COMPLICATIONS.
I. Hemorrhage.—This always accompanies miscarriage in the early months. Generally intermittent, it is usually well borne by the woman; at times, however, it may be because of difficulty in the separation of the decidua, it may be because of special hemorrhagic tendency, or of a natu ral stony of the genital syatem; it becomes very profuse, and is accom panied by syncope, small pulse, cold extremities, in a word, by all the symptoms indicative of great loss of blood. It is particularly at from two months to three and a half that such hemorrhages are noted, and when ever miscarriage occurs in two stages. The reason is that, in such cases, the ovum separates but slowly, and that the cervix closing up after the expulsion of the embryo, a second labor is necessary for the shedding of the remainder of the ovum. Now, we have seen, that this second labor may last a number of days or weeks, and all this time the woman loses blood, oft,en profusely. The hemorrhage, therefore, is grave, not only from its profuseness, but from its duration. If it does not compromise the life of the woman, it does her health, leaving her in a state of anemia, from which she may recover but slowly.
II. Retention of the Ovum, and of t7u3 Placenta.—" From the study of the means of union of the placenta to the uterus, Meyer states that this union, very intimate in the early months of pregiaancy, becomes less so as pregnancy advances, through the retrograde processes which occur in the decidua serotina and in the utero-placental vessels; and that retention of the placenta depends, on the one hand, on the feebleness and irregu larity of the uterine contractions, and, on the other, on the firm adhesions of the placenta to the uterine wall in case of miscarriage, whether these adhesions are normal or due to a pathological process. In the early stages of pregnancy, the placenta is divisible into two portions, the maternal and the fcetal. The bond of union between these is feeble, and the fcetal villi are easily separable from the maternal portion of the placenta. Still,
the uterine mucous membrane, and, in particular, that between the uterus and placenta, adheres firmly to the uterine wall, whence one of the rea sons why it is often retained in the uterus after miscarriage. Up to tho end of the third month, this mucous membrane separates slowly and with difficulty. Afterwards, the changes which it undergoes renders its shed ding easier, and, consequently, its retention unusual. Up to the third month, hence, we observe either the retention of the entire placenta, or, oftener, of the serotina and the adjoining parts of the fcetal placenta. This retention is due to: 1. The firm adhesion of the maternal placenta to the uterine wall. 2. The ease with which the fcetal portion separates from the maternal. 3. The feeble development of the muscular tissue of the body of the uterus. 4. The slight dilatation of the cervix. 5. The pathologic,a1 processes which are often the cause of miscarriage, and which may exist in the uterus, in the fcetal annexes, in the organs neighboring on the uterus.
When the miscarriage is not determined by premature involution of the decidua, or by pathologic,a1 processes which necessitate the complete sep aration of the decidua, the expulsion of the product of conception is usually incomplete. Either the entire placenta, or shreds of the decidua, or of the serotina, remain in the uterus. Now the expulsion of these remnants may require an interval of many weeks, and even months." The placenta retained in the uterus may undergo cystic degeneration, as has been pointed out by Meckel, Scanzoni, Muller, Virchow, and others.
We would further mention as causes of placental retention, the diseases of this placenta, and endometritis.
These placentas, thus retained for a longer or shorter time in the uterus, may: a. Be expelled not altered, not putrid. b. Altered and putrid. c. With symptoms of septic fever. d. Without such symptoms. e. Be absorbed. f. Remain indefinitely in the uterus.