection is a frequent cause of such an inflammation, which so alters the decidua that a satisfactory implantation of the ovum is impossible, and it perishes from lack of nourishment. Uterine misplacements, particularly retroflexion and prolapse, are important causative factors in abortions. This is because the malposition interferes with the blood supply and lesions in the endometrium result. This also presents an unsatisfactory lodgement for the ovum and it cannot survive for long.

3. Acute infectious diseases all tend to cause the death of the fetus and thus cause abortions. Fetal death in these cases is believed to be due to the transmission of toxic material from mother to child, as may occur also in such poisoning as phosphorus, lead and illuminating gas.