Floodings are seldom fatal to women before the two or three last months of pregnancy; the gradations of danger increasing to the end of the ninth month, at which period the uterine blood vessels are enlarged, and the hemorrhagick torrent is in proportion. The mouth of the womb also being then less distended than in ordinary parturition, is more difficultly forced open to expedite delivery. Floodings may at intervals, and some weeks precede natural parturition or miscarriage; and after a temporary cessation, are prone to return on the slighted irregularity. Their danger is estimated from the quantity of blood, the suddenness of the torrent, and the effects on the mother; such as paleness, weakness, coldness of the extremities, quick fluttering pulse and respiration, fainting, dejected countenance, weak voice, convulsions: these portend imminent danger to the mother and infant, as do floodings near the full period of gestation, and not accompanied with labour pains. Uterine hemorrhages may occur not only in abortion and natural parturition, but also immediately, or soon after the birth of the infant, and extraction of the placenta. Sometimes also during parturition, when the child’s head blocks up the pelvis, the hemorrhage has been unperceived, and often unsuspected, until after the exclusion of the infant: but the uncommon weakness and faintness of the mother, without any evident causes, might have given the alarm.
The predisposing and occasional causes of abortions and floodings are, frights, terror, anger, violent agitation of mind or body; strong muscular exertions and efforts; external injuries, blows, falls, running, leaping, coughing, crying, fainting, hystericks; plethora; errors in the non-naturals; impetuous flow of blood to the womb, salacity; too much amorous dalliance; too strait lacing and dress; hot close rooms; foul air; disagreeable smells; cravings not gratified; spirituous liquors; abuse of emmenagogue, cathartick, and diuretick medicines; hardened feces and costiveness; piles; extreme irritability of the body and womb; weak hysterical constitution; weak diseased small, contracted, not sufficiently dilatable womb; weakness of the uterine vessels from preceding abortion, irregular menstruation; poor blood; fluor albus; previous injuries during parturition; repetition from habit; the habitual tendency towards menstruation every month; hereditary; acute or chronic diseases; morbid adhesion of the placenta, and also coalescence with the womb from previous inflammation; partial separation of the placenta; rupture of the vessels on the surface of the placenta; separation of the false chorion from the womb; adhesion of the ovum or placenta to the neck of the womb; blights of the fœtus, scarcity of nourishment in the womb, its violent efforts, monstrous size, its diseases in the womb; rupture of the navel string, a noose formed upon it; long compression of the infant’s head or navel string during parturition; injuries by the hands or instruments of the accocheur; a dead fœtus.
The signs of a dead fœtus are in the mother subsidence, softness, and coldness of the abdomen and breasts, sickness, faintness, shiverings, cold sweats, sensation of a heavy tumour within the belly, cessation of the motion of the fœtus after quickening, putrid discharge from the vagina, evacuation of the waters, dejected languid countenance: if, during actual labour, the mother perceives no motion of the infant, and is cold; no pulsation can be felt between the interstices of the infant’s parietal bones, nor at its wrist, nor navel string; its outer skin easily peels off; it has a lifeless coldness; and there is a cadaverous smell and fetid discharge from the vagina.
Convulsions
may happen before, during, and after delivery. They resemble epilepsy, with froth at the mouth, distortion of the countenance and body; and are a much more terrific and frightful spectacle than hysterical and nervous spasms. In the advanced state of pregnancy, convulsions are still more dangerous, and, like the sudden impetuosity of a whirlwind, sometimes close the fatal scene; especially if at the same time a violent pain is felt at the stomach. The plethoric and robust are not exempt from this tremendous assailant; but the hysterical and delicate are the most frequent victims. The predisposing and occasional causes are morbid sensibility; profuse uterine hemorrhage; want of due quantity of blood; plethora; frights; low spirits; fear, dread, surprize, and sudden emotion and agitation of mind at this critical period; dead fœtus.
Irregularity of the Lochia,
comprehending excess, obstruction, and suppression. After delivery, there is generally a gush of red blood, from about a half to two pounds. The mother is then weak and infirm, from the fatigue and efforts of parturition; from the great evacuation and diminution of the womb and abdomen; from the loss of blood; from the agitation and anxiety of mind; and from the increased irritability: and, according to certain states of the air and seasons not yet explained, women are then more than at any other time prone to fevers. In most cases the placenta is expelled in ten, twenty, or thirty minutes after the infant. Afterwards, the orifices of the uterine vessels continue to discharge red blood, which gradually becomes thin and serous, and even in some degree purulent. This discharge named Lochia, is various in duration and quantity, from two to ten ounces daily, and, gradually decreasing, in about ten or twenty days is dried up; nature having then restored the womb to its natural size: and at this stage all immediate puerperal danger is escaped. Sometimes there are great variations in the lochial duration in different women: in some, they cease after a few days; in most, after two or three weeks; and in a few others, not until after one or two months: the duration and quantity being varied by climate, season, constitution, mode of life, and state of the breasts. Lochial excess is determined more by the morbid effects than the absolute quantity; such as weakness, paleness, dejected countenance, feeble voice and pulse, fainting, convulsions. Or in its consequences it may more slowly sap the pillars of health, and occasion consumption or dropsy. Obstruction and suppression of the lochia is much more frequent and dangerous than excess. Most of the usual complaints after delivery, says Smellie, originate from obstruction of the lochia, or of milk: the former is accompanied with pain of the back and loins, pudenda, and groins; heat, shivering, hard quick pulse, restlessness; sometimes colick and diarrhœa, and difficult oppressed perspiration.
Inflammation of the Womb
begins generally between the fourth and ninth day after delivery, and commonly with retention of the lochia: with fever, heat, and pain about the uterine region, elevation and hardness of the abdomen below, with tenderness and acute sensibility on pressure, irritation to urine and stools, colick, intense headach, strong full pulse. The whole, or different parts only, of the womb may be inflamed, whence the contiguous viscera of the pelvis will be differently affected. Where the inflammation is not violent, the crisis is about the fourth or seventh day from the attack; but if severe, may be protracted to the ninth, eleventh, and fourteenth, and be then discussed with some sensible evacuation, by perspiration and sweat, urine, diarrhœa, lochial discharge, or current of milk from the breasts; or may terminate fatally in gangrene, delirium, and convulsions.