Concerning the varied results of eclampsia, the opinion seems to be growing that if it develops during late pregnancy, labor is likely to set in and a premature child be born spontaneously; in some cases, however, for reasons already given, labor is induced, while in others the mother dies undelivered. The fetus may die, after which the convulsions practically always cease and the infant is often born later in a macerated state; or the patient may recover, go to term and give birth to a normal, healthy baby.
When eclampsia occurs during labor the pains usually increase in force and frequency, thus hastening delivery, after which the convulsions usually cease. It will be noted that death or expulsion of the fetus is in almost all cases followed by immediate cessation of the symptoms and by ultimate recovery.
Treatment and Nursing Care. There is so little definite information about the cause of eclampsia that there is quite naturally some difference of opinion as to the best methods of curative treatment. Unquestionably, prevention is of first importance and this is accomplished through the watchfulness and care during the antenatal period as described.
Dr. Edgar characterizes eclampsia as a preventable disease, and though an occasional case will develop in spite of preventive treatment the general results achieved tend to bear out his definition. For example, in a series of 1200 maternity cases at Bellevue Hospital during 1920, prenatal care was given to 900 women and not one case of eclampsia occurred among them, while among the remaining 300 women who had not been seen during pregnancy, there were ten eclamptics. It is but fair to bear in mind that as some of these patients were taken into the hospital because of their having eclampsia, the proportion is abnormally high. The Henry Street Settlement reports through its maternity service that there was but one case of eclampsia among 7600 women who were given prenatal care by its nurses in 1920. These figures, contrasted with the average of one case in about every 500 pregnancies, furnish astounding evidence of what can be done through prenatal care in the prevention of this one disease alone.
As to curative treatment, the variations of opinion are after all of little consequence to the nurse, for there is almost entire unanimity concerning the general principles, and it is these that shape the nursing care. Broadly speaking, they comprise effort to dilute the toxic material in the system, promote its elimination through the various excretory channels and quiet the patient’s nervous excitability.
Since eclampsia occurs only in connection with pregnancy, and the convulsions usually cease if the fetus dies or is born, one line of reasoning is that the most effective way to treat the disease is to terminate pregnancy. Formerly this was almost always done, and is still practised by some obstetricians. Those who do not agree with this theory contend that the eclamptic woman is a very ill woman whose nervous system is so irritated that the slightest stimulation or irritation works harm. In view of this they feel that manual or instrumental dilation of the cervix, preparatory to delivering the child through that channel, or delivery through an incision in either the abdominal wall or cervix, constitutes a shock that outweighs the advantages of emptying the uterus; therefore, that as a rule, less harm is done by noninterference, quieting the patient and increasing her eliminative functions, than by terminating pregnancy. This line of reasoning also takes into consideration the fact that from 15 per cent. to 20 per cent. of the cases of eclampsia are postpartum, indicating that convulsions may occur even after the uterus has been emptied.
The growing tendency is to adopt a middle course and treat each individual case according to the conditions and indications which it presents. Thus the same doctor will hastily induce labor in a case where the blood pressure and albumen remain alarmingly high, or increase, in spite of all efforts to reduce them, and in another case will go to the extreme of conservatism, doing nothing but quiet the patient with morphia or chloral, or both, and stimulate all of her excretory organs with abundant fluids.
But the nurse’s duties, and I may say her opportunities, for she is privileged to do much, are virtually the same no matter which course is followed, except, of course, the preparation for delivery, if this is performed.
The nurse is concerned with helping to reduce the intake of nitrogenous food, or proteids; diluting the toxines retained in the body; promoting the activity of the kidneys, bowels, liver, lungs and skin; guarding the patient against all avoidable stimulation from without, such as noise, light, ungentle handling and undue resistance to the patient’s convulsive movements; and protecting her from injuring herself by biting her tongue, falling out of bed or striking the wall or head of the bed during convulsions.
By striving to accomplish these general results for her eclamptic patient the nurse will aid immeasurably in saving her life.