Other causes of premature births are the toxemias of pregnancy, chronic nephritis, diabetes, pneumonia, typhoid fever, organic heart disease, continuous overwork during the latter part of pregnancy, and such poisoning as lead and illuminating gas, while of alcoholism, Dr. Ballantyne says, “prematurity of birth is an undoubted result.”
Another important cause of premature births, of comparatively recent recognition, is previous operation upon the cervix, particularly high amputations; while placenta prævia and malformations of the fetus, or monsters, are also reckoned with as causative factors. Hydramnios sometimes brings on a premature labor by so distending the uterus as to stimulate contractions.
Labor is sometimes induced prematurely when this procedure may be expected to relieve an abnormality or complication which threatens the life of the mother or baby, or both. Some of the indications for this course are: seriously overtaxed heart or kidneys; a marked disproportion between the size of the child’s head and the mother’s pelvis, or a fetus that has been dead for two weeks or more. However, the reasons for it and the methods employed in inducing labor will be discussed more at length in the chapter on obstetric operations.
A therapeutic induction of premature labor, like a therapeutic abortion, is not of itself usually considered any more serious for the mother than a normal delivery, since it can be performed with care and cleanliness, qualities not usually associated with the work of practitioners who are willing to do criminal operations.
Treatment. The nursing care of the patient after a premature labor is the same as that given after a normal delivery. Much invalidism would be avoided if all women could be convinced of the importance of staying in bed just as long, and having just as good care after a premature as after a full-term labor. The difficulty of so convincing her is perhaps due to the fact that the small, premature child is expelled more quickly and less painfully than a baby at term and there is comparatively little blood lost in the course of its birth.
ANTE-PARTUM HEMORRHAGE
Fig. 44.—Diagram of centrally implanted placenta prævia.
Ante-partum hemorrhage, which is a hemorrhage occurring before delivery, is another serious complication of pregnancy. During the early months, hemorrhages are usually due to abortion, menstruation or lesions of the cervix and are not severe as a rule. But during the last three months hemorrhages are almost invariably due to placenta prævia or premature separation of a normally implanted placenta, and are often profuse.
Placenta Prævia is one of the most serious conditions met with in obstetrics, the maternal mortality being about 40 per cent. and the baby death rate about 66 per cent. The frequency with which it occurs is variously estimated as from one in 250 cases to one in every 1000.