The bearings of chronic disease of the heart upon pregnancy, parturition, and childbed : with papers on puerperal pluero-pneumonia and eclampsia / by Angus MacDonald.

  • Macdonald, Angus, 1836-1886.
Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: The bearings of chronic disease of the heart upon pregnancy, parturition, and childbed : with papers on puerperal pluero-pneumonia and eclampsia / by Angus MacDonald. Source: Wellcome Collection.

    89/308 (page 77)
    and led to the necessity of shortening the second stage. With the delivery it is to be noticed that the irregularity of the pulse abated, but did not entirely disappear for some time. Now this we observe in all such cases, except perhaps when the main lesion is aortic insufficiency. In that case, after delivery, the threatening symptoms usually subside rather suddenly on the successful conclusion of the second stage of labour. It is evident from this case, as well as from several others, that during the first stage of labour there is not such an amount of extra pressure in the arterial system as makes any great demand upon the action of the heart. But so soon as the irritation due to the pressure of the uterine contraction has the down-bearing effort superadded to it, symptoms of an alarming nature are apt to arise. It is easy to understand that a very little more irregularity and feebleness of pulse might have ended in fatal syncope during either of the two confinements. The successful termination of her second confinement, notwithstanding the threatening symptoms occurring from the sixth month onwards, may fairly be in no small part ascribed, as it appears to me, to the careful management of the patient during the latter months. The patient's safety was also doubtless greatly secured by the prompt means that were adopted to abbreviate artificially the second stage of labour on both occasions. It is also worthy of remark that the condition of this patient's heart, as ascertained by the increase of the trans- verse cardiac dulness, had been greatly altered for the worse between her first and second confinement. A peculiar circumstance is brought out in this and the following two cases, viz. that a systolic murmur is usually developed in those obstructive cases during the second stage of labour. The pro- bable cause of the phenomenon is discussed under Case V.