Since abortion seems to be due, so often, to excessively irritable uterine muscle fibres that respond to even slight stimulation, a patient who is known to have difficulty in carrying a child to term is usually advised to avoid the marital relation throughout pregnancy.
Some patients with defective uterine lining will have slight bleeding for a long time, possibly throughout the entire period of pregnancy, because a small area of the placenta has separated, leaving, however, a sufficiently large attached area to nourish the fetus. Such women should, of course, be under a doctor’s care and sedulously avoid all shocks to the uterine musculature, for the separated area may very easily be increased to such a size that the fetus will be unable to secure adequate nourishment, and die as a result. And the mother’s life, too, may be endangered by hemorrhage from the separated surfaces.
To sum up in a word, we may almost say that, after pregnancy has begun, preventive treatment consists of rest and avoiding physical shocks, particularly during the first sixteen or eighteen weeks and at the time when menstruation would occur were the woman not pregnant.
Treatment, in the different degrees of abortion, employed by most physicians, is usually along some such lines as the following:
1. Threatened. A threatened abortion is one in which there is some loss of blood, associated with pain in the back and lower abdomen, but without expulsion of the products of conception. The treatment, as a rule, is absolute rest in bed and the administration of powerful sedatives.
2. Incomplete. An incomplete abortion is one in which the fetus is expelled but the placenta and membranes remain in the uterine cavity. The treatment is removal of the retained tissues, followed by the same care that is given during the normal puerperium. Prompt action in completing the delivery is important because of the hemorrhage that usually persists until the uterus is entirely emptied of its contents. Since the pregnant uterus is very soft, the retained membranes are more often removed manually than instrumentally, for a curette may be very easily pushed through the uterine wall, and peritonitis would be likely to follow.
3. Complete. A complete abortion, as the term suggests, is one in which all the products of conception are expelled. The treatment and care are exactly the same as are given after a normal delivery. This point cannot be stressed too strongly, for it is because so many women fail to appreciate the necessity for adequate post-partum care, that abortions are so often followed by ill health and invalidism.
Many doctors follow these various remedial measures with a search for the cause of the abortion just past, in order that it may be corrected if possible and recurrent abortions prevented.
A missed abortion occurs but rarely, and is one in which the embryo, or fetus dies, and is retained within the uterine cavity for months, or even years, sometimes without any unfavorable results to the mother. In these cases, symptoms of abortion sometimes appear and then subside without any part of the uterine contents being expelled. In other cases there are no signs except that the abdomen stops growing. There are cases on record in which the fetus has become mummified and others in which it has been partly absorbed by the maternal organism.
In addition to abortions which occur spontaneously there are also induced abortions, and these are designated as therapeutic or criminal, according to the motive for the induction.