LETTER XIII.. Disorders of Pregnancy.

DISORDERS OF PREGNANCY.

Fainting—Its Causes—Symptoms—Results—Treatment.

Fainting sometimes happens in pregnancy, even with those who are not subject to it at other times. It is more apt to occur at or about the time of quickening. Some persons are very subject to it, from very slight causes, during the whole period of pregnancy; others experience it only occasionally; and some have it repeatedly, and some periodically. It is more commonly the weakly and delicate who are thus attacked; but some healthy females are subject to it. It happens with some every month periodically, with others every week, and in some cases every two or three days, or even oftener.

Causes.—Fainting in pregnancy is often excited by the first movements of the child, even while they are weak, and by subsequent ones when strong. It is sometimes a consequence of palpitation, or derangement of the heart’s action and of the circulation. Too great exercise of either mind or body, want of exercise and employment, violent mental emotions, running too quickly up stairs, want of sleep, offensive sights and odors, overeating, and too great heat in the apartment—each of these may bring on fainting in pregnancy. Dr. Campbell observes, “As in the gravid (pregnant) state, fainting seizes individuals so suddenly, and that, too, while they are in perfect health, it is difficult, more especially in the early months, to account for it, since the uterus at this period cannot, from its bulk, produce any interruption or irregularity in the circulation of the heart or larger vessels. The womb, however, may influence the heart in another, viz., through the medium of the nerves, whereby irregularity of its action, as often happens from a similar cause on other occasions, is produced; this inordinate action may lead to some irregular distribution of the blood in the cerebral vessels, and hence fainting.”

Symptoms.—The patient experiences a feeling of langour, weariness, and weakness, and there is a frequent inclination to yawn or sigh; the sight becomes dim; surrounding objects appear to turn round; specks float before the eyes; there is a ringing or buzzing in the ears; the face becomes pale, and thus the patient becomes faint and insensible. The premonitory symptoms, if any appear, are sometimes so rapid in their course, that the patient is unable to call attention to them.

During the fit there is no pulsation at the wrists; the heart beats but faintly; breathing is nearly suspended; the muscles lose their power, and a cold sweat breaks out over the surface. But there is no convulsive motions of the limbs, nor any frothing at the mouth, in a case of simple fainting.

This condition of things may last only a few minutes, or for several hours. When the fit begins to pass off, respiration becomes more distinct, the patient utters a few long-drawn sighs, the heart begins to act with more energy, the pulse at the wrist becomes more perceptible, some color appears in the face, and the consciousness is again restored. In some cases consciousness is not entirely lost, and in some it is long before it is fully regained.

“There is a species of syncope,” says Dr. Burns, “that I have oftener than once found to prove fatal in the early stage of pregnancy, dependent, I apprehend, on organic affections of the uterus; that viscus being enlarged, or otherwise diseased, though, perhaps, so slightly, as not previously to give rise to any troublesome, far less, pathognomonic symptoms. Although I have met with this fatal termination most frequently in the early stage, yet I have also seen it take place so late as the sixth month of pregnancy.”

Cases of organic disease of the heart, however, are rare, so that you ought not to think, at every little fainting spell you may experience, that you have a disease of this organ. If in the syncope there is convulsive motion of the limbs, distortion of the features, and frothing at the mouth, it is only a hysterical spasm.

If fainting happens most toward the close of pregnancy, it is to be regarded with more suspicion, according to the opinions of some authors; not so much, however, for the immediate consequences, as for its effect upon the convalescence after parturition.

This symptom sometimes occurs in consequence of an internal hemorrhage, in which case it is generally never prolonged, accompanied with fullness and tension of the abdomen, dull pain and weight in the pelvic region, permanent blanching of the surface, and after a short time a discharge of blood from the vagina.

Results.—In fainting, the circulation becomes for the time almost suspended. When, therefore, we consider the dependence of the fetus upon the maternal circulation, we cannot suppose that its frequent recurrence is wholly innocuous to the child. Occasional fits of syncope, however, appear to do no harm to the fetus; and yet it is always best to avoid the occurrence as much as possible. It has been known to cause abortion when it has been often repeated.

Treatment.—The patient should, during the fit, be placed in the most comfortable posture, the recumbent being the best, the head at the same time being laid rather low, and, if possible, where a current of cool or cold air can be made to blow over it, particularly upon the face; sprinkling cold water in the face, and washing and rubbing the face and hands in cold water are useful measures. In some cases it would be also advisable, or rather necessary, to wash and rub the whole surface.

A full injection of tepid water will aid materially in bringing about consciousness and circulation in these cases.

This water-treatment is incomparably better than that which is usually adopted, such as giving the patient wine, brandy, spirits, carbonate of ammonia, etc.

It generally happens that people themselves, without the aid of the physician, have to manage cases of syncope. This they can readily enough do as a general thing; but if it should prove at all persistent or troublesome, they should lose no time in getting the best medical advice they can obtain.

Prevention.—Every thing should be done that may be to restore the general health. Oftener by far than otherwise, fainting is purely a symptom of debility. This fact of itself suggests the measures that should be adopted in order to ward off the attacks.