The treatment for a concealed hemorrhage consists of emptying the uterus speedily in order that the muscles may contract and stop the bleeding by closing the uterine vessels; and of treating the accompanying shock which may be almost, if not quite, as serious as the hemorrhage itself.
It is very disappointing to have to realize that there is very little that a nurse may do, before the arrival of the doctor, for a patient who is having an ante-partum hemorrhage. As has been explained, it is often necessary to pack the cervix or introduce a bag, for the purpose of stopping the bleeding by pressure, and of stimulating the uterine contractions which will expel the child and empty the uterus. These measures are surgical operations and quite evidently the nurse cannot attempt to perform them. She can, however, put the patient to bed and have her lie flat, without a pillow, and, partly for the mental effect upon the patient, apply ice-bags or compresses to her abdomen. As nervousness and excitement only tend to increase the bleeding, the nurse has an excellent opportunity to try to soothe and quiet a frightened woman, and convince her that she can help herself, in this emergency, by quieting her mind and body.
Pending the doctor’s arrival, the nurse should have a large receptacle of water, boiling, to sterilize the instruments and bags that he may want to use; clean towels and sheets, a nail brush, hot water, soap, and a basin of an antiseptic solution for his hands.
TOXEMIAS OF PREGNANCY
There is probably no group of complications which prove to be more baffling to the obstetrician than the toxemias of pregnancy. Certainly they are challenging the best efforts of many earnest investigators, for it is known that the toxemias cause some of the gravest conditions that arise during pregnancy, and they are suspected of being the underlying cause of still others which are as yet unaccounted for.
Comparatively little is known of the origin of the toxemias, except that they are due to pregnancy. But happily, a good deal is known about preventing them, and also about relieving them, particularly in the early stages; accordingly many mothers and babies are saved who otherwise would perish.
The entire subject of the prevention and treatment of these disorders will be somewhat simplified for the nurse if she will recall the general question of the adaptations of the mother’s physiology during pregnancy. She will then remember that there were certain alterations of function which were necessary to keep the maternal organism normal, while it bore the strain of supplying nourishment to the fetus from its own blood stream, and received in turn the broken-down products of fetal activity. If these adaptations are insufficient to meet the demands made upon the maternal organism, a serious toxic condition may result.
To put the matter briefly, there is in the toxemias of pregnancy a disturbance of the mother’s metabolism, involving the liver and kidneys, and a resulting retention within her body of something which should be excreted. The retention of this material, which may be of fetal or maternal origin, or both, may give rise to symptoms which range anywhere from slight headache or nausea to coma, convulsions and death.
Beyond these general facts, there seems to be deep obscurity concerning the cause of this group of complications, of which pernicious vomiting, pre-eclamptic toxemia and eclampsia are the most widely and generally recognized.
While nephritic toxemia and acute yellow atrophy of the liver cannot be designated, quite accurately, as toxemias due to pregnancy, they are usually included in this group. This may be because they are toxemias which have many features in common with those of pregnancy, as to symptoms and treatment, and because of the frequency with which they appear coincidently with pregnancy, although not always due primarily to that state.