Abortion During the First Month.— This usually gives rise to symptoms simulating those of retarded menstrua tion. Slight pains in the back in the region of the uterus are complained of; the symptoms, in this particular, resem ble those of normal labor, but are very much less marked. Blood, blood-clots, and flakes of the mucous membrane of the uterus are gradually expelled during several days. The ovum is expelled en tire, but it is so small that it is rarely discovered.
Abortion During the Second Month.— Inasmuch as the uterus has decidedly increased in size as compared to the first month, the contractions and pains are proportionately stronger. The embryo is usually expelled inclosed in the un broken membranes. Sometimes, how ever, the latter arc ruptured.
The embryo and membranes may be detached from the uterus in two ways: (a) By haemorrhage between the mem branes and the uterus, followed by uter ine contraction.
(b) By contraction of the uterus, fol lowed by haemorrhage. In the latter case the abortion is more prolonged, the mem branes being detached but slowly from the uterus.
If the embryo be still living, the abor tion lasts longer, and the haemorrhage is greater. If the embryo be dead, the whole is usually expelled like a foreign body, and without rupture of the mem branes.
Examination of the uterus will show that it is increased in volume, and situ ated lower down in the pelvis than nor mally. The cervix is dilated, softened, and filled with blood-clots. The dilata tion is more marked in multipartu than in primiparm.
The cervix, though dilated, does not become effaced; and the embryo con tained in the unruptured membranes may pass through the cervix and be ex pelled. If the membranes are ruptured, however, the embryo passes by itself, the very thin umbilical cord breaks, and the cervix closes. The membranes are, in this latter case, expelled later on. The membranes are ruptured about once in every two cases.
Abortion from the Beginning of the Third to the End of the Fourth Month.— This occurs nearly always in two stages, the first consisting in the expulsion of the foetus, and the second in the expul sion of the membranes and placenta.
The cervix in this form of abortion tends to diminish in length. The uter ine contractions act more powerfully than in the previous forms of abortion. Under their influence the membranes are ruptured and the foetus is expelled.
The placenta may still be adherent; the cervix then closes again, and the placenta and membranes are expelled later on. Hxmorrhage is likely to ac company the delivery of the placenta and membranes, especially when the former is only partly detached. Under these circumstances each uterine con traction is accompanied by Innmorrhage.
The placenta may be already detached when the foetus is expelled; in such a case it is likely to be expelled imme diately after the latter, before the cervix closes, but part of the decidua may re main in the uterus after delivery of the placenta. This occurs most frequently when the foetus is dead.
Statistics show that retention of the placenta occurs most frequently during this period.
At three months the placental form is well established, and the uterine contents behave much as they do at full term, with these differences: the placenta is less firmly put together and is more firmly united to the uterus. There is
danger, therefore, of masses of placenta being retained, even though much may be expelled. Ayers (N. Y. Med. Record, Sept. 28, '95).
Abortion During the Fifth and Sixth Months.—The foetus and placenta are al most always expelled separately. Uterine contraction is more marked; the cervix tends to become more effaced and to dilate.
Delivery of the placenta usually fol lows delivery of the fetus rapidly, and the tendency to haemorrhage is less marked than in the previous forms of abortion.
Of 501 cases of abortion analyzed by Varnier and Brion, the foetus, or em bryo, and the placenta were expelled separately in 453, and together in 48 cases. When the delivery occurred in two stages, the time found to elapse between the expulsion of the foetus and that of the placenta was as follows: 120 cases, within 15 minutes; S1 cases, from 15 to 30 minutes; 7S cases, from 30 to 60 minutes; 83 cases, from 1 to 4 hours.
In 275 cases treated in the last two years of those cases terminating natu rally expulsion of the whole ovum oc curred in hospital in 145 cases. The remaining 39 were admitted with the placenta partially or entirely retained. Complete expulsion occurred after a period varying from a few hours to three days as a maximum. During this time rigorous antiseptic precautions were ob served (douches, etc.). All these cases terminated favorably with two excep tions: one patient was septic on ad mission, and died of septicaemia; the other case died of pulmonary tubercu losis. Maygrier (L'Obstetrique, July, '97).
Whenever the placenta and membranes are not expelled within four hours after the expulsion of the foetus, or embryo, there is retention of the membranes and placenta.
Abortion may take place suddenly, or resemble, in that particular, the irregular periodicity of normal labor, with more or less hmmorrhage. It may, indeed, last several days, owing to weakness of the uterine contractions or adhesions to the uterus or retention in the cervix of the masses to be expelled. (Rokitansky, Schiilein.) Sudden or rapid abortion is frequent during the first two months; when the expulsion takes place after the third month it generally presents the charac ters of normal delivery.
Pathology. — Abortion comprises a period of uterine dilatation, the expul sion of the ovum, and involution of the uterus; when delay occurs in any one of these three stages the abortion is protracted. The most frequent cause is failure of the os and cervix to dilate, resulting from a rigid condition of the tissues following laceration or previous inflammation. The internal os may be closed and the external os and cervix dilated, or the external os may be closed while the internal is dilated. The mus cular wall of the lower portion of the uterus is thinned in abortion, so as to give a lower segment, which is as well marked in the aborting uterus as in the uterus in labor at full term. The peri toneum over this part of the uterus be comes loosened, as the result of the ex pansion of the muscular wall; and the decidua over the same area is also sepa rated from the same cause. (Berry Hart.) Complications.