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Misca11iage and Abortion

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MISCA11:!IAGE AND ABORTION.

These terms are both used to indicate that the offspring Las been expelled from the womb before the full period of pregnancy is com pleted. Abortion is the word which ought to be employed when the expulsion takes place before the eighth month, before the period, that is, when the child has the chance of sur• viving, and miscarriage is employed after that period, when it is still possible for the child to live. The phrase premature labour is still better to indicate the latter state of affairs. There is no doubt that the product of concep tion is very often expelled from the womb within a few weeks of conception taking place, without the woman being aware of the fact. She thinks her monthly illness has only been delayed. The commonest period for abortion is between the eighth and twelfth week of pregnancy.

The causes are very numerous. Accidents, blows, falls, &c., indiscreet exertion in dancing, for example, irritation arising in the bowel from the presence of worms, or the occurrence of diarrhoea, irritation in the genital passage or womb itself, all these may cause it. It may be due also to disease, diseases attended by fever, or any serious disease whatever ; it may be the result of a diseased ovum, of tumours connected with the womb, or displacements of the womb. Strong emotion may excite it, and various drugs act on the womb in a way to excite it to expel its contents.

It must be noted also that the womb may readily acquire a habit of expelling its contents at a particular period. If abortion has occurred once or twice about the same time, there will be special danger of the same occurrence about the same time in future pregnancies.

Symptoms.—The chief symptom, to begin with, is pain—pain in the back and in front also. If the abortion is very early, the pain may be trifling, but the more advanced the pregnancy the larger will be the mass to be expelled, and the greater the pain. Previous to the pain, a cold uneasy feeling is experienced at the lower part of the belly in front, along with a sense of weight, and the morning sick ness and fulness of the breasts may have dis appeared. The pain lasts for a time, passes off, and, after a longer or shorter interval, returns. A discharge of blood also appears, which varies in amount in different cases. On the quantity of blood which has been discharged one bases an opinion as to whether or not the threatened abortion can be prevented. If the discharge has been considerable, and repeated, and if the pains keep returning, there is little hope of averting the expulsion of the contents of the uterus. If the pregnancy is advanced to the formation of membranes and fluid, and if the membranes have ruptured and the waters escaped, that is conclusive evidence that the process cannot now be checked.

If any reliable information could be obtained as to whether the offspring were alive or not, that would be a great aid in solving the chief difficulty of the situation. If its death were

certain, the expulsive efforts of the womb would be encouraged; if its life were certain, they would be restrained if possible. The feeling of coldness and weight referred to are held as in dicating the death of the offspring. Should the pregnancy be advanced beyond the period of quickening, the cessation of all movements on the part of the child would lead to the conclu sion that it was dead. This must not be too readily accepted as proof. It has often hap pened that the movements have ceased for days, till the mother became convinced of the child's death, and yet it has been born alive. In some cases the expulsion of a dead ovum has not taken place for a long time after the death had occurred.

When the abortion or miscarriage actually occurs, the important thing to secure is that everything is expelled from the womb. It is always desirable, in order to make certain that this has occurred, for all clots, &c., to be kept till seen by the medical attendant In abortion in the earliest months everything is usually expelled together in the form of a fleshy mass, but from the third month there is greater lia. bility of something being retained, which will lead to subsequent trouble. After the sixth month the miscarriage becomes similar to labour at full time, but more easily accomplished. Treatment —The first and most essential part of treatment is rest, complete rest in bed, the patient lying flat, with head low. If the abortion or miscarriage is only threatened, this is the first and chief means to ward it off. Un stimulating light diet is to be given, and always cold. If pain is the chief symptom, an opiate is very valuable, say 20 drops of laudanum, which would be best given mixed with a tea cupful of thickish starch as an injection into the bowel. If a discharge of blood is the chief symptom, acid drinks and a lead and opium pill is advised. Repeated doses of opiates should, however, never be given without medical orders. If the abortion is arrested, rest must be con tinued for a prolonged period, and great ctre exercised. If such treatment does not arrest the expulsive action, if the pains are returning at regular intervals in strength, and the dis charge of blood is considerable, and certainly if the waters have come away, other treatment, designed to aid the process, is needed. For this purpose from a half to a tea-spoonful of liquid extract of ergot is given every third hour till everything is expelled.

A woman who has miscarried or aborted must be treated in every way as one who has been delivered at the full time, and must be allowed as long a period of rest in bed after wards. Further, such an one must remember that she runs special risks of repeating the same performance at a similar period of a later pregnancy, and must, therefore, take special precautions about such a time, avoiding undue exertion and fatigue, and, it is specially to be noticed, avoiding all sexual excitement.