If delivery is spontaneous, the woman may improve, and even become pregnant again, or she may succumb to the disease later; if labor has been long, the lesions of the cervix produced by the passage of the child are followed by gangrene of the diseased parts, septicaemia, and peritoni tis, and the mother succumbs to the puerperal complications.
P ro gnosis. —This depends upon the character, location, and extent of the disease, but in general it is more grave for the child than for the mother. Chantreuil noted 25 deaths during and after labor among 68 women; out of 70 children, 28 were born alive. Among 126 women ob served by Cohnstein, 54 survived; 42 children out of 116 'ere born alive, while of the 74 who perished, 7 were delivered after embryotomy, 14 were retained in the uterus, and 6 died from the effects of protracted labor and extraction. The total mortality .was 38.8 per cent.
Treatment. —The first question which presents itself with reference to cancer of the uterus is: Can we, and should we, operate upon the cancer during pregnancy ? Should cauterization, amputation or extirpation of the diseased part be attempted ? A number of cases have been reported in which the cancer was excised during pregnancy, not only without in terrupting its course, but with the result of rendering labors less difficult, and causing the delivery of living children.
We can not view the subject in this light; in the presence of a disease which is certain to destroy the mother sooner or later, we should think first of the child. Operations performed during pregnancy not only com promise seriously the life of the mother, but almost inevitably interrupt gestation, and hence defeat the end which we propose, viz., the safety of the child. The treatment should be expectant, limited to controlling the hemorrhage by astringent and antiseptic injections. As soon as labor has begun we should be ready to incise the cervix and apply forceps if the interest of the child demands it; this applies also to cases in which the disease has extended to the os internum. Expectant treatment is far from being without danger, since out of 47 cases in which this was adopted, 12 terminated fatally in consequence of rupture of the uterus, and three from laceration of the cervix. Manual dilatation has been tried in vain, but incision of the cervix, as advised by Baudelocque, followed by the use of the forceps, version, or the cephalotribe, has been most generally adopted, the average results being 50 per cent. of recoveries for
the mothers and 62.5 per cent. for the children. It seems as if the forceps should be much preferred to version, since we find that with the former 75 per cent. of the mothers and 50 per cent. of the children were saved, while after version, only 18 per cent. of the mothers and 12.5 per cent. of the children survived. Cephalotripsy does not appear to offer any advan tages for the mother. Out of 6 cases collected by Cohnstein, 4 died.
Incisions followed by the application of the forceps is really the best procedure, since dilatation with Barnes' bags, followed by version, has given much less favorable results. We believe that the induction of premature labor should be absolutely rejected, in view of the incurable nature of the mother's malady and the importance of saving the child; the same interference is necessary after the induction of artificial labor as in labor at term, hence there is no advantage in it. Ccesarian section has been performed five times, two children being delivered alive, one of whom died immediately after the operation. These results are certainly dis couraging; still, if the disease had invaded the lower segment of the uterus, if the pregnancy had reached full term, the foetal heart-beats were nor mal, the membranes intact, and the cervix had not, for several hours, been affected by the uterine contractions, we believe that we should hardly be justified in hesitating, and that we should have recourse to Cmsarian sec tion, which ought under these circumstances, to give a living child.
VI. Fibroid Tumors of the .Uterus.
These are designated by various terms (fibroma, fibro-myoma, etc.) ac cording to the relative predominance in them of fibrous or muscular tis sue. They may be interstitial, sub-peritoneal, or sub-mucous, the intra uterine growths being frequently polypoid. Their most common site is the posterior wall of the corpus uteri, fibromata of the cervix being rare. Out of 74 cases of fibroid in the non-pregnant woman, Chahbazian found only 4 in the cervix, Guyon 21 out of 111, and Sims 2 out of 114 cases; out of 380 cases in which pregnancy and labor were complicated by fi broids, Chahbazian found 80 tumors in the cervix, 38 being sub-mucous polypi, 10 sub-mucous sessile growths, 29 interstitial, and 2 sub-periton eal. They usually occupied the posterior lip of the cervix, and rarely involved both.