4. Mental or emotional stress may be the cause of an abortion, but less importance is attached to these factors to-day than formerly. There is an occasional case, however, which can be explained on no other grounds.
5. Physical shocks, such as falls, blows upon the abdomen, jumping, tripping over carpets, jars, jolting or overexertion, may be the exciting cause of an abortion where there is a marked irritability of the uterine muscles. This factor is largely influenced by individual stability, however, as a slight jar will cause an abortion in one woman, and violent experiences will have no effect upon another, at the same stage of pregnancy.
Symptoms. For purposes of differentiation in treatment, abortions are usually divided into three groups and designated as threatened, complete and incomplete, but the premonitory symptoms of all of the varieties are the same. They are bleeding, with pain that is usually intermittent, beginning in the small of the back and finally felt as cramps in the lower part of the abdomen. Since menstruation is suspended during pregnancy, it is a safe precaution to regard any bleeding during this period, with or without pain, as a symptom of pending delivery.
Prevention of abortions is of course more satisfactory than remedial treatment, and a nurse may be very helpful in this respect, by explaining the underlying causes to the patients in her care, and winning their cooperation in preventing a deplorable accident.
Preventive treatment really begins very early. In the chapter on menstruation we referred to the importance of a young woman’s ascertaining the cause of painful menses, in the interest of good obstetrics, since inflammation of the uterine lining or a uterine misplacement might be responsible not only for the dysmenorrhea, but if neglected might, later, be factors in causing interrupted pregnancies. The correction of such physical defects, then, no matter when they are discovered, is an important step in preventing abortions.
A misplacement may be corrected, frequently, by means of a pessary, though suspension is done in some cases; an inflamed lining, which provides unsatisfactory lodgement for the ovum, may be removed by curettage. The new lining which replaces the old one is sometimes capable of receiving and holding the ovum.
There are also some more immediate preventive measures. A woman who is pregnant for the first time, and who, therefore, does not know whether or not she is likely to abort, should avoid such risks as fatigue, sweeping, lifting or moving heavy objects, running a sewing machine by foot, running, jumping, dancing, traveling or any action which might jar or jolt her during the first sixteen or eighteen weeks of pregnancy.
On the other hand, there are many groundless beliefs concerning the causes of abortions which the nurse may well dispel. Purgatives and other drugs have much less effect in causing abortions under normal conditions than is generally believed. But with a patient who has very irritable uterine muscles, such a drug as quinine, for example, may act as the last straw in producing an abortion which would almost certainly have been brought on by some other slight stimulation had the drug not been taken. Nor can reaching up, or sleeping with the arms over the head, possibly separate the embryo from the uterine lining, yet many women believe that they can.
In the case of an expectant mother who has had an abortion, even more precautions than I have suggested will have to be taken, for she is in greater danger of aborting than is a woman who has not had this experience. It is of prime importance that she have the cause of her previous abortion discovered, and if possible, corrected. In addition to this, she should be particularly careful to observe precautionary measures as she approaches the stage of her pregnancy at which the previous abortion occurred. The accident is most likely to be repeated at about the same time, or a little earlier, in each succeeding pregnancy. The patient should remain quietly in bed for at least a week before and after the time when an abortion is feared.
Complete rest and physical relaxation are such effective preventive measures that patients with a tendency to have abortions, who have been willing to stay in bed throughout practically the entire period of gestation, have gone through pregnancy without interruption, and been delivered of normal babies at term. As out-of-door exercise is clearly impossible in such cases, it is imperative that the patient keep her room particularly well-ventilated all of the time, and, under the doctor’s direction, have massage or bed exercises.