By the term "miscarriage" we mean that for some reason the progress of pregnancy has been interrupted and the fetus is expelled from the womb. A miscarriage or abortion (both terms meaning the same—the difference between the two terms is a technical one and need not concern us here) can occur any time after conception up to approximately the seventh month, when, if labor takes place, the child may be born alive. The condition would then be termed a premature labor. A miscarriage or abortion is an immature labor and implies an immature or dead child.
The condition is a serious one no matter whether it is attended with grave symptoms or apparently no symptoms. If it occurs shortly after conception, during the first few months of married life it is serious, if not in its physical consequences, it is in its significance, because it establishes the tendency to miscarry,—a tendency that may result in great mental distress because of the worry and fear it engenders, and of sorrow and heartache because it may blast the hope of parentage. Such a miscarriage may take place at once after conception. If so, the following menstruation may be delayed for a week or so and is then a little more profuse than is customary. This will be the only indication that a life has been sacrificed that the young wife may have, and frequently the significance of such an occurrence is never understood, yet the tendency to miscarry is nevertheless established, and a seeming sterility is apparently the fate of the woman. It is, therefore, of the greatest importance that extreme care should be taken to bring the first pregnancy to a successful consummation. A young wife should realize that she is apt to become pregnant at any time. Her conduct therefore should be such at least as not to harm the life principle with which she has been entrusted. To this end any excessive sexual activity should be strictly avoided.
Causes of Miscarriage.—Any strenuous physical effort must be guarded against. Included in such efforts may be the following: dancing, running, jumping, surf-bathing, sewing on a machine, sweeping, washing, house-cleaning, moving furniture, etc. Sometimes the primary cause of a miscarriage is to be found in some hygienic act, such as a hot bath, too prolonged or too many hot douches near the menstrual periods. A blow or a fall, even a fright or shock may cause a miscarriage. Anything that violently shakes or agitates the womb, which may at this time be irritable because of its condition, will be sufficient to excite it to contract and miscarry. Hence violent coughing or vomiting should be avoided if possible; horseback riding, jolting in a carriage, convulsions, hysterical crying, may also be the causative factors. Displacement of the womb by limiting its tendency to grow when pregnant, may cause it to miscarry. Very severe general diseases such as small-pox, pneumonia, etc., will cause the womb to empty itself. Disease of the fetus or the presence of syphilis in either of the parents will also have the same result.
The Course and Symptoms of Miscarriage.—The cause of a miscarriage or abortion is much the same as an ordinary labor at term. Whatever interrupts the pregnancy causes the death of the fetus. The dead fetus acts as a foreign body and excites the womb to contract as it does during an ordinary confinement. The contractions open up the mouth of the womb and the fetus is expelled together with its membranes and after-birth. The significant and the most important symptom of a miscarriage or abortion is hemorrhage or bleeding from the privates. The flow of blood may not amount to much or it may be excessive and alarming; it may not be constant, it may come from time to time in the form of clots.
The next significant and important symptom of miscarriage or abortion is pain. The pain, like the flow of blood, may be only slight or it may be very severe, sometimes it is absent in very early miscarriage. As a rule the pain is severe when the miscarriage occurs after pregnancy has lasted for a number of months.
A miscarriage or abortion is said to be "complete" when the fetus with its membranes and after-birth is expelled clean and whole, or in other words when the womb empties itself completely. A miscarriage or abortion is said to be "incomplete" when some part of the embryo is left in the womb.
What to Do When a Miscarriage is Threatened.—When a woman, who is pregnant, begins to flow she should at once go to bed and keep perfectly quiet and send for a physician. A miscarriage is a treacherous condition and is so regarded by all medical men. It may not amount to much or it may, on the other hand, develop into a serious situation. The immediate danger is from hemorrhage; the ultimate or remote danger is sepsis or blood poisoning. The condition is one that can only be taken in charge by a qualified physician in whose hands we can safely leave the conduct of the case.
As a general rule it is quite safe to assert that a woman will not bleed enough at the beginning of a miscarriage to do any permanent harm. Consequently there is no occasion for unnecessary alarm. She must, however, as stated above, heed the warning and go to bed, keep perfectly quiet and send for a physician. If she fails to follow this advice it is quite possible that she may have a hemorrhage during the course of the miscarriage of a sufficiently serious character to endanger her life or from the effects of which she may suffer for the remainder of her life.
There is practically no danger during the course of or after a "complete" miscarriage. The danger which may ensue from an "incomplete" miscarriage is hemorrhage and a form of poisoning caused by the absorption into the system of putrifying products of the part of the dead embryo left in the womb.
There are a large number of cases of criminal abortion in which septic poisoning occurs caused by the utensils or instruments used in inducing the abortion. All of these cases are operative cases which must be attended to promptly to save life.