The veins of the vulva and legs furnish the most vivid illustrations of these ob structive conditions. They are frequently enlarged to an enormous size, and their rupture, especially those of the vulva, during parturition may be attended with the most serious consequences.
(c) Pressure upon the uterus by a new growth which has developed coin cidently with pregnancy. This compli cation is, of course, an unusual one. Pregnancy may incite abnormal activity in growths which were previously quies cent or not troublesome, or the first in timation of their presence may come with the obstruction which they cause during pregnancy. Ovarian cysts and fibroid tumors of the uterus furnish familiar ex amples of this form of obstruction. Less frequently seen are bony tumors of the pelvis, malignant growths of the pelvis and abdomen, and ascitic accumulations, with tuberculosis and with disease of the liver, spleen, and kidneys.
Scarcely one-fifth of all cases compli cated by fibroids terminate without surgical interference, and about one-third of the mothers and one-half of the chil dren die during or soon after delivery in consequence of the morbid growths. Operations during early pregnancy give better results than those undertaken later, and enucleation per vaginant should be elected when possible. Sutu gin (wretch, Jan., '91).
From one hundred and thirty-five cases, in literature, of ovariotomy performed during pregnancy following conclusions are drawn: (1) complication of pregnancy with ovarian tumor is to be considered a very grave occurrence, in which, with few exceptions, extirpation of the tumor comes into question; (2) the further pregnancy progresses, the more danger ous is the situation; (3) the puncture of ovarian cysts and the production of abortion are to be considered only in an emergency; (4) ovariotomy gives the best results for the mother in the sec ond, third, and fourth months of preg nancy, for the product of conception in the third and fourth; (5) if an early ovariotomy is not possible for various reasons, it is to be carried out in the later months of pregnancy, as good re sults can be even then expected. D. Sirne (Archly f. Gyn., B. 24, H. 3, '92).
It is but seldom, notwithstanding their great frequency among child-bearing women, that fibroid tumors give rise to any inconvenience during pregnancy, and very rarely do they require surgical in terference. Halliday C'room (Edinburgh Med. Jour., Oct., '92).
Ovariotomy strongly advocated dur ing pregnancy. In 150 ovariotomies personally performed, 5 were done dur ing pregnancy and 11 very soon after the puerperium. Of the 5 pregnant cases, 1 died of shock; but suppurative peri tonitis following suppuration of the cyst and tension of the pedicle had set in before operation. In the other 4 little or no difficulty was encountered.
Out of the 11 cases of ovariotomy shortly after delivery, 2 died, in both cases from acute suppuration of the cyst. In all the 11 there were dangerous or troublesome complications. In all 150 cases suppuration of the cyst was only seen in 16. In half of these cases the complication was due to childbirth. Hence, ovariotomy in pregnancy is less dangerous than expectant treatment and operation deferred till after delivery. The operation should be performed di rectly the tumor is diagnosed, preferably in the course of the first five months. Mangiagalli (Berliner kiln. Woch., May 21, '94).
Following conclusions reached regard ing treatment of cancer of gravid uterus: 1. During the first three months vaginal hysterectomy is the operation of choice.
2. When the foetus is viable (seven and one-half months) the Caesarean operation, immediately followed by total extirpa tion of the uterus and appendages, meets all the requirements. 3. Between four months and seven and one-half months, total abdominal hysterectomy should be practiced without delay. Hernandez (Annales de Gynec. et d'Obstet., Aug., '94).
In ovarian tumors complicating preg nancy statistics show that pregnancy is interrupted in about one-third of the cases operated on, and therefore in the interest of the child it is better to wait as long as possible; nevertheless the tumors should be removed as soon as may be in case of pregnancy, especially if adherent. Staube (Monats. f. Geburts. u. Gyn., Oct. 4, '95).