Many cases are susceptible of relief by such means which would otherwise ter minate in abortion. If the uterus is re troflexed and also fixed by adhesions, re lief may be obtained by the judicious use of the tampon or pessary, or the adhe sions may be liberated as the organ en larges; but in the majority of cases an abortion will be the result. With this displacement there are usually various annoying complications: the rectum is irritable from the constant pressure upon it and a troublesome diarrhoea or an equally troublesome constipation may ensue. Relief will come only when the cause has been removed. The bladder may also give trouble, owing to the con stant traction at its neck, and the patient will be distressed with constant desire to .• micturate, each effort being followed by tenesmus. All things considered, uterine displacements bring about as much dis comfort as any of the disorders to which the pregnant woman is subject.
In retrodisplacements the pregnant uterus spontaneous cure will be limited by four factors: adhesions, the sae:al angle, the chamcter of the displacement, and the degree of the displacement. If displacement be not corrected by Nature or art, sometimes pregnancy goes on to full term, the uterus becoming saccu lated; much more frequently abortion takes place.
These retroflexed uteri have natu rally much difficulty in expelling their contents. Challeix has reported 3 cases of extreme flexion in which the foetus was retained S, 5, and 1 month, respect ively, after its death. If abortion does not take place grave results are gener ally not long delayed. Gottschalk has collected 67 deaths from this cause, and 10 more personally found, making a total of 77. Of these 13 were from rupture of the bladder, IS from ura;uia, and most of the others from sepsis, its origin being practically always in the bladder. Malcolm Storer (Boston Med. and Surg. Jour., Mar. 9, '99).
Embolism and Thrombosis.
Enlargement of the veins during preg nancy is not an unusual occurrence. The veins of the lower extremities and the vulva are most frequently implicated. The condition is less common in pri miparam than in multiparm. If the blood tension is weak the formation of thrombi is favored. Portions of these thrombi may be detached as emboli and, passing onward, may find their way into the arte rial circulation, especially into the arter ies of the lungs and brain. When ar rested in these vessels the most violent symptoms may ensue: pain, dyspncea, effusion, even death. Such accidents, however, are more frequently the se quences of labor, especially when the thrombi are formed within the uterus at the site of the placenta. Pregnant
women who suffer with varicose veins should always be cautioned against vio lent exertions or anything which would tend to the formation of thrombi, or to their disintegration when formed. The treatment in such cases must necessarily be expectant and stimulating, the patient being kept in bed most of the time upon fluid diet. If it is necessary or desirable that she should be up and around, the feet and legs should be bandaged, but not too firmly.
Ectopic Gestation.
This terrible complication rarely ex ists as an accompaniment of uterine ges tation, though such cases are not un known. It will be considered at this time only or mainly as a complication of pregnancy, and not with that detailed statement which would be required in connection with the unimpregnated uterus.
Case of extra-uterine pregnancy asso ciated with an intra-uterine gestation operated upon by abdominal section, with recovery. Review of literature of 2S cases of combined extra-uterine and intra-uterine pregnancy, 21 of which the writer has been able to confirm. Thir teen of the patients were advanced in pregnancy, and these showed a mortality by all methods of treatment of nearly 54 per cent. There is but little doubt that labor should, in such eases, be al lowed to be completed, and that then the extra-uterine sac should be treated by la parotomy. Phillips (Lancet, Oct.
1902).
The ectopic-gestation sac usually ruptures from the sixth to the tenth week of its history and it would be al most an impossibility for ectopic gesta tion to occur after utero-gestation had been established. If, therefore, the two conditions co-exist, the former will usu ally begin coincidently with the latter or a short time—a few weeks—previously. Utero-gestation usually causes the abey ance of menstruation, but when it co exists with ectopic gestation one of the first symptoms indicative of the situation will be haemorrhage. This may appear at the customary time for menstruation, thus misleading the patient with regard to her condition, or it may appear a few days or weeks subsequently. But it will differ from the customary menstrual flow by its continuance after the usual dura tion, and also by its greater abundance. This fact may serve to warn the patient that her condition is not that which at tends ordinary menstruation. The bleed ing may or may not be attended by the discharge of shreds of decidua, this being by no means a constant symptom.