Symptoms.—These vary with the period of pregnancy where they occur. In the earlier months the symptoms are those of profuse menstruation, sometimes accompanied by more pain perhaps than usual. The ovum is then so small that it escapes notice. In the profuse flow there may be unaccustomed clots of blood; when this trouble occurs later in pregnancy there are two constant symptoms which, together with the history of the case, render the diagnosis easy. These prominent and constant symptoms are pain and bleeding. The symptoms may be preceded by a bearing down feeling in the lower abdomen, with backache, frequent calls to pass urine, and a discharge from the vagina, that is a mixture of mucus and water. After these symptoms last for a shorter or longer time, labor pains set in, the bleeding increases and the contents of the womb are discharged. The ovum may be expelled whole when it looks like a huge blood clot, or it may be expelled partly and the membranes left behind; or the embryo (child) alone, surrounded by the transparent membrane, escapes.
If the after-birth has formed it may be cast off entire or piecemeal. The embryo (child) alone may escape, the neck of the womb contracts and shuts; bleeding persists for an indefinite period, for weeks and weeks, until the health of the poor woman is seriously affected. Persistent bleeding of this kind is almost always due to the retention of portions of the after-birth or membranes, and should prove to the woman that there is a serious condition existing which should be speedily corrected. A physician should be called who should make a thorough examination; and if such a condition as above described is found, should free the womb from its retained products, which are not only sapping the woman's life, but also rendering the future health of the womb very uncertain.
Threatened Abortion.—If a bleeding takes place in the woman who is pregnant, abortion may be assumed to threaten; a careful examination will usually settle this matter.
Inevitable Abortion.—The abortion is probably inevitable if the bleeding becomes persistent and free, the cervix softens, the womb dilates and the labor pains set in. Still in spite of all these conditions, the bleeding and pain may cease, and the pregnancy go on to full term, The result of these cases, if carefully and properly treated, is favorable as far as the mother is concerned.
Treatment. Preventive. In women where repeated abortions have occurred, the cause should be diligently sought for. If syphilis exists the treatment should be begun at the beginning of pregnancy. But when no special cause can be found, and an irritable condition of the womb is suspected to be present, the patient must be kept quiet in bed, especially at the time when menstruation would normally occur. She should also be guarded against lifting, fright, worry, over-exertion; and medicines like bromide of potash, five to fifteen grains at a dose, given to quiet and allay the nervous irritability.
Treatment of Threatened Abortion.—The patient should go to bed, lie down and remain there, and if possible be not only quiet physically, but also quiet mentally. The main remedy is opium, and if necessary to obtain a quick action it can be given hypodermically in the form of morphine. Otherwise, laudanum may be given by the mouth, twenty drops, repeated cautiously, every three or four hours as required, or it can be given in thirty-drop doses combined with a couple of ounces of starch water by the rectum. Extract of opium in pill form, one grain three times a day by the month; or a suppository of opium, one grain, may be inserted into the rectum every four to six hours. After the bleeding and pain have ceased, the emergency is probably passed; but rest in bed and quiet should be the routine for one or more weeks, and the patient should always rest in bed at the usual time of the menstrual period, during the remainder of the pregnancy.
[OBSTETRICS OR MIDWIFERY 527]
Treatment of the Inevitable Abortion.—If the cervix is hard and the canal is not dilated, especially if the bleeding is free, the vagina should be packed full at once, if possible, with iodoform gauze. Rolls five yards long and two inches wide can be bought perfectly adapted to this purpose. A speculum should be used (Sims' or Graves') and the gauze should first be packed tightly into corners (fornices) around the cervix, then over the cervix and well down to the outlet. This should be held in place by a proper (T) bandage. The gauze can be removed in from twelve to twenty-four hours, and the ovum will generally be found lying upon the upper part of the packing, or in the canal that is now dilated, from which it can easily be removed. Sometimes it is necessary to repack and allow it to remain for another twelve hours as the canal has not been sufficiently dilated by the first packing. This packing not only causes the canal to dilate but usually stops the bleeding. After the ovum has been expelled an antiseptic vaginal douche should be given twice a day for a week or longer.
If at the first examination the cervix is found softened and the mouth of the womb is open, but the womb has not yet expelled its contents, the sterile (clean) finger may be introduced into the womb and the ovum and membranes loosened and taken away, while this is being done counter pressure should be made over the abdomen. After the womb has been cleared of all its contents an antiseptic solution should be used, carefully, in the womb to wash it out, and this followed by washing out of the vagina. The after treatment is the same as that for labor at full term. The woman should remain in bed at least ten days.
Placenta Praevia.—The after-birth is placed in the lower part of the womb; (after-birth before the child). This is a dangerous condition and terrible bleeding may occur. It occurs about one time out of every one thousand. The main symptom is bleeding and this may occur at any period of pregnancy. It usually appears from the seventh to the ninth month. The outset is without any appreciable reason and without pain. The amount of blood lost at the first attack may be so slight as to escape notice or copious enough to endanger the life of the mother. This flow may occur at any time during these months, and it may be small or great. If during the course of pregnancy the bleeding occurs at intervals in the increasing amount, the greater will be the loss of blood during the labor.