After labor the placental circulation is eliminated, arterial blood-pressure is lowered, venous blood-pressure is elevated, and the right heart is threatened. In case of mitral insufficiency and dilatation of the left ventricle, without compensatory hypertrophy of the right heart, the effect of these sudden variations in vascular tension is obviously serious. Dyspnoea, pulmonary catarrh, general oedema, albuminuria, ascites, pleural effusions, occur. Fritsch40 is of the opinion that these phenomena, sometimes observed in the course of mitral disease after labor, are due to the sinking of intra-abdominal pressure, the accumulation of blood in the great abdominal vessels, and cardiac paralysis from insufficient blood-supply.
40 Arch. f. Gyn., viii. p. 373; x. p. 270.
During parturition Spiegelberg41 thinks the chief danger in all forms of valvular defects consists in pulmonary oedema as the result of circulatory disturbances.
41 Lehrbuch d. Geburtshülfe, 1882, p. 248.
Löhlein and Kleinwächter42 believe that the chief danger of chronic valvular disease occurs during the puerperium, and lies in the tendency to the recurrence of endocarditis.
42 Kleinwächter's Grundriss d. Geburtshülfe, 1881, p. 190.
TREATMENT.—The treatment of acute and chronic heart disease is not materially modified by the coexistence of pregnancy.43 In threatened asphyxia the induction of premature labor is indicated in the interest of the child. During labor the timely performance of version or application of the forceps lessens the bearing-down efforts, and may prevent alarming complications.
43 Carl Braun, Lehrb. d. g. Gynaek., 1881, p. 708.
Diseases of the Lungs.
ACUTE LOBAR PNEUMONIA.