During pregnancy convulsions generally cause abortion, either by bringing on uterine contractions or by causing the death of the child. Some few patients have suffered from them however, and yet gone their full time, but this must never be expected. A gradual extinction of the vital spark, during the stupor is the ordinary termination, though sudden death is not unfrequent, during the fit. Gradual recovery is occasionally witnessed, but seldom without partial loss of memory, or some other affliction. Madame Lachapelle says that one-half of the females attacked with convulsions die, and of their children many more.
There is no doubt but that the tendency to this fearful affliction may be very much lessened in many females, by proper attention to diet and regimen. Those who are of a full habit, and disposed to headache, and rush of blood to the head, should live low, and carefully avoid everything of a heating or stimulating character, and also every kind of excitement or agitation. The bowels should be kept free, and the skin well rubbed and kept warm, and the head cool.
Treatment.—While the patient is in the fit, care must be taken that she does not fall off the bed, or bite her tongue, to prevent which the jaws must be kept apart, by putting something between, as a piece of soft wood, or the handle of a spoon covered with cloth, or even a knotted napkin. The face should be sprinkled with cold water, and the whole body well chafed, particularly the hands and feet, which should also be made warm as soon as possible. As soon as the spasm is over it is customary to bleed, either at the arm, or by leeches to the temples and behind the ears. Mustard poultices should also be applied to the feet, and inside the thighs, and an enema should be given of warm water and a table-spoonful of salt. Ice, or cold water, should be applied to the head constantly, and if possible the body should be immersed in a hot bath, which will, in many instances, bring the patient round immediately without any other treatment. The bladder should be also looked to, as well as the bowels, and if necessary the catheter should be used. As soon as she can swallow a few drops of laudanum may be given, or a little ether, but not a full dose by any means.
The propriety of bleeding, even in these cases, is denied by many, and I am almost inclined to think myself, that a prompt and persevering use of the other remedies mentioned, would be fully as successful without it. At all events, the fearful mortality in spite of it proves that it has not much power, and may well raise a doubt of its utility.
Convulsions however are so fearful and violent, that few practitioners can resist the temptation to bleed, because it seems so well calculated to give prompt relief; and besides it has popular prejudice in its favor. Some authors however assert that it makes the danger greater of paralysis, and loss of memory, afterwards.
When convulsions occur during pregnancy they seldom cease entirely till the uterus is emptied of its contents. It is therefore necessary to bring on labor, and terminate it as soon as possible, after the parts are in a proper condition. When they occur during labor it must also be finished in the shortest time possible, to afford the best chance of saving the child, and also because no treatment will prevent the attack while the patient remains undelivered. All means of bringing on dilatation of the mouth of the womb, mentioned in the article on Rigidity, may be resorted to, excepting Ergot, which should never be used in these cases.
M. Chailly tells us, that in thirteen cases of convulsions nine were first pregnancies, and seven of the females were dropsical. Only one was attacked during pregnancy, ten while in labor, and two after. Only two died, and ten of the children.
It is worthy of remark that where pregnant females have had convulsions, apparently from living too high, the children have also had them after delivery.