Trealment.—Forbid marriage and conception in every case. During pregnancy oppose the threatening abortion, and do everything to prolong the pregnancy until term. Surgical interference is limited to small ses sile or pediculated growths, situated in the inferior segment and accessible through the vagina; the latter form being removed with the ecraseur, the former excised. Induced abortion, as well as Porno's operation, should be rejected, especially before term. During labor, allow nature as large an opportunity as is possible, then reduce the size of the foetus, or try to enucleate the tumor. Tarnier prefers version, Depaul the forceps. Susserott reports 20 forceps deliveries and 20 versions out of 147 cases, 12 mothers and 7 children being saved by the former method, 8 mothers and 3 children by the latter. Out of 26 forceps deliveries, reported by Lefour, 19 mothers and 13 children were saved. The forceps seem, then, to give better results than version. But, in some cases forceps or version do not avail, and we are obliged to have recourse either to the cephalotribe or to embryotomy. Finally, as a last resort, we have Caesa rean section. Cazin noted 24 deaths in 28 operations, only 15 children being saved; hysterectomy has been performed 5 times with 5 deaths.
Chahbazian resumes, in the following table, the results of treatment of fibroids of the cervix during pregnancy and labor: 4. During the which have escaped detection during pregnancy by reason of their being flattened, often appear after de livery, inconsequence of sub-involution. Interstitial or sub-serous tumors with broad bases then become pediculated and may be palpated, but, as a rule, the tumors undergo atrophy similar to that of the uterus, so that they may even disappear entirely. Sometimes it has been observed that fibroid tumors are enucleated and expelled from the uterine cavity; in other cases the tumor has sloughed away. Hemorrhage, retained placenta and consequent septic absorption, serious nervous troubles, syncope, peri tonitis, inversion of the uterus, eclampsia, and rupture of the bladder, are among the resulting complications. Interference during convalescence depends upon the condition of the tumor, the nature of the complications, and the general state of the woman.
VII. Hera ice.
It is extremely rare for the uterus to escape by one of the natural open ings of the abdomen, such as the inguinal or crural, so as to form a true hernia. According to Schroeder, umbilical and ventral hernia' are most common. True ventral hernia of the gravid uterus is very rare; there are on record, however, a number of cases in which the uterus at an ad vanced stage of pregnancy was situated in a hernial sac, formed by the dilatation of a large cicatrix in the abdominal wall. A few cases are on record in which pregnancy advanced to term in a uterus which formed a crural or inguinal hernia. The diagnosis of hysterocole is difficult dur
ing the first half of pregnancy, when the portio vaginalis is outside of the hernial sac; at a later stage the disturbance of micturition, the dis placement of the urethra, and the movements of the foetus, help to clear up the diagnosis.
The treatment consists iu the reduction of the hernia, and, if this is unsuccessful, in the induction of abortion, and in the use of version or the forceps. But, in the majority of the known cases, the termination of the labor per vial naluraks has been impossible, and it has been neces sary to resort to Caesarean section.
VIII. Ovarian Tumors.Viii. Ovarian Tumors.
Although the possibility of conception is admissible a priori in cases in which only one ovary is affected, whatever may be the size of the tumor, it is difficult to understand how it can occur when both ovaries are dis eased, and yet the facts reported by Atlee, Spiegelberg and others, prove the possibility of conception under these conditions, and with ovarian tumors of different kinds. The following statistics of Jetter show that any vari ety of ovarian tumor may complicate pregnancy. Out of 166 cases, there were 97 ordinary cystomata, 31 dermoid cysts, 11 carcinomata and 27 un certain. In most of the cases the tumors existed for some time before the occurrence of pregnancy; the latter has taken place where one, or even both, of the ovaries was diseased, and this proves that as long as a portion (no matter how small), of the ovary remains in a healthy condition, ovu lation and conception are possible.
The Influence of Pregnancy on ovarian this influ ence is usually nil, or at least insignificant, in a number of cases the tumor undergoes marked changes. Spiegelberg affirms that tinder the influence of pregnancy, and the increased activity of the pelvic circula tion, ovarian tumors often grow with extreme rapidity. Wernich not only adopts this view, but also believes that under the influence of preg nancy, a benign growth may become malignant. Rnge explains the lat ter change by supposing that a malignant element was originally present. Doumairon has called attention to the frequency with which localized peri tonitis developes in consequence of the friction of the cyst against the ab dominal walls, the intestines, and uterus, as well as to the changes and inflammations that may take place within the cyst. He has even reported rupture of the cyst and escape of the contents into the abdominal cavity, and some rare cases in which, in consequence of inflammation, cysts have discharged spontaneously, either externally, or into one of the pelvic vis cera. Simple cysts are most frequent, and dermoid the next; the latter are most influenced by pregnancy, since, on account of their relatively smaller size, they occupy the true pelvis.