If the diagnosis is made before rupture or abortion the _treatment_ is laparotomy. If rupture occurs, the laparotomy must be done immediately to check the hæmorrhage, which threatens the life of the patient. In tubal abortion, if the diagnosis is certain, some delay may be permitted under extreme watchfulness of the nurse and physician. In such case, the nurse will keep the patient absolutely quiet and forbid exertion of any kind.
If operation is necessary, the utmost gentleness must be used in preparing the abdomen. The tincture of iodine application to the site of the incision is sufficient preparation, and, of course, an abundance of sterile gauze, cotton, and towels should be supplied, as in every case where laparotomy is done.
If the rupture occurs while the nurse is present, the doctor should be notified at once, and if not at home, another doctor should be summoned. Meanwhile, the nurse prepares the room, solutions and utensils for an abdominal operation. Immediate incision to check the hæmorrhage and remove the mass offers the greatest safety.
The after-care is the same as for any laparotomy, with the additional duty of making up the lost blood as soon as possible by nourishing foods, normal saline solution by rectum, and, if necessary, by hypodermoclysis.
=Acute fevers= are a serious complication of pregnancy on account of the danger of abortion or premature labor, which may come on either from the associated high temperature or from the transmission of the disease to the ovum.
The following diseases are known to affect the fœtus _in utero_: cholera, yellow fever, small pox, scarlet fever, typhoid, measles, erysipelas, meningitis and syphilis.
=Tuberculosis= does not affect fertility or the course of the pregnancy, but the progress of the disease is hastened, and the maternal death accelerated.
The question of artificial abortion in the early months must be seriously considered, and if the case goes on to term, the child must not be nursed or cared for by the mother.
=Syphilis= is the most frequent systemic cause of the interruption of pregnancy. It is a blood disease, due to an organism, called spirochæta pallida, and it appears in three distinct stages. The first is the primary stage, wherein a hard, nodular ulcer appears on some part of the body, as the vulva, lips, gums, tonsils, or hand. It is _not always_ venereal in origin. The second stage begins six or eight weeks after the sore, and is marked by a general eruption of red spots, chronic sore throat, falling hair, and rheumatic pains in the joints. The third stage is the name given to the later conditions of the disease which affect the bones, blood vessels, and nervous system.