Causes residing in the Ovum.—Here are included all the diseases of the placenta, of the membranes, of the cord, of the fcetus itself. Let us only recall the alterations in the placenta, the hemorrhages and their results, the alterations in the villi, the premature rupture of the mem branes, shortness of the cord, anomalies, knots, stenosis or phlebitis of the vessels of the same; in a word all the diseases which may cause the death of the fcetus.
Symptams.—One great fact dominates the symptomatology of miscar riage, and this is uterine hemorrhage, profuse or moderate. At thnes, says Jacquemier, it is the provoking cause of miscarriage; again, it is not caused by the contractions of the uterus, but the separation and the ex pulsion of the ovum are accompanied, from the start, by a slight flow which frequently assumes, in character, the proportions of a hemorrhage.
The causes of miscarriage produce the following three results: 1st. Either the ovum is abruptly severed from its attachments, and the mis carriage is an immediate phenomenon. This is rare; 2d. Or uterine con tractions, premature, are determined, and there results immediate sepa ration of the ovum; 3. Or, finally, there results uterine congestion, which entails rupture of blood-vessels, and separation of the placenta. Then there follow uterine contractions, and these are secondary, consecutive. This is the most frequent form, and it is here that are observed the pro dromic phenomena of miscarriage.
Signs of impending Miscarriage. —If, in certain instances, miscarriage results suddenly, without the women being aware of it, except through the appearance of the ovum, this is not always the case, and there are usually prodromic signs, more or less marked, and which vary with the etiological factor at work. Often these symptoms are simply an exagger ation of those common to the menstrual period, a feeling of malaise, of general weakness, accompanied by pain in the loins, radiating to the rec tum and to the bladder. At the same time, the touch reveals certain changes in the cervix, accompanied by flaccidity of the vagina and in creased secretion. Three circumstances, above all, influence these symp toms, which vary accordingly: 1st. Imminence of hemorrhage; 2d. Causes acting directly or indirectly on uterine contractility; 3d. The death of the fcetus.
Where hemorrhage is imminent, plainly it is congestive phenomena which are in the foreground; phenomena not limited exclusively to the abdominal organs, but affecting the whole body, as evidenced by the ac celerated circulation, by the force and fullness of the pulse beat, by con gestion of the face, or again, by irregular chills, by pain and tension in the loins and the abdomen, increased by the least fatigue. Rarely, true uterine contractions exist; usually the woman is conscious of these, with out being able to exactly locate them. Often a slight show appears, ceases under rest or appropriate treatment, and the pregnancy goes on to term.
Again these symptoms may recur, and, at length, after two or three simi lar recurrences, the ovum is expelled. These congestive symptoms al most always coincide with a menstrual epoch, and similarly the miscar riage occurs.
In other instances, instead of congestive phenomena, the signs are char acteristic of uterine irritability, merging, on the slightest provocation, into contraction. The least fatigue, the least effort, results at once in pain in the loins and abdomen, with sensation of weight in the rectum and bladder, and, filially, true uterine contractions, appreciable often to the hand where the woman is thin, or the uterus has risen above the brim, set in. In such cases, the cervix is less changed, remaining firm, and resisting, and it is only when the miscarrage is well under way, that blood appears.
When the fcetus is dead, the phenomena are far different,. When the fcetus has developed sufficiently to allow us to feel its movements, and to hear the pulsations of its heart, we may, so to speak, be present at its death, by following the slow disappearance of these signs of fcetal life; and then it is that the women experience all those sensations which we have referred to when speaking of the death of the fcetus. But, when the ovum has not reached such a developmental stage as to allow us to appreciate the signs of life, the diagnosis becomes difficult, and the precursory phe nomena are obscure, and not easy to differentiate. It is exceptional, in such instances, for miscarriage to follow at once on the death of the fcetus. Tjsually it is only at the end of six to ten days, and often longer, that the fcetus is expelled. Where the fcetal death results from acute feb rile disease of the mother, miscarriage, on the other hand, follows soon, and the precursory signs are masked under the symptom the outcome of the maternal disease. When, however, the fcetus succumbs to a slow in toxication, or from accidental cause, then the precursory signs are sharply accentuated. To the positive signs of fcetal death, are joined symptoms from the side of the mother; paleness, feebleness, lassitude, a sensation of something abnormal. At times a gentle evening rise of temperature, a feeling of weight in the pelvis, the cessation of the sympathetic signs of pregnancy, swelling of the breasts, exudation of a milky fluid from the nipples, followed by decrease in size of these organs; relaxation of the cervix, patency of the external os; above all, the appearance of a red dis charge, which may increase markedly, and become sero-sanguinolent of stale and disagreeable odor. Again, this discharge is intermittent, ceas ing for a few hours, or days, and reappearing with greater intensity. From time to time, appear true uterine contractions, at first gentle, and then intense, and followed by greater discharge. Then these contractions cease, and all is quiet and normal, until, at last, labor frankly sets in.