The following table, which we take from Chahbazian's monograph, shows the influence which pregnancy and labor exert in particular on fibromata of the cervix. In 39 cases:— Hypertrophy during pregnancy,7 . . .
Displacement,.
.
.
.
. .
.
.
Softening,. 10 .
.
.
.
.
. .
.
. .
.
.
.
Expulsion, . . 4 .
. .
.
.
.
Irritability, . . 3 Atrophy after labor,. • . .
.
.
.
.
The Influence of Fibrous Tumors on Pregnancy.—Lefour has found that a certain proportion of cases of extra-uterine fcetation are associated with fibroids; hence he believes that the ovum is prevented from ing the tube that has become obliterated in consequence of its being dis placed or compressed by the fibrous growth (Fig. 137). When the ovum has succeeded in reaching the uterine cavity, fibroid tumors tend to make it descend to the lower segment of the uterus; hence the relatively greater frequency of abnormal insertion of the placenta.
Thus Nauss found abnormal insertion once out of 49 cases, and Lefour once out of 23.71 cases. This frequency, indeed, is much greater than aside from fibrous growths, as is proved by the following statistics cited by Lefour.
Schwartz, . . . . . 1 in 1564 labors.
Collins, . . . . . ,, 1492 " McClintock and Hardy, . . ,, 829 " Klein, . . . . . . ., 760 " Arneth, . . . . . " 725 " Ramsbotham, . . . . g, 665 " At Wurtzbourg Maternity, . . ,, 472 " At Paris Clinic, . . . . " " Spiegelberg, . . . . " 1000 " It is a curious fact that the placenta may oe inserted not only at the inferior segment of the uterus, but even on the fibrous growth itself (Fig. 138). On the other hand, pregnancy may pursue its regular course, even in cases of multiple fibroids (Fig. 139). However, abortion and premature labor result in about once in 1.4 cases. Chahbazian found that in 114 cases of fibroid (especially of the cervix) there were 50 de liveries at term (in 10 labor was very difficult), 10 premature births and 8 abortions, 10 in which hemorrhage occurred during pregnancy, and 6 in which it took place during, or after, delivery; rupture of the uterus resulted in 5 instances, prolapsus in 5, flattening of the fcetus in 5, and retention of the same in 3.
The situation of the tumor is important. If it is outside of the true pelvis, it rises with the enlarging uterus, and only affects the progress of pregnancy in so far as it gives rise to pressure-symptoms. If a sub peritoneal fibroid with a long pedicle is situated between one side of the uterus and the corresponding pelvic wall, the pressure will be such as to diminish the chances of the pregnancy going on to term; if the tumor is situated merely between the walls of the pelvis, it ceases to press upon the uterus as soon as the latter has risen out of the pelvis (fourth month). The myoma may undergo morbid changes which exert an unfavorable influence on the general health, incompatible with the prolongation of pregnancy. Moreover, tumors in the posterior uterine wall may cause retroversion, with consequent incarceration and abortion.
If the tumor is intrauterine, it grows simultaneously with the foetus; if located between the pelvic wall and the lower two-thirds of the uterus these tumors, whether sessile or pediculated, are the most dangerous of all, as regards pregnancy, especially if they are in the posterior wall. Hemorrhage is less common than might be supposed, since it most often accompanies sub-mucous tumors which are rarely associated with preg nancy as compared with sub-peritoneal. Finally, Gusserow has shown that the tumor may, during pregnancy, compress the foetus itself, and thus may cause abortion.
Delivery in Case of Fibroid Tumors.—The location of the fibroids is of more importance than the number and size. If the tumor is situated at the cervix it may, by its size alone, become a cause of dystocia, but by enucleating it, the obstacle will usually be overcome. If the tumor is sub-mucous it is also 'proportionately. less dangerous, because it is pedic ulated, and if it is situated in the inferior segment of the uterus, it will often be expelled before the foetus, and then the pedicle will either rupture itself, or it may be divided, thus facilitating the expulsion of the child.