Six personal cases of fibroids compli cating pregnancy, and not one resulted in serious complications. All the mothers lived, and five of the children. Therefore, with few exceptions, myoma tous tumors of the uterus had better be let alone until the commencement of labor. Julius Rosenberg (Med. Rec., Mar. 7, '96).
One hundred and sixty-six cases of carcinoma of the pregnant uterus col lected since 1886. Conclusions as to best methods of treatment are: In cases of early pregnancy, when the disease has not yet extended beyond the cervix, vaginal hysterectomy should be per formed at once; but if pregnancy is too far advanced to permit of extirpation by vaginal route, it is better to perform Freund's operation. Statistics show that vaginal hysterectomy, when performed in the early weeks of puerperium, does not appear to be attended with any ad ditional risks. At full term Caesarean section followed by total extirpation is the ideal operation if the foetus cannot be born through the natural passages; but if there is any extension of growth into the parametric tissue, the Caesarean section alone should be done. G. H. Noble (Amer. Jour. of Obstet., June, '96).
Case in which a triplet pregnancy was complicated by the presence of multiple fibroids of the uterus. The patient was a primipara, aged 36, and pregnant about three months. The abdomen, however, was as large as at full term, and was rapidly increasing, and the woman's condition was precarious, so it was decided to open the abdomen. Uterus was found to be studded all over with interstitial and subserous myomata, and it was only after the whole mass had been removed by hysterectomy, and the uterine cavity laid open, that it was discovered that inside it were three foetuses in two bags of membranes. Age was three months. Patient made a good recovery. W. Jepson (Amer. Gymec. and Obstet. Jour., Aug., '97).
Hysterectomy in fibroid uteri in preg nant patients is demanded for four in dications: (1) when, independently of pregnancy, the fibroid tumor would make hysterectomy justifiable; (2) when the fibroid occupies such a position that labor would be impossible; (3) when the tumor is degenerating or sup purating, and when a retained placenta complicates the case; (4) hysterectomy should be performed in a case of labor complicated by fibroid tumor of the uterus after the child has been extracted by Cmsarean section. Keiffer (Gaz. Hebdom., No. 34, '97).
1. Solid neoplasms of the ovary com plicating pregnancy are exceedingly rare.
2. The diagnosis may be difficult. In certain eases it may be aided by recto abdominal palpation under narcosis, using Kelly's method to gently produce artificial descensus of the uterus. The physical examination with the signs of pregnancy, and those which belong more particularly to solid ovarian growths, generally enable us to make a probable diagnosis and one sufficient to warrant an exploratory section.
3. The prognosis in ease of solid growths of the ovary complicating preg nancy is much worse, both for the mother and child, than in those of cystic neoplasms of these organs. Abdominal section and extirpation of solid tumors during the early months of pregnancy produce equally good results, so far as the foetus is concerned, as in ease of cysts. The result to the mother depends on the malignant or benignant nature of the growth.
4. In extirpation during the second and fourth months of gestation the maternal mortality is but 5 per cent., due to hmmorrhage, shock, sepsis, etc., whereas the foetal mortality due to abor tion is only 20 to 22 per cent., as com pared with 40 per cent. for the former, and SO per cent. for the latter, when those cases are left to unaided. Nature.
5. The compulsory operation (during the latter part of gestation, during labor, or the puerperium) will rarely be re quired. Swan (Bull. Johns Hopkins Hosp., Mar., 'OS).
History of 6 eases in which uterine fibroids complicated pregnancy. In a general way, the rule may be established that, where the lower third of the uterus and the entire cervix are free from any neoplasm, the physician may safely await the result of the pregnancy, even if the fibroid is of considerable size. Ford (Med. News, Mar. 31, 1900).
Ovarian tumors which prevent the descent of the child may be punctured per ragintpin and removed later, but if they are small they may be pushed up out of the way by baying the patient in the Trendelenburg position. Fibroid tumors at or near the fundus seldom cause trouble at time of delivery, but they prevent the rapid contraction of the uterus, and unusual precautions must be taken against hmmorrhage. In the early months of pregnancy, if the location of the fibroid is such as to presuppose diffi culty in the birth of the child, abortion should be performed, or, if this is impos sible, hysterectomy. Otherwise it means a Cmsarean section, or a hysterectomy at term, with all their attendant dangers. G. W. Jarman (Annals of Gyncee. and PEed., July, 1900).