Small-pox. — This disease manifests a preference for women in whom the preg nancy is not far advanced, but proves much more dangerous when it occurs near the parturient state. It attacks pregnant women oftener than any other disease. The probability of abortion varies with the intensity of the process present. Varioloid causes abortion in about one-tenth of the cases attacked (Mayer). Discreet variola causes abor tion in about one-half the cases, while in confluent variola and hemorrhagic variola abortion nearly always occurs, especially if the pregnancy be advanced.
The foetus may be expelled during either one of the stages: invasion, erup tion, or suppuration. It may present characteristic variolous cicatrices. Occa sionally the child remains unaffected; it may also suffer from the disease before or soon after birth, the mother remain Ing immune.
Among 72 eases of small-pox in preg nant women, 31 miscarriages and 26 deaths. Sangregorio (Med. Standard. May, 'SS).
Abortion occurring during variola is usually attended with more than the ordinary amount of hemorrhage. Gas parini (Gaz. Med. Lombarda, No. 1S, '02: l'Union Mod., July 5, '92).
Several serious cases occurring during convalescence after small-pox. The grave symptoms are due to the retention of the foetus, which has died during the acute stage of small-pox, and which is frequently only expelled during or after convalescence. Arnaud (Gaz. des HOp., July 2S, '92).
Cholera. — Women are the most sus ceptible to this disease during the later period of pregnancy. Abortion almost always occurs, even in comparatively slight attacks, and the prognosis for mother and child is most unfavorable. The abortion has been ascribed to uter ine contractions, to acute hemorrhagic endometritis, and to disturbance of the f(ntal circulation caused by the thicken ing of the blood. It is probable that these three factors are present simulta neously, in addition to placental granu lar degeneration, which cause the death of the fetus.
Icterus.—This disorder rarely presents itself during pregnancy. It may occur in three forms:— (a) Simple catarrhal icterus, in which abortion frequently, though not always. occurs; (b) icterus gravis, in which abor tion always occurs, and is almost invari ably fatal; and (c) the epidemic icterus. peculiar to pregnant women, which causes abortion in the great majority of cases.
Icterns presents a peculiar feature that renders it important in connection with pregnancy: i.e., its tendency to either precede or accompany the fatal patho logical changes attending yellow atrophy of the liver. Pregnancy exerts a perni cious influence upon the course of even simple icterus, owing probably to the obstruction afforded not only to hepatic circulatory functions, but also those of the kidneys. This would tend to cause reabsorption of the biliary acids and to produce yellow atrophy. Fatal icterus during pregnancy is also due occasion ally to the lesions attending phosphorus poisoning.
Malaria does not frequently compli cate pregnancy, but causes abortion in about one-half of the cases attacked. Pregnancy seems occasionally to cause a relapse in women apparently cured of malarial fevers. On the other hand, parturition suspends periodical parox ysms, in a large proportion of the cases, for two or three weeks. The malarial paroxysms occurring during pregnancy are characterized by irregularity, and the foetal movements may be suspended while the paroxysm lasts. Quinine may safely be given even in large doses, which best control the febrile phenomena. The case is different in habitual abortion (q. v.).
Action of quinine on pregnant women. In 4!) pregnancies quinine was used in 47. the patients suffering more or less severely from malarial fever. Of these, 47 eases terminated at the usual period by the birth of a child, and 2 aborted. In these :2 cases it is extremely probable that the high fever from which they suffered was instrumental in producing abortion. Medicinal doses of quinine are powerless to induce abortion. The drug may be safely given in therapeutic doses during pregnancy. O. Frederici (La Clinica Ostetrica, April, 1902).
Chorea rarely occurs as a complica tion, and especially affects primiparx. It causes abortion in about one-half of the serious cases, and the exhaustion consequent upon the violent muscular movements occasionally proves fatal to the mother. The child, when parturition is approaching, may not be lost with the mother, but it is frequently affected with chorea. In a small proportion of cases of chorea paroxysms cease at the beginning of parturition.