ABORTION.
Definition.—Abortion is a term used to denote the expulsion of the product of conception, alive or dead, during the first six months of pregnancy; or, more exactly, the expulsion of a product of pregnancy which has not yet attained the period of viability, thus including cases where the foetus may perish dur ing the sixth month of pregnancy and be delivered a month or so later.
A number of authorities, especially American and English, only apply the term "abortion" to expulsion of the ovum during the first three months, while "immature delivery" and "miscar riage" are applied to expulsion of the product of conception from the end of the third month to that of the seventh, —i.e., from the formation of the pla centa to the time the child becomes viable. When the expulsion takes place between the period of viability and the normal term of pregnancy, it is called "premature delivery." Frequency.—It is difficult to ascer tain the frequency of abortion (1) be cause during the first two months of pregnancy it often occurs without being detected; (2) because, when known and even when occurring at a late date, it is frequently allowed to go without treat ment.
The statistics obtained in maternities give a proportion of one abortion to three normal pregnancies; but such a proportion cannot be accepted as a rule, lying-in hospitals receiving only women in an advanced state of pregnancy. It is generally admitted that spontaneous abortion occurs most frequently during the first three months of pregnancy.
Viability. — Until recently the foetus was clinically looked upon as viable only after the seventh month; but more care ful treatment—above all, the use of the incubator and of artificial feeding by means of the stomach-tube—has caused children born during the sixth month to be looked upon, clinically, as well as legally, as viable.
A very young hetus may breathe after delivery. This occurred in three eases in the fifteenth. fifteenth, and nineteenth weeks respectively. In the first of these
there were six respiratory movements be fore and five after severing the cord, the fetus living one hour. In the second case the fetus lived an hour and a half and breathed five times. The third hetus lived but half an hour and breathed eight times. The autopsy showed air in the stomach, hut the lungs were empty. tackner (('ent. I. Gyn., No. 1, '90).
In performing an autopsy upon a woman who is supposed to have at tempted abortion search should be made for the embryo or pieces of it, or for the placenta. lf the uterus is empty, the thickness of its walls must be meas ured, and the insertion of the placenta sought, as this can be recognized up to the tenth day after the expulsion of the embryo. This is possible even later, if the uterus is kept in 90 per cent. alcohol. The examination of the ovaries is of only relative importance, as no positive signs exist there. Stains of meconium, if found, gill prove the abor tion. if an instrument has been used to cause abortion, traces of the damage done by it will be seen. This is espe cially true when the uterus has been perforated. Brouardel (Jour. des Pra ticiens. Jan. 12. 1901).
is divided as to its symptomatology by the majority of obstetricians into four classes: 1. Abortion occurring during the first month.
2. Abortion occurring during the sec ond month.
3. Abortion occurring between the beginning of the third month and the end of the fourth month.
4. Abortion occurring during the fifth and sixth months.
After the third month the abortion presents very distinct clinical characters.
Abortion in general is usually pre ceded by dysmenorrhceal pains, extend ing as far as the loins, and a sensation of bearing down in the pelvis, or con tractions of the uterus with or without haemorrhage.
When the death of the fcetus precedes the abortion, the uterus ceases to in crease in size, and all reflex symptoms caused by pregnancy disappear.