In albuminuria of pregnancy there is a large fœtal mortality which, to a degree, is independent of eclampsia. The infant dies in utero or is born feeble, or prematurely.
Eclampsia is the sudden appearance of convulsions in the course of pregnancy. It may precede, follow, or accompany albuminuria. It occurs rarely in the absence of albuminuria in a woman who was apparently in good health. The two phenomena are best explained as a consequence of toxæmia due to poisons at present unidentified.
Treatment of the albuminuria is treatment for impending eclampsia. Regular examination of the urine is indispensable. The presence of albumin suggests toxæmia. The daily output of urine and the output of urea must be compared, for a fall in urea is a premonitory sign of eclampsia. The bowels and the skin should be stimulated, respectively, by saline cathartics, hot baths and packs. The digestive organs must be spared as much work as possible, especially the liver. Water is given in abundance, and milk is the staple diet. Koumiss, butter milk and ice cream may be allowed. As the patient improves, vegetables are allowed. The food should be salt-free; and alcohol, as well as rich, indigestible things should be forbidden. In the milder cases boiled fish and a little chicken may be permitted.
The course of the disease and the condition of the patient is determined by frequent examinations of the urine, while in all serious cases an examination of the fundus of the eye must be made to detect a possible albuminuric retinitis.
The treatment of eclampsia will be considered under the complications of labor, where the attack usually begins.
Pyelitis of pregnancy is an acute, and rarely, a chronic infection of the pelvis of the kidney, due to the Bacillus coli. It usually appears after the fourth month (fifth to eighth) and attacks by preference the right side. Extension to the kidney substance, ureters, and bladder is occasionally observed.
Symptoms.—Sudden, acute abdominal pain, at first diffuse, but after a few hours, becoming localized in the right side, and on this account is often confused with appendicitis, especially as vomiting is not infrequent. A chill may mark the onset and the temperature rise to 103° F. or 104° F. The bowels are constipated, the tongue coated, and there is tenderness over the kidney. The urine is scanty, turbid, slightly albuminous and contains pus and epithelium in the urinary canal. A culture reveals the bacillus which has obtained access to the kidney, either by extension of the ureter from the bladder, by direct invasion of the tissues from the adjacent colon, or through the circulation.
Treatment.—The diet should be fluid and mostly milk, the bowels should be moved freely and frequently. The urine is alkalinized with sodium citrate, since the Bacillus coli lives only in an acid medium. As the symptoms subside, urotropin may be administered. If the patient does not improve within two weeks, abortion must be seriously considered. Nephrotomy is not to be thought of unless abortion has failed.
Hyperemesis Gravidarum.—The nausea and vomiting of pregnancy is so usual as to be regarded as normal. It usually ceases from the fourth to the fifth month spontaneously; has no ill effect upon the ovum, and may respond readily to treatment.
Hyperemesis comes on at the same period and exhibits all stages of violence, from the mild form above described, to cases that end fatally.