The duty of the nurse is to put the patient in a cool, dark room, on her back, elevate the foot of the bed, put ice bags on the lower abdomen, and summon the attending physician, with the hope that an abortion can be averted. Bromides and opium are the drugs most to be relied upon. Opium may be given in suppository, 1 grain night and morning.
If the hæmorrhage is alarmingly profuse and the nurse is skillful and clean, under exceptional circumstances she may pack the vagina with sterile cotton while waiting for the doctor. Then the room should be set for operation.
Dead Ovum.—The ovum may be discharged in pieces or in a single complete mass.
The egg may die at any period of the pregnancy, and be discharged in a few hours, or it may not be expelled for weeks, if at all. Fœtal death in the uterus may have its cause on the paternal side in a father too old or too young, or affected with such diseases as diabetes, nephritis, tuberculosis, syphilis, or chronic lead poisoning; on the maternal side, the same diseases, plus cancer, anæmia, insufficient food, and inflammation of the uterus; on the part of the embryo, syphilis or any transmitted or primary disease of the ovum.
The results of retention of the dead ovum vary with the case. Infection of the ovum is rare, except where the membranes have ruptured and an open channel exists. No harm follows the death of the fœtus, except in the presence of infections, all other changes are benign. The embryo in the first and second months may be absorbed, but at later periods, it becomes macerated petrified, or otherwise altered.
Among the signs of fœtal death are prolonged cessation of fœtal movements after being definitely observed, chilliness, languor and malaise of the mother, sense of weight in abdomen, and possibly a bad taste in the mouth. Furthermore, the uterus does not correspond to the period of pregnancy, and may have become smaller. Retrogressive changes take place in the breasts.
The diagnosis is only certain when the heart tones are persistently absent, or the macerated head of the fœtus is felt through the partly dilated os as a flabby bag of bones.
Treatment in noninfective cases is expectant. Spontaneous expulsion will occur sooner or later and there is no necessitous indication for interference. Local signs of putrefaction, however, make the immediate emptying of the uterus necessary.
CHAPTER VII
PREPARATIONS FOR LABOR AND THE NORMAL COURSE OF LABOR
The Nurse.—Scientific obstetric nursing is a specialty that enlists the interest of exceptional women only.