The course of large hematomata is often lightning-like, the large tumor frequently bursting when the fetal head has only reached the centre of the pelvic cavity, and death following rapidly. (Cases of Stoudel, Riecke, Carus, and others). At the autopsy the cavities which had con tained the blood were from l to two inches broad.
As a rule the hematoma only invades one labium. Sedillot and Beau delocque have, however, seen one or more hematomata in both labia.
Recurrence of these tumors is exceptional. One physician alone has recorded an instance of recurrence in the next succeeding pregnancy.
The first symptom of hematoma is a transient sensation of pain. Then comes the feeling of traction and pressure from the blood in the cellular tissue, and concomitantly the violet-colored tumor appears in the labia. Many women complain of frequent desire to micturate. When the hematoma is large, fluctuation is to be detected. Further symptoms either point to hemorrhage or else to inflammation, as, for instance, either a weak small pulse, great restlessness, or fever, intense localized pain, and retention of urine. The sensation of pressure in one limb depends on distension of the artery higher up. Owing to the great stretching of the skin gangrene readily sets in at some point with inflammatory symptoms, and occasionally in the presence of most acute septicemia the purulent contents are evacuated.
In case during labor the tumor is so large or extends so much into the vagina as to lead to fear of rupture during delivery, it is questionable if it be not good practice to incise the mass and suture the bleeding vessels. It may be that the position of the head is such that much hemorrhage is not possible, in which event, of course, interference is not called for.
The prognosis of intra-partum hematoma vulva; is serious. From an old compilation of Deneux it appears that out of sixty women so affected twenty-two died, and in every instance where death occurred before the completion of delivery the child could not be saved. Hematomata outside the puerperal state are never so large nor so serious.
As for the treatment we simply refer here again to the value as a pro phylactic measure of the T-bandage. The nurse must be instructed to send at once for the physician in case a hematoma forms during labor. If she waits till the hematoma bursts, then, as has often happened, the physician may only reach the patient after her death. To cause absorp tion of the tumor by means of compresses, etc., during labor is of course out of the question. Large hematomata in this situation are liable to worse accidents than simple rupture, such as purulent degeneration. After incision the hemorrhage may be checked by sutures and ligatures.
In case one labium is distended by the hematoma, then, after careful dis infection of the skin and shaving of the pubes, it may be incised at its lowest part. In case the swelling extends further up, however, then the crease between the greater and lesser labia is distended, and this is where the incision should be made and the cavity evacuated.
To prevent the forming of pus and to hinder great extension, cold compresses or ice bladders may be laid over the tumor. In view of the disastrous results of procrastination, that treatment should be instituted for all hematomata larger than a lien's egg which consists in free incision and ligature of the vessels. Why, indeed, should we wait until the blood has distended the cellular tissue? By waiting so long, the blood has already degenerated, and then incision, etc., is far more dangerous. Smaller hematomata are quickly absorbed and project so little that surgical interference is not necessary That careful antisepsis is called for, we rigidly insist. The expectant treatment has the further disadvantage of requiring protracted stay in bed. condylomata should be spoken of in tion with venereal diseases. We must refer to them here, however, because under certain conditions, namely neglect, they may develop into tumors of considerable size, which may be mistaken for other forms. These condylomata are in appearance best compared to blackberries or to mulberries. They vary in size from a pea to a bean. Some are broad, spreading and pointed; others are conglomerate and cover the free edge of the nymplue from above below. The edge of the labia minors becomes one to two finger-breadths in thickness and bleeds readily. The growth of condylomata is always dependent on some irritant. The most common cause is a profuse leucorrhea, the virulent blennorrhagia, to which latterly the erroneous term gonorrhea has been applied. In certain cases the slight inflammations, the result of degeneration of the smegma, may un questionably cause the formation of condylomata, but they may also result from non-infectious balanitis or vulvitis. During pregnancy dis charges are very common, and therefore there exists a tendency to the for mation of these growths. The so-called vaginitis granulosa, the papillary hypertrophy of the vagina, are deemed to be dependent on a specific leucorrhea, and in pregnant women both these conditions are often found. By pulling apart the papillae genuine condylomata are found. It is likely then that both conditions have a similar origin. Histologically these condylomata are papillary tumors, and more than once it has been claimed that they should be called papillae.