Amniotic fluid

“ The general assembly finds that the method or technique of abortion known as saline amniocentesis whereby the amniotic fluid is withdrawn and a saline or other fluid is inserted into the amniotic sac for the purpose of killing the fetus and artificially inducing labor is deleterious to maternal health and is hereby prohibited after the first twelve weeks of pregnancy. ”

“ If the disturbance causing the abortion has been of rapid progress, the cavity is large, the embryo approximating in development the period of expulsion; whilst if the changes have taken place slowly, the walls are thick, the cavity small, and the embryo may appear merely as a small mass pendent from the navel-string, or may have entirely disappeared, and can be traced only by the fine detritus in the amniotic fluid, the cord itself perhaps only in part remaining, and even this may have disappeared. ”

“ The Ovum.—Pathological changes of the ovum itself, of the embryo, of the surrounding membranes are less frequent as primary causes of abortion, and they are of less importance to the practitioner as being in no way amenable to treatment. When they do occur they usually lead to expulsion in the earlier months.
Those conditions liable to lead to abortion are especially diseases of the [p. 490] chorion, placenta, and umbilical cord, rarely of the amnion, the embryo itself, or the amniotic fluid. ”

“ The differences observed between putrefaction and decomposition in utero and in the open air must not be lost sight of. In the one case, according to Orfila, Devergie and Martin, Moreau, P. Dubois, Danyau, Cazeaux, Tardieu, and my own experience, a uniform and characteristic reddish-brown hue obtains in proportion to the time of retention after death, varied perhaps by the action of the amniotic fluid; [128] the fœtus wrinkles, dries, and becomes mummified, unless in earliest pregnancy, when it generally resolves itself into a gelatinous mass. ”

“ Outside the embryo there now remains nothing but the highly vascular [Pg 199] allantois and the bloodless serous membrane and amnion. The amnion, whose fluid during the later days of incubation rapidly diminishes, is continuous at the umbilicus with the body-walls of the embryo. The serous membrane (or outer primitive amniotic fold) is, by the completion of the cleavage of the mesoblast and the withdrawal of the yolk-sack, entirely separated from the embryo. The cavity of the allantois, by means of its stalk passing through the umbilicus, is of course continuous with the cloaca. ”

“ The uterine contractions at the onset of labor compress the fluid; in turn the fluid attempts to escape but is held in check by the amniotic membrane, which it drives into the canal leading from the uterine cavity to the vagina. Acting like a wedge, the fluid gradually pushes the mouth of the womb wider and wider open, until it is large enough for the child to pass. The sac usually ruptures when that point is reached, the fluid escapes, and in due time the child is born. ”

“ Very early in pregnancy this sac becomes a double-walled structure; and, though its layers are intimately blended, and together measure not more than 1/16 of an inch in thickness, with a little care they can be separated. The outer layer, which comes in contact with the inner surface of the uterus and has to do with the matter of nutrition, is called the Chorionic Membrane; the inner, the so-called Amniotic Membrane, is much the stronger and is devoted to the protection of the embryo, which it completely surrounds with fluid, at the same time retaining the fluid within set bounds. ”

“ The chorion is the more external of the two fetal membranes; it early surrounds the ovum and throws out processes (villi) toward the decidua reflexa and serotina. These processes are at first formed equally all over the chorion, but those which lie in connection with the decidua serotina grow more rapidly in size and complexity, and remain to form the main part of the placenta. The membrane in which the fetus lies is the amnion. Contained within the amnion is more or less fluid, the liquor amnii, in which the fetus rests as in a water-bed. ”

“ Very soon, however, it invests the embryo completely, and the membranous sac is intact, excepting where it is pierced by the umbilical cord. The amnion, too, is derived in part from the ectoderm, but is a stronger, denser membrane than the chorion. At first there is an appreciable space, and some fluid, between 71the two membranes, but as the amnion increases in size with the advance of pregnancy, it comes in contact with and is loosely adherent to the chorion. ”

“ Occasionally water may form between the three membranes, and during labor the chorion may rupture [Pg 174] and not the amnion, and the waters between them be discharged. In like manner, water which has formed between the decidua and the chorion may come away. These, then, are two sources of fluid which may be discharged from the vagina in labor when the amnion is intact.
Umbilical Cord.—The organ by which the fetus is attached to the uterus is a whitish, glistening structure which springs from the fetus at the center of the abdomen, and passes to the internal aspect of the placenta. ”

“ The life of the fetus, therefore, is absolutely contingent upon an uninterrupted, two-way flow of blood through the cord.
The Fetus. In tracing the development of the ovum after its implantation in the uterine lining, we begin, as previously stated, with a shaggy-looking vesicle, containing fluid, with a clump of cells hanging toward the centre from their point of attachment on the inner surface of the sac. This clump develops into the embryo. ”

“ From these facts and observations we may safely infer, that the fetus in the womb is nourished by the fluid which surrounds it; which during the first period of gestation is absorbed by the naked lacteals; and is afterwards swallowed into the stomach and bowels, when these organs are perfected; and lastly that the placenta is an organ for the purpose of giving due oxygenation to the blood of the fetus; which is more necessary, or at least more frequently necessary, than even the supply of food. ”

“ It also affords the fetus greater freedom of motion, and protects the womb and other parts from injuries which might otherwise be inflicted by the fetus after quickening. Within this fluid the fetus floats during its formative period, and when the time of birth comes the breaking of the sac which contains this fluid enables it to flow out, lubricating the parts, or channel, through which the newly formed being is to pass in its exit into the outer world. ”

“ This fastens itself to one side of the uterus, takes oxygen as well as nutriment from the mother and sends it through the umbilical cord to the child, the point of attachment being at the navel, the depression left on the belly of the child by the cutting of the umbilical cord at birth. In the same way it takes the waste product from the child to the mother, and she, in turn, throws them out of her system through the kidneys, bowels and skin. The child and placenta are both encased within a membraneous sac, which secretes and serves to hold a watery fluid in which the child swims. ”

“ The secreting or inner involucrum (amnion) of that Ovum, when laid open, was found tinged with blood and the cord distended by the same fluid which pervaded also the liquor amnii, as well as the fœtus itself. The morbid adhesions, contracted by the middle membrane with the chorion in consequence of plethora, are well marked in one part of the drawing by the artist to whom I carefully dissected the preparation. The chorion itself is in a morbid state.
Fig. 12. Ovum opacum plethoricum. (Eleven weeks after menstruation.) ”

“ This is very necessary, both for the
mother and the child, and prevents subsequent troubles. The fluid
contained in the breast is at this stage called colostrum, and is
intended by Nature to act upon the child as a laxative. This first
nursing stimulates the secretion of the milk and causes uterine
contraction, which is very much needed at this time. It is well to wash
the infant's mouth out with sterilized water every time it feeds. For
this purpose use clean water which has been boiled and allowed to cool,
or a solution of boric acid in boiled water--5 grains to the ounce of
water. ”

“ No. 3448 is a single spherical denudated diaphanous Ovum about six inches in diameter, without the slightest appearance of any placenta, filiform or cotyledonous vessels, or other of the nutritive involucra or membranes. The secreting or amnionic membrane, is capable of containing more than six ounces of fluid; yet the embryo is not larger than an embryo at one month. ”

“ The symptoms may be preceded by a bearing down feeling in the lower abdomen, with backache, frequent calls to pass urine, and a discharge from the vagina, that is a mixture of mucus and water. After these symptoms last for a shorter or longer time, labor pains set in, the bleeding increases and the contents of the womb are discharged. The ovum may be expelled whole when it looks like a huge blood clot, or it may be expelled partly and the membranes left behind; or the embryo (child) alone, surrounded by the transparent membrane, escapes. ”

“ On the next day the membranes were ruptured and 4 more fetuses were delivered. Traction on the umbilical cord started hemorrhage, to check which the physician placed his hand in the uterine cavity. In this most arduous position he remained four hours until assistance from Lugano came. Then, in the presence of the three visiting physicians, a sixth amniotic sac was delivered with its fetus. The woman had a normal convalescence, and in the following year gave birth to healthy, living twins. The News says the children all moved vigorously at birth ”

“ For some embryos have a more perfect structure provided for them, such as that fleshy substance mentioned above, which in some is altogether wanting. In some, also, the placenta is observed to be thicker, larger, and more loaded with blood; whilst in others it is more spongy and white, like the thymus or pancreas. But there is not more variety found in the placenta than in the mamma or viscera generally: for instance, the liver in some animals is red and filled with blood, in others, as is the case with fishes and some cachectic persons in the human species, it is of much paler hue. ”

“ In one point of view, more especially, is the present diseased Ovum particularly interesting to me; for it exhibits the most distinct proof that what I call the cortex of the Ovum, and which others have, without direct evidence, considered as a membrane of the uterus, is, in good truth, a natural covering of the Ovum. It is this very natural covering of the Ovum which is liable, from disease, to become fleshy, opaque, vascular, and lastly coriaceous, thereby cutting short the supply, or accretion of substance to the fœtus, and thus destroying its life and producing abortion. ”

“ As the watery condition of the blood increases with advancing pregnancy, so dropsy of the amnion is a disease of the last four or five months of gestation. The abdomen is large and pendulous, and the swelling fluctuates under pressure, though the solid body of the fetus can still be felt to strike against the hand pressed into the swelling. ”

“ Some have ascribed the nutrition of the fœtus to a regular deglutition and digestion of the amnionic fluid. Many facts render this opinion probable (Meckel) . But there are also facts which would make nutrition by such a means impossible (Dr. Hunter) . 1st. An embryo, at an early period, cannot be nourished by the mouth. 2dly. The amnionic fluid is mere water with a vestige only of albumen, the only nutritive quality in it. 3dly. A fœtus was seen whose intestine, a little below the duodenum, was impervious and divided through, and the lower end began at some distance from the higher portion. ”

“ If such be the case, can it have the power of retaining the germ in the womb, when on the most minute examination of the young, I could not detect, by cicatrice or line of abrasion on any part of the abdomen, that they ever possessed umbilical vessels, or had been in any way nourished by a placenta? Let us take into consideration the small size of the animal found in the pouch, its utter helplessness, its slight power of motion, and its firm attachment to the nipple. The more it is in the embryonic state the firmer is its attachment to the mother ”

“ When the placenta is examined, it is found that certain changes have taken place in its structure which interfere with the circulation of the blood through the placenta, and may indirectly bring about the death of the fetus. The child is also subject to the same toxic conditions which the mother has had and may die from failure of the liver and kidneys or in convalescence. ”

“ Frontal section of the pregnant human womb, showing: end of the decidua, uterine cavity, chorion (laeve) , amniotic cavity, foetal placenta, oviduct, spongy decidua serotina, umbilical vesicle, amnion, decidua reflexa, decidua vera, muscular wall of the uterus, mouth of the uterus. (From Turner.) The embryo (a month old) hangs in the middle of the amniotic cavity by the ventral pedicle or umbilical cord, which connects it with the placenta (above) .
FIGURE 1.199. Human foetus, twelve weeks old, with its membranes. Natural size. The umbilical cord goes from its navel to the placenta. ”

“ Ovum pene-solidum; placenta sarcomatosa cum tuberculis hœmatosis; involucra fœtûs solidificata. (Gestation four months and a half?)
What havoc has disease effected in this Ovum! Scarcely can we recognize a single element of its structure. The placental covering is composed of many substances, has lost its spongy vascularity—it has acquired several solid tumours, and is altogether unfit for its intended function. The cortex of the Ovum is fleshy; but within it a supernumerary fine membrane is seen, which might, but must not, be mistaken for the chorion. ”