In the first degree, the excess of fluid accumulates very slowly, and the woman only suffers from discomfort and an increase of the usual malaise of pregnancy. As a rule no diagnosis is made, and it is only at the mo ment of delivery that the excessive amount of liquor amnii strikes the ac coucheur. Every obstetrician must have met such e,ases.
In the second degree, there is more fluid, and the uterus reacts more strongly. Besides the ordinary accidents of dropsy of the amnion, uterine contractions causing premature rupture of the membranes, and expulsion cd the fcetus, are liable to occur.
In the third degree, the same premature contractions exist, but they are not sufficient to determine labor, at all events for a certain time. The patients are very sick, and are exposed to the various accidents that we have noticed, so that active interference is sometimes required. It is especially in cases where hydramnion occurs with phenomena that have caused errors of diagnosis (ascites, ovarian cysts, etc.), that active meas ures have been taken.
This is by no means the case in the fourth set of cases, which we have called acute hydramnion. In these cases, the diagnosis is made. The rapidity of its evolution, and the serious nature of the accidents that may occur, can in a short time compromise the life of the woman, and neces sitate immediate intervention.
Here the enormous distension of the uterus, out of all proportion to the presumed stage of the pregnancy, the excessive pain, the v.omiting, the emaciation, the intense fever, the circulatory and respiratory troubles, the asphyxias, cedemas, eclampsias, and even abortions, give us a very different form of the disease.
In regard to delivery itself, let us note the frequency of faulty presen tation, and the occurrence of procidentia and uterine inertia, either dur ing labor or at delivery, and the hemorrhages. The following table of observations, deduced from 80 cases collected from literature, show the result and the presentations: MacClintock, out of 31 cases: presentation of the vertex, 20; breech, 9; foot, 2.
We understand to what extent hydramnios complicates confinement, by the fact of the a,bnormal presentations, and these figures only include single pregnancies. As for the hemorrhages which accompany or follow delivery, and which are due to uterine inertia, all the authors have noticed them in the cases of exaggerated distension of the uterus, either by a very large fcetus, ot in cases of twin pregnancy. It is not extraordinary
to see them produced in cases of hydramnios, or this exaggerated disten sion of the uterus produced in an extreme degree. We confine ourselves, with Sallinger, to citing the cases of Senlen, Valenta, Schmatz, Lumpe, Gueniot, Martin, Hansen, Klink, Harlin, Parieu, Rigler, Quadrat, Huber, Keating.
As regards the child, the prognosis is still more grave, and though in the observations of Liegener, out of 40, there were 31 infants living, we do not hesitate to say that hydramnios is one of the diseases which most compromise the existence of the fcetus. In many cases, indeed. it is ex pelled dead from the uterus (we may ask if the death of the ketus had not been the det,ermining cause of the malady); in others, more frequent ly, it dies shortly after birth. We have seen that often delivery occurs before term.
In addition, the frequency of multiple pregnancy, and of dangerous pres entations complicating the confinement, put the infant in unfavorable conditions and render the prognosis more grave.
Finally, we recall the frequency of monstrosities in cases of hydramnios, and the connection between syphilis and hydramnios.
MacClintoek considered hydramnios as one of the morbid conditions very common in abortion, and he regards it SS a frequent cause of the premature death and expulsion of the embryo. Out of 33 cases of hy dramnios noted by him, one terminated by abortion at five months, one at six months, ten resulted in premature delivery. In 21 cases the child appeared to have attained the normal term, and he says " there is good reason to think that some c,ases of the disease in question are a disease or the ovum and not of the uterus. The abnormal excess of the amniotic fluid, or perhaps the morbid action of which it is the result, appears very unfavorable to the fcetus. Thus, 9 of the children were still-born, of which 5 were putrid, and 10 born alive died some hours after birth. This was oftener the case among the girls than the boys (25 girls to 8 boys).