CAUSES DUE TO THE FETUS On 31 Ent of the villosities of the chorion, hydramnion, and vicious insertion of the placenta are the main causes of abortion due to abnormalities of the foetus and the secundines.
Prognosis.—The embryo, or foetus, al ways perishes; the prognosis, therefore. only applies to the mother. Cases of spontaneous uncomplicated abortion al most always recover with proper care. The cause of the abortion, the date of the pregnancy, the degree of antisepsis employed, or the previous cleanliness observed by the patient all bear influence upon the final issue of the case.
In Pinard's service the mortality of abortions was 0.81 per cent.; of abortions having begun outside the service, 27.5 per cent. At Bellevue Hospital no case of death has occurred since it has become customary in that institution to empty the uterus in every case of incomplete abortion. Out of 926 cases noted by Hirst there were 13 deaths: a mortality of 1.4 per cent.
As to the mortality of the product of conception, out of 434 cases in Pinard's service, the fcetus was born alive in 221, dead and macerated in 199, and died during delivery in 14 cases.
In abortion due to syphilis the foetus is almost always dead and macerated; in abortion due to vicious insertion of the placenta, almost always alive; in albu minuria in about equal proportions.
Involution of the uterus is usually more rapid than after normal delivery, on account of the lesser size of the uterus. Incomplete delivery may be a cause of imperfect involution. Patients should be kept in bed ten days. Metri tis is likely to be the sequel of abortion when the patient is allowed to leave her bed too soon. The influence of perfect involution on future pregnancies is marked.
A woman may lose immense quanti ties of blood in a threatened abortion, appear moribund from exsanguination, and yet rally and go on to full term tinder appropriate measures.
Diagnosis. — Pain, hemorrhage, dila tation of the cervix, and descent of the ovum are the characteristic features of abortion which easily distinguish it from other disorders.
DYsmnicouturcEA may be mistaken for impending miscarriage. In this disorder the cervix is closed and firm and the pain precedes haemorrhage. In abortion, on the contrary, the cervix is open and soft and the hemorrhage usually precedes the pains.