The Influence of Cysts on Pregnancy.—The size of the cyst does not usually have any considerable influence on pregnancy, as long as it is non adherent, and has a pedicle sufficiently long to allow of its floating freely in the abdomen. If the tumor is small, it nearly always lodges in the posterior cul-de-sac, especially at one side; if not adherent, it rises into the abdomen with the uterus. If, on the contrary, it is a solid growth, and contracts adhesions that keep it within the pelvis, it gives rise to symptoms of incarceration on the part of the uterus, with compression of the bladder and rectum. When the cyst has risen out of the pelvis, it occupies one side of the abdomen, while the uterus occupies the other, so that two distinct tumors are felt on palpation, the character of each being so distinct as to allow of an exact diagnosis; the abdomen is then enormous, and oedema, ascites, varices, disturbances of respiration, etc.. result. Again, the cyst may be situated in front of the uterus, so as to conceal the development of that organ, and thus to deceive the physician.
The Influence of Cystic Tumors on Delivery.—They often cause dysto cis, so that interference becomes necessary. If the cyst is small and fluid and non-adherent, with a pedicle more or less relaxed, it is generally pushed upwards above the superior strait, and does not descend into the pelvis again till after delivery. If it is of large size, but is fixed in the abdomen, obstruction occurs only when a portion of the cyst is at the same time engaged in the pelvis; it is then imprisoned between the head of the foetus and the pelvic wall, and thus forms a direct impediment to the expulsion of the child. Ordinarily, these cysts act indirectly by caus ing oblique deviation of the uterus and mal-presentation of the fcetus, and by interfering with the strength and regularity of the uterine con tractions. If the cyst occupies the pelvis, the case is different; such cysts are originally located in the posterior cul-de-sac, and before they grow sufficiently to fill the entire pelvis, they are more or less fixed by adhe sions, and thus form a more or less complete obstruction of the canal. Sometimes the foetal part will tend to push the tumor before it, but the efforts of the uterus will be ineffectual; or the tumor may prevent the foetal part from engaging, and keep it above the superior strait, when compression will take place. (Fig. 142.) Hemorrhage, rupture of the cyst, etc., have occurred, as well as bruising and inflammation of its walls, but the patients in these cases have all recovered.
The influence of the Cyst on the Puerperium.—Cases are on record in which women have died of exhaustion from the length of the labor, seine days after delivery; incontinence or inflammation may occur. Rupture and inflammation of the cyst have been noted.
the existence of tumors is unknown before concep tion, they may escape recognition after the uterus has become enlarged. If the cyst is small and is situated in the pelvis, the diagnosis may be es tablished by the vaginal touch, as fluctuation will thus be detected. But, if the tumor is harder and more resistant, it may be mistaken for peri uterine hrematocele or a fibroid. It is only in the early months that it could be confounded with retroversion of the uterus. If pregnancy is recognized and is already advanced, the diagnosis in cases of intra-pelric cysts may be very difficult. Such a cyst will distend the posterior fornix, rendering it so tense that the consistence of the tumor can only be im perfectly made out; however, as a rule, there is more or less distinct fluc tuation, so that an hiematocele alone could be mistaken for a cyst. But liwmatocele has never been observed during pregnancy, so the diagnosis is simplified accordingly. If the tumor is above the superior strait, the distension of the vaginal walls sometimes renders palpation very difficult, and the touch does not give much information; if the growth is in the false pelvis, it may be situated in front, or at the side of the uterus, the organ being more or less displaced, according to the size of the tumor. In exceptional cases a groove of separation can be recognized between the two tumors. Even where fluctuation is not obtained, the peculiar elasticity of the tumor, and its location to one side of the uterus, throw light upon the diagnosis; moreover, with the exception of hydmmnios, ovarian tumors alone cause such distension of the abdomen. In hydram nios, prolonged palpation will usually establish the presence of uterine contractions, which are not present in the ovarian growth; puncture may be resorted to when a positive diagnosis is necessary.
depends absolutely on the size, location, and character of the tumor, and the operative procedure. Doumairou reports 41 cases, 25 mothers and 17 children surviving; Litzmann 56 cases with 24 mater nal deaths; Jetter 215, with 64 deaths, and Playfair 56, with 23 deaths. During recent years the number of successful cases has somewhat in creased.