Aside from the changes which pregnancy and parturition cause in myo mata, they may become hypertrophied, atrophied, futty degenerated, col loidal (geodes of Cruveilhier), and vascular; in consequence of the latter, (edema, congestion, infiltration, extravasation of blood, or gangrene may be consecutive to thii vascular dilatation. Each of these conditions may affect the general health and cause peritonitis, usually circumscribed, which results in the formation of adhesions between the myoma and neigh boring parts.
Myomata do not offer an insurmountable obstacle' to pregnancy, and we must study in succession the relations which these tumors bear to fe cundation, pregnancy and parturition.
1. Fecundation.—Although this is not impossible, there is a connec tion between sterility and the presence of these fibromata. While many writers believe that sterility is itself a direct cause of the development of fibroids, nearly all specialists in gynecology think fibroids cause sterility. We indorse the latter view, since it is easy to understand how the catarrh and hemorrhage due to the presence of these tumors (especially the sub mucous variety) prevent conception. The modifications in the shape, situation, and cavity of the uterus, and the altered relations between the ovary and tube, are so many mechanical obstacles to fecundation.
In addition fibroids are more common in married than in sangm women, since out of 1634 women 1192 were married and 442 single. Marion Sims found 119 cases of fibroids in 605 sterile women; among 255 women, observed by the same writer, who had had only one child, fibroids were detected in 38; among 250. who had never been pregnant, 57 had tumors; while in 100 young girls, suffering from pelvic troubles, 24 had fibromata. That the chances of fecundation are greatly lessened by the presence of fibroids will appear from the fact that among 1554 women with fibroids, observed by Winkel, Schroeder, Gusserow, and others, 476, or 1 in 3.05, were sterile. Now, on the authority of Courty, Simpson, and Spencer Wells, sterility is present in 1 marriage out of every 8 or 8.5. These tumors, indeed, really prevent the union of the male and female elements, by causing displacements of the uterus, obliterating the uterine cavity and the opening of the tubes, causing spasmodic contraction of the os in ternum, etc.; also by leading to catarrh and hemorrhage, and to cir
cumscribed peritonitis, with the disturbances consequent upon the forma tion of adhesions.
The Influence of Pregnancy on Fibromata. —As the myoma is composed of tissue identical with that of the uterus it is not at all strange that it should be modified by pregnancy; but we must distinguish between fibro mata, fibro-myomata, and inyomata, since they undergo different changes. These changes depend, moreover, upon the seat of the tumor; the more intimate its relations to the uterus, the more will it share in the physio logical phenomena which take place in that organ, and the more closely its structure approaches to that of the uterus the more profound will be these modifications. Thus, sub-peritoneal tumors undergo relatively fewer changes than the interstitial and sub-Mucous variety. Fibromata, the of which is denser and more compact, are less affected than myomata, in which muscular fibre is the predominating element. These changes are of several kinds, viz.: 1. Fibroid tumors increase in volume during pregnancy, and after de livery undergo a retrogression or involution, analogous to that of the uterus; this has been determined beyond doubt by numerous observers. The entire disappearance of a myoma is very rare, and as a rule it may be affirmed that although fibroid tumors do undergo involution, they are always a little larger than they were before the occurrence of pregnancy.
2. At the same time that they increase in size, the fibroid growths become actually softer. This softening may be due simply to the cedema which results from increase in the blood-supply, or it may be a pathologi cal process.
3. Finally, during the latter months, these tumors seem to undergo a peculiar change, that is due to true absorption of their. tissue. Depaul says that neither hypertrophy nor softening is constantly observed, and that one condition might exist independently of the other.
In many cases these tumors may become flattened, so that they can not be felt during pregnancy, and are not recognized until after delivery. This phenomenon is most often observed in pure interstitial myomata.