TRAUMATIS3I DURING PREGNANCY.
1. The Influence of Traumatism on Pregnancy. —Ganiot shows that in 1876 the total number of observations amounted to 245, since which time many others have been added. The following points are to be noted: 1st. There is no fixed law regarding the innocuous influence of trauma tism on pregnancy. These consequences are entirely different, according to the feeble or increased irritability of the uterus, the healthy or diseased state of the fcetus, or the freedom of the mother from certain morbid con ditions; 2d. These results vary, but to a less extent according as the injury does, or does not, affect directly the genital tract, as the hemor rlmge at the time is slight or profuse, and as it is, or is not, complicated by an inflammatory process of some intensity. Thus, when a perfectly healthy pregnant female is injured (whatever may be the character or severity of the lesion), the pregnancy is not usually affected. There are three exceptions to this rule, viz.: A. If the lesion is situated in the genital tract, or ano-perineal region, the course of pregnancy is often in terrupted, and the injurious effect seems to depend rather on the duration or repetition of the traumatic action than on its degree of intensity; B. Again, whatever may be the seat of the lesion, if it causes in a very short time a considerable loss of blood, the pregnancy is seriously threatened, and the woman's life is more or less compromised; C. Finally, if the wound is subsequently complicated by inflammation (erysipelas, phlegmon, lymphangitis, etc.), it can, through this cause, interrupt the pregnancy; 3d. When pregnancy is complicated by a pathological condition (abnor mal irritability of the uterus, disease or hypertrophy of the ovum, albu minuria, etc.), the wound, however slight it may be, and wherever it may be situated, generally leads to the premature expulsion of the product of conception. In this instance the true cause of the trouble, which is attri buted to pregnancy, really lies in the organic or functional affection that complicates the latter condition, and not in the injury, which simply acts as an adjuvant or secondary cause; 4th. Nevertheless, in view of the
extreme difficulty, and often impossibility, which the surgeon encounters in diagnosticating some of these morbid conditions (uterine irritability, dise,ase of the ovum, etc.), it is well to be very circumspect in performing operations during pregnancy. If the surgical lesion will involve the genital tract, the pregnant condition offers, save in cases of necessity, a formal contra-indication to the operation.
2. The Influence of Pregnancy on Traumatism. —If we consider the facts thus far published, pregnancy, in the great majority of cases, does not exert any injurious inflnence upon traumatism. Thus, contusions and wounds, even dislocations and fractures, are not followed by any higher mortality in pregnant women than in other individuals; moreover, the cure of such injuries takes place in the usual manner and within the period that is common to each variety of lesion. The following excep tions, however, are included under this rule: A. When the injury affects the genital tract, it may be rendered milder or complicated in its course, or its termination may be delayed, by the existence of pregnancy; B. This holds true even after the third month of gestation, provided that the injury affects the lower limbs or a region in which vascular changes have taken place. The ordinary complications in A and B are hemor rhage, lymphangitis, erysipelas, gangrene and atonic ulceration; C. As regards fractures in particular, although cases of non-union during preg nancy are very exceptional, this condition can not always be exonerated from exercising a certain influence in retarding the formation or the so lidity of the callus; D. In complicated pregnancy (above all, where the complication tends to produce premature expulsion of the ovum), wounds, by leading to abortion, sometimes acquire indirectly a gravity quite un usual, because the woman is then exposed to the different accidents that regularly accompany delivery—metrorrhagia, metro-peritonitis, etc.