I. CAUSES WHICH ARE PRESENT WHEN PREGNANCY IS INSTITUTED. - Of the causes of disorder in pregnancy which are present at the inception of the preg nant state there are, as before stated, 1. Faults of Structure.—(a) Struct urally-defective pelvis. This may con sist in the various deformities—pelvis too large, pelvis too small, or pelvis of irregular contour—which interfere with the proper and symmetrical development and enlargement of the uterus and the ovum which it contains.
This interference in the development of the uterus may lead to abortion; may produce pain, nausea, and vomiting; faults of digestion, constipation, inter ference with the pelvic circulation, and a variety of distressing phenomena dur ing pregnancy, as well as difficulty dur ing parturition. The pelvis may also be the scat of serious disease (e.g., osteo malacia), weakening its structure and rendering it unfit as a support for the body and incidentally for the pregnant uterus.
(b) Defective uterus. This may con sist in a faulty position or in imperfec tions of structure which may properly be attributed to bad nutrition. The dis placed uterus—whether the displacement be anterior, lateral, or posterior—is cer tainly a defective uterus for any purpose and in any situation, and it becomes the more strikingly so when it has been impregnated. Normal development is hindered, the circulation becomes im paired, pain and discomfort give annoy ance, and unless the displacement is cor rected uterine contractions may be pro voked and the contents of the uterus ex pelled. Correction may be and often is spontaneous, but is not always a result, especially if the displacement is a poste rior one. The diagnosis is almost always susceptible of determination by means of a careful bimanual examination, and successful treatment is usually possible unless the uterus is fixed by adhesions in its faulty position.
(c) Tumors in various parts of the body, especially in the pelvis or abdo men. A tumor in any part of the body, especially if of a malignant character, may so impair the general condition as to militate against the successful con tinuance of pregnancy. This is notably
the case, in addition to malignant dis ease, with the tumors which develop in connection with tuberculosis, syphilis, and other constitutional diseases. With the tumors of the pelvis and abdomen, whatever their character, it is easy to see that, by their very presence, by their encroachment upon the space required by the uterus as it enlarges, they may be an efficient cause of pain, of disturbance in the circulation, of digestive disorders, etc., and if they do not compel the uterus to throw off its contents they may so complicate the situation that parturition will become not only difficult, but posi tively dangerous. Indeed, successful de livery by the ordinary method and meas ures may be quite impossible, and re moval of the tumor may be required be fore the uterine contents can be removed.
2. Faults of Nutrition. — (a) Badly nourished uterus. The uterus which thus becomes a source of disturbance dur ing pregnancy may be congenitally de fective, or its defects may be the result of disease, bad habits, or traumatism. The entire organ may be rudimentary and poorly developed, or the difficulty may be limited to the muscular structure or to the endometrium. Arrest of devel opment during fcetal life from causes which are not always traceable is not particularly rare. Arrest of development from the diseases common to childhood or from constitutional disease (syphilis, tuberculosis, etc.) is also not infrequent. Traumatism, as from rape, from the forcible thrusting of sticks or other hard substances into the vagina, from burns, and from caustic substances is of less frequent occurrence.
In any of these cases pregnancy comes to an organ ill prepared to perform its function, and it does not respond to the demands which are made upon it. We should not be surprised that pain and discomfort accompany such a pregnancy, and that its termination should be an abortion in the early months.