DUF.ATION OF RETENTION.
The dead fcetus may remain a variable time in the uterine cavity before being expelled. There is no absolute limit. Where death occurs in the course of an acute disease, or as the result of traumatic influence, expul sion is ordinarily rapid.
If, on the contrary, it follow a chronic affection, syphilis for example, or causes which only act slowly on the fcetus, it may be retained longer in the uterine cavity, and this without danger to the mother. Sheltered from contact from the air, it does not undergo putrefaction, but a pecu liar alteration, which constitutes maceration, to which we shall return, and the health of the mother is, in general, but little influenced. At the best, some trifling pains in the abdomen; sometimes, slight general malaise, without fever, and slight hemorrhage, at first sero-sanguinolent, of negative odor and more or less acid; and then delivery occurs a little more slowly, often in the normal way.
However, generally the fcetus is expelled rapidly enough after death, but may be retained many months in the uterus.
Such are the cases of:— In addition to these extraordinary cases, we must mention what have been called prolonged gestations, where the Rails has remained in the uterine cavity beyond the normal term of rstation, and then been ex pelled more or less altered.
Such are: (See in this connection, " Prolonged Pregnancies.") At what period do the infants habitnally succumb, and how long before delivery? These are the two questions which Ruge has endeavored to solve in his memoir on infants born dead and macerated; and, basing his assertions on the comparative weights of the fcetuses, and on the mater nal recollections, he has arrived at the following conclusions, which, he is careful to say, are only approximate, and which WC tabulate: It results, then, that dead and macerated children are usually met with from 6+ months to 10+ months, remembering that the Germans count pregnancy by lunar months.
But, how long can the fcetus remain in the uterine cavity? In case of abortion, it is not rare to see the fcetus expelled and the placent,a retained to vegetate for a longer or shorter time. We have seen three cases our selves: once, with symptoms of putrid infection of the mother (138 days), the mother recovered; once, three months, the mother having no other symptoms than little trifling flooclings from time to time; the placenta, was expelled during our kbsence, and the associate who assisted could not give us any information, except that it was without odor and shriv elled up. There was a slight hemorrhage. In a third, in the service of Dr. Guyot, the placenta was only expelled at the end of five months.
In case of stillborn and macemted fcetuses, it is generally 14 or 16 days after the cessation of the fcetal movements that expulsion should take place, according to Ruge. We have seen two cases, in which one followed this rule, 14 days; the other was prolonged until 18 days. It is not rare to see the expulsion rather sooner; but it may also come off more tardily still, and Muller reports a certain number of cases where the fcetus re mained in the uterus many months, and even up to term. There are a certain number of cases of multiple pregnancies where this has occurred; we have seen an example. One of the twins dies, and the other lives, and both are expelled at the same time. But, e,an the dea,d fcetus be retained in the uterus beyond term or indefinitely ? We have developed this point in the article on prolonged gestation, and have seen that these extremely mre cases should only be admitted with reserve. (Menzies, Herrgott.) Symptoms: lst. Signs perceived by the are absence of active fcetal movement,s, signs only having value as they have been per ceived quite clearly at first, but especially when she noticed that they gmdually weakened, presented irregularities, and ceased sometimes sud denly. Sometimes, the cessation has been preceded by an unusual exag geration of the movements which seem to be convulsive. Some women complain of a sensation of coldness in the abdomen, and these sensations, contested by most authors, have been found once by Hourlier. Schl ing has established, by the aid of thermometric observation, that there is con siderable elevation of the uterine tempemture, compared to that of the vagina, when the fcetus retains life. The abdomen sinks, the uterus—losing its tonicity, and not finding resistance in the fcetal parts—collapses on its lower segirnent, spreads out, and its centre tends to be depressed. The mother feels the child move about in the abdomen, take next differ ent positions, and fall to the side to which she inclines. Often, in the two or three days which follow the death of the fcetus, there occurs at the breasts a kind of congestive manifestation, a kind of lacteal showing, which is more or less us the woman is advanced in pregnancy, and to which succeeds shrinking of the breasts, and sometimes flowing of lacte scent liquid. Then all the sympathetic symptoms of pregnancy disap pear, the vomiting particularly. The abdomen ceases to enlarge, and at the same time in some women there is a vague feeling of malaise, charac terized by loss of appetite, a feeling of lumbago, of fatigue, of general lassitude; sometimes in very delicate women, a slight febrile reaction, especially towards evening.