Uterine Hemorrhage During Pregnancy
( Originally Published Early 1900's )
Its' Usual Significance and Temporary Treatment-Placenta Praevia—Precautions after Previous Abortions-Treatment after Miscarriage.
Uterine Hemorrhage, or a discharge of blood from the womb, during pregnancy, is usually a sign that miscarriage is threatening, and hence requires prompt medical attention. In summoning a doctor under these circumstances it is always desirable to send a note, rather than a verbal message, and to state clearly the nature and urgency of the case. Meantime an endeavor should be made to restrain the hemorrhage by causing the patient to lie down, with the head low and a pillow under the hips, by admitting plenty of cool, fresh air into the room, and by ensuring perfect quietness.
If possible, the services of a trained nurse should be obtained at once, and she, with perhaps one other person, should alone remain in the room. Cloths, dipped in cold water or in vinegar and water, must be applied to the external genitals for a few minutes at a time, the application being frequently repeated. If wet cloths are kept on for a longer period, they are sure to become warm, and so, by acting as a poultice, defeat the object in view, and indeed tend ' rather to increase than to check the flow of blood. When the hemorrhage continues, or becomes very profuse, the nurse must not hesitate to send for the nearest doctor as well as for the ordinary medical attendant. In such cases it will be desirable for her to take a dry napkin or two, and, having folded them in the form of a pad, to press them forcibly against the external genitals and hold them there. All the discharges, whether solid or fluid, should be carefully retained for the inspection of the medical attendant.
These alarming hemorrhages are often brought about by accidents, such as blows or falls, or by the lifting of heavy weights, But when flooding first makes its appearance, at the seventh month or later, and there has been na such accident to account for it, the probability is that the case is one of placenta proevia a, in which the after-birth is in an unusual position—namely, over thy mouth of the womb, constituting a very dangerous complication. The temporary treatment of flooding due to this condition in no way differs, however; from that already described.
When previous pregnancies have been cut short by miscarriage, it is very necessary that the greatest precautions should be observed to avoid the repetition of such an accident. Now, we know from experience, that miscarriages are most apt to take place at those times which, in the absence of pregnancy, would have been the ordinary menstrual periods. It is on these occasions, therefore, that preventive measures are most needed and most likely to be useful. Every month, then, during the time that the patient would, under other circumstances, have been unwell, she should maintain the recumbent posture, if not in bed, at any rate on a Couch. If this simple rule were attended to, many a miscarriage would be averted. A woman known to be liable to abortion should, moreover, be specially careful to avoid all its most common causes; she should abstain from exciting entertainments, violent exercise, fatiguing or rough journeys, strong purgative medicines; and exposure to cold. And, lastly, as it is very doubtful whether any of the causes I have named are sufficient in themselves to bring on abortion, without a predisposition thereto, from some local or general weakness or disease, it is very desirable that patients who have formed the so-called "habit'' of aborting, should consult their medical attendant at the commencement of pregnancy with a view to being placed under a regular course of treatment.
The after-treatment of patients who have miscarried is a most important matter, and one which receives far too little attention; It is no uncommon thing among patients of the laboring and middle classes for women to go about their ordinary duties as early as the second or third day, and some do not even rest for more than a few hours. Now, although this neglect of proper pre-caution may not result in any immediate ill-effects, it frequently lays the foundation of chronic disease with much attendant misery and suffering. Whenever nurses have an opportunity they should tell their patients what there is in store for them if they resume their ordinary duties too soon ,after such an occurrence. No absolute rule can he laid down as to the length of time during which rest is necessary; it depends so entirely on circumstances that vary in different cases. Thus, in a cue of abortion during the early months, for instance, where the loss has been small and the health has not suffered, four to six days' absolute rest in bed, followed, during the next ten to fourteen days, by the greatest care and prudence, will, in the absence of special directions from the medical attendant, be generally found sufficient. When the health is unaffected it becomes very irksome to lie in bed for the time here indicated; nevertheless, this rule cannot be neglected without running grave risk.
Should the pregnancy be further advanced, or the circumstances less favorable, a longer period of rest will be required. Where there has been severe or long-continued flooding, a patient is frequently reduced to a condition of weakness quite equal to that following an ordinary confinement. In such cases it is only reasonable to expect the same care to be exercised as after a labor at full term.
On no account should a patient leave her bed, after a miscarriage, so long as any discharge of blood continues, as, while that persists, it is uncertain whether there is not some portion of the after-birth or membranes still remaining in the womb, and rendering the patient liable to further attacks of flooding.