Obstetrics for NursesReed, Charles B. (Charles Bert)
Science
Obstetrics for Nurses
Reed, Charles B. (Charles Bert)
Maternity nursing
Abortions happen about once in every five or six pregnancies, and more
frequently at the third month than at any other time.
_The symptoms_ are hæmorrhage and pain. The _dangers_ are hæmorrhage and
infection.
Infection is most common and most serious in abortions that are brought
about mechanically.
Hæmorrhage, in some degree, is an invariable symptom, which has its
origin in the separation of the ovum from the uterine wall. Hæmorrhage
from the uterus is serious at whatever stage of pregnancy it appears.
The duty of the nurse is to put the patient in a cool, dark room, on her
back, elevate the foot of the bed, put ice bags on the lower abdomen,
and summon the attending physician, with the hope that an abortion can
be averted. Bromides and opium are the drugs most to be relied upon.
Opium may be given in suppository, 1 grain night and morning.
If the hæmorrhage is alarmingly profuse and the nurse is skillful and
clean, under exceptional circumstances she may pack the vagina with
sterile cotton while waiting for the doctor. Then the room should be set
for operation.
=Dead Ovum.=—The ovum may be discharged in pieces or in a single
complete mass.
The egg may die at any period of the pregnancy, and be discharged in a
few hours, or it may not be expelled for weeks, if at all. Fœtal death
in the uterus may have its cause on the paternal side in a father too
old or too young, or affected with such diseases as diabetes, nephritis,
tuberculosis, syphilis, or chronic lead poisoning; on the maternal side,
the same diseases, plus cancer, anæmia, insufficient food, and
inflammation of the uterus; on the part of the embryo, syphilis or any
transmitted or primary disease of the ovum.
The results of retention of the dead ovum vary with the case. Infection
of the ovum is rare, except where the membranes have ruptured and an
open channel exists. No harm follows the death of the fœtus, except in
the presence of infections, all other changes are benign. The embryo in
the first and second months may be absorbed, but at later periods, it
becomes macerated petrified, or otherwise altered.
Among the _signs_ of fœtal death are prolonged cessation of fœtal
movements after being definitely observed, chilliness, languor and
malaise of the mother, sense of weight in abdomen, and possibly a bad
taste in the mouth. Furthermore, the uterus does not correspond to the
period of pregnancy, and may have become smaller. Retrogressive changes
take place in the breasts.
The diagnosis is only certain when the heart tones are persistently
absent, or the macerated head of the fœtus is felt through the partly
dilated os as a flabby bag of bones.
_Treatment_ in noninfective cases is expectant. Spontaneous expulsion
will occur sooner or later and there is no necessitous indication for
interference. Local signs of putrefaction, however, make the immediate
emptying of the uterus necessary.
Public-domain text, read in full here on John Shaqi.
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