A knowledge of the various causes of premature expulsion will materially
assist us in the prophylactic treatment; under all circumstances, even
where there is not the remotest fear of such an accident coming on, it is
nevertheless highly important to pay strict attention to the state of the
stomach and bowels, for these are almost always more or less influenced by
the presence of pregnancy; the vomiting and sickness must be relieved in
the manner already pointed out under the chapter on the TREATMENT OF
PREGNANCY; the bowels, if constipated, must be moved by the mildest
laxatives, such as castor oil, Confect. sennæ, or a Seidlitz powder; and
thus all sources of irritation in the primæ viæ prevented as far as
possible. The patient must carefully avoid every thing which may excite
the circulation, such as violent affections of the mind, rich indigestible
and stimulating food, violent exertion, &c. The diet should be light,
nourishing, and moderate; heavy meals must be forbidden, and especially
suppers; she should keep early hours, take gentle and regular exercise,
and in fact, endeavour by every means in her power to raise her health to
a full degree of tone and regularity. In those patients who have already
miscarried in their previous pregnancies, these precautions must be
enforced with double vigilence; for the system becomes exceedingly
irritable, and the uterus soon acquires, as it were, a habit of retaining
its contents only to a certain period, and then prematurely expelling
them. When this is the case, it becomes exceedingly difficult, and is
often actually impossible, to make it carry the ovum to the full term of
utero-gestation, and, despite of the greatest care, the symptoms of
premature expulsion will come on at about the same time at which they
occurred in former pregnancies, and sometimes to the very same week.
In the treatment of such cases, where there is so much liability to
abortion, we must first examine the precise condition of the circulation,
and ascertain whether it be above or below the natural standard of
strength; for as abortion may arise from very opposite conditions of the
circulation, our treatment must consequently vary. If there be signs of
arterial excitement, a small bleeding may be necessary; it unloads the
congested vessels, diminishes the force of the circulation, and therefore
also the chance of an extravasation of blood between the uterus and ovum;
the bowels must be kept open by cooling saline laxatives, and the
circulation may be still farther controlled, by the use of nitre two or
three times a day. The diet must be spare; she must take regular exercise
in the open air, wear light clothing, dress loosely, and sleep upon a hard
mattress.
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