Cases of pregnancy in which the car diac symptoms are slight, as a rule, have a favorable issue, but if the cardiac symptoms are marked, and have a tendency to increase, it is questionable how far the expectant treatment is justifiable. Thirty-five or 40 per cent. of cases with serious complications are fatal.
Expectation of life in children born of women with serious heart-lesions is much impaired; so that too much tion for the life of the child, without benefit to either, probably has been given.
Of 7 cases of women collectively preg nant 31 times. Of the 15 children born before the cardiac symptoms became so severe as to require advice, 12 are alive and 3 are dead. In the 16 other preg nancies, in which the cardiac symptoms were marked, all but 3 are dead and 1 of the 3 surviving has but a few months to live. George Sears (Amer. Medico Surg. Bull., Apr. 15, '95).
In pregnancy with cardiac disease sole thought should not be given to heart; by watching and treating the kidneys, the skin, the intestines and the lungs, the state of the heart may be relieved, asphyxia and intoxication be prevented, and time gained. Artificial labor is rarely indicated in a pregnant woman in whom the cardiac symptoms have ended or are about to end in asystole. Venesection acts more favorably and rapidly, aided by oxygen to stimulate the lungs, milk for the kidneys, purga tives. and intestinal disinfectants. Ri viere (Gaz. Hebdom. des Sci. Med. de Bordeaux, June 30, '95).
Influence of pregnancy on 62 women who were the subjects of mitral stenosis. Of these 23 died, either in the course of pregnancy, in parturition, or within three weeks after delivery. The most fatal period for such women is just after delivery; 14 of the 23 died between six teen and twenty-two days after the birth of the child, 2 died in labor, and 7 be fore parturition set in. Abortion or premature labor was not infrequent.
Haemorrhages from the lungs and uterus are pretty common, but are to be regarded in a favorable light, for they occurred in only S of the 23 fatal eases, whereas they happened in IS of the cases that ran a favorable course. Anasarca, albuminuria, and convulsions are not constant. H. B. Allyn (Glasgow Med. Jour., Oct., '95).
To relieve symptoms of the disturbed heart's action in pregnancy every exer tion must be interdicted, and the pa tient should remain in the recumbent posture the greater part of the day.
Frequent examination of the urine is in dispensable. A strict milk diet must fol low the finding of the first trace of albu min. Cardiac stimulants are indicated. If this mode of treatment is not followed by an amelioration of symptoms and the cardiac incompetency increases in spite of efforts, question of the pro priety of terminating pregnancy may justly arise. Success can only be ex pected if the pregnancy is terminated before the onset of serious symptoms. Julius Rosenberg (N. Y. Med. Jour., Jan. 18, '96).
Conclusions regarding heart in relation to pregnancy, parturition, and puerperal state: 1. Fact of hypertrophy of the left ventricle occurring in normal pregnancy should be accepted as proved. In deli cate and feebly-developed subjects it may sometimes be absent, and in these cases signs and symptoms of cardiac in sufficiency are likely to occur. 2. A cer tain amount of dilatation of all the chambers of the heart does normally occur in pregnancy. 3. Failure of the ventricle has a distinct effect upon the course of pregnancy. In the early months it leads to abortion, and in the later months to premature delivery. 4. The heart during pregnancy and the puerperium is specially liable to undergo fatty degeneration. 5. The condition of the muscular heart-wall is of more im portance during pregnancy than the val vular lesion; many women with val vular lesions pass through their early pregnancies without any sign of heart failure, but as the heart-muscles become deteriorated by the strain of repeated pregnancies they show increasing evi dence of cardiac insufficiency. 6. Of all the forms of valvular lesion, mitral stenosis of a marked degree is the most disastrous. M. Handfield-Jones (Lancet, Feb. 1, '96).
It is necessary to interrupt pregnancy in cases of heart disease only in those patients in whom there is a disturbance of compensation. In all other instances satisfactory results will follow close care during the latter months of pregnancy and labor, as well as in the puerperium. If heart disease be discovered during ges tation a milk diet, constant rest before and after labor, and heart-tonics will generally suffice. In mitral disease heart-failure is most apt to occur during the second stage of labor. In aortic dis ease the most dangerous period is im mediately after labor. Luoff (AnnaIcs de Gynec., Dec., '97).