Lateral displacements are usually least significant in so far as disturbance to the pregnant state is concerned. If there are no adhesions the uterus usually corrects itself as pregnancy advances, and if no other complication supervenes parturi tion will follow in the natural sequence and involution will restore the organ to its normal place and relations in the pelvis. If adhesions exist or are acquired they may be pulled apart as the uterus enlarges, or their firmness may be such that they will not yield, uterine contrac tions being excited and the uterine con tents expelled, or the latter may require removal at the hands of the physician. Anterior displacement may be slight or extensive and the uterus may or may not be adherent to the bladder. If the dis placement is slight and there are no ad hesions, spontaneous correction will re sult as the uterus enlarges and no further difficulty from this source may follow.
If the displacement is extensive, the subsequent enlargement of the uterus will be asymmetrical, the function of the bladder will be encroached upon, and there will be constant irritation of that viscus, with frequent micturition, and possibly the development of an annoying cystitis. This may continue until the end of pregnancy, or the irritation may be so great that uterine contraction and abor tion will result. The danger of this mis hap is greatly increased if the uterus has become adherent to the bladder. After the uterus has been emptied the union to the bladder may persist with such an noying symptoms that a surgical opera tion may be required to effect relief.
Should the uterus be displaced poste riorly the difficulties and dangers will usually be greater than in either of the other varieties of displacement.
The uterus may be merely retroverted or it may be acutely retroflexed. If the former, and there are no adhesions, Nature may again correct the trouble and no further difficulty ensue. If adhesions are present, the enlargement of the uterus will almrst certainly produce such irritation that contractions and abortion will follow.
In 24,000 pregnant women Martin found 121 cases of retroversion and re troflexion, and in 94 cases retroversion persisted after repeated pregnancies. A Mantle (Quart. Med. RIM' July, '97).
Pregnancy probably occurs more often in eases of retroversion than is com monly supposed. Reposition can gener ally be effected. If unsuccessful, emli otomy is a better course than produc tion of abortion, as it is practically without risk to the mother, and in most eases saves the foetus. Eleven cases
dealt with in this way: in 10 the pa tient's pregnancy went on to term; in only 1 abortion took place, four days after operation. (Jonr. d'Ac couchements. Apr. TO, '98).
In eases of incarcerated retroversion of the gravid uterus, when all attempts at replacement per raginant have failed, instead of inducing labor abdominal sec tion should be performed and the fundus pulled up by the hand introduced be hind it. if the uterus completely fills the pelvis, attempts at replacement from below must fail. M. D. Mann (Amer. Jour. Obstet., July, '98).
Partial retroflexions of the gravid uterus are generally due to an incarcer ated retroflexion which has remained un reduced, the enlargement of the uterus into the abdominal cavity having taken place chiefly at the expense of the an terior wall of the organ. A similar bulg ing of the posterior wall may result from perimetritic adhesions, or from its being kept down by tumors or by a con tracted pelvis. The prognosis in the ex treme degree of retroflexion is very bad. Diihrssen (Archly f. Gyn.. B. 57, S. 70, '99).
Case of pregnant uterus resting, in the position of laterotlexion which was mis taken for an ovarian cyst. Notwith standing laparotomy the pregnancy con tinued to term and the patient was de livered of a living child weighing 3500 grammes. Lateroflexion of the pregnant uterus may he confounded with ectopic pregnancy. ovarian cyst, or salpingitis. Coneordanee with Mauricean in the im portance of making the diagnosis as early as possible in order that the dis placement may be corrected. The ex pectant plan may be adopted or, if the flexion is so strong and irreducible as to be incompatible with the normal evolu tion of the pregnancy, an exploratory incision should be performed and the uterus freed. II. Vander (Anales de Gynde. et d'Obstet., Feb., 1901).
Case of right-sided lateroflexion of the pregnant uterus which was mistaken for an extra-uterine pregnancy. Laparot umy was performed; the uterus was replaced, but abortion followed. The patient made an uninterrupted recovery otherwise. lloutier (Annales de Gynee. et d'Obstet.. Feb., 1901).
When the uterus is acutely retroflexed it is possible that the displacement may be remedied as it enlarges, but one must not depend too much upon the unaided effort of Nature. It will be far better to place the patient in the knee-elbow posi tion, restore the organ to its normal posi tion with the fingers, and then secure it with a tampon or a suitable pessary.