Another class of cases is that in which the uterus is defective from growths within its structure, especially fibroid growths. Whether these are located within the muscular structure, upon the peritoneum, or within the uterine canal, they are always a menace to pregnancy, and frequently are an efficient cause in producing its premature termination. While the disorders which attend this class of cases consist principally in dis turbance which affects chiefly the uterus itself and its immediate surroundings, it not infrequently happens that sys temic infection is added, and the final result may be a disastrous one for the patient.
The impaction of the uterus with fibroids secondary to conception is not only responsible for pain,—and in a cer tain proportion of cases to retention of urine from direct pressure on the ure thra,—but it probably accounts for the frequency with which abortion occurs under these conditions, and it is inter esting to observe how even a relatively small fibroid will impede the ascension of the uterus as it enlarges during preg nancy and give rise to much trouble. The tumor may likewise obstruct deliv ery when the pregnancy grows to full term. Septic endometritis is rendered more serious when the infected uterus contains fibroids. Necrosis and conse quent gangrene of the fibroid arises usu ally from injury, and may even result from the efforts of the uterus itself to expel the pedunculated tumor. It does not necessarily follow that in every parturient woman with a fibroid the tumor becomes septic. In cases compli cated by tumor which have reached term, if the growth cannot be pushed out of the pelvis, Cmiesarcan section should he performed. Bland-Sutton (Lancet, Feb. 16, 1901).
The form of surgical interference, al ways indicated when any surgical pro cedure is warranted at all, is myomec tomy. Statistics before 1S90 are of little value. Between 1390 and 1900 the re ported cases of myomectomy in preg nancy amount to 44, the maternal mor tality being 9 per cent.; the foetal, 21 per cent. Since January 1, I900, to April, 1901, 5 cases of myomectomy in pregnancy have been reported (Doleris, Lewis, Muir Evans, Gemmel, and Eni met's present case). In 3 delivery oc curred at term. Green (Jour. Amer. Med. Assoc., Mar. 16, 1901).
(b) Local disease in any organ, or any disease which seriously modifies the gen eral condition. Aside from disease in the uterus itself antedating pregnancy, there may be disease in the tubes or ovaries or both which may give rise to much trouble. Simple inflammatory conditions of these organs or infectious disease, acute or subacute, may excite much discomfort and perhaps lead to serious results.
Disease of the liver, kidneys, heart, or lungs may antedate pregnancy and may suffer exacerbation as pregnancy ad vances.
The disturbance may be sufficient to provoke abortion or the patient may go to term in spite of the concurrent ease. Death during parturition is not uncommon with those who suffer with such disease. In other cases the patients recover a moderate degree of health after a prolonged and severe puerperium.
Twenty cases of pregnancy compli cated by cardiac disease noted and fol lowing conclusions reached: Women with heart disease conceive as often and as easily as healthy women, but gesta tion is more apt to end in abortion Pregnancy generally aggravates the car diac trouble, either temporarily or per manently, and under certain circum stances is attended with great danger The causes which may determine death are pulmonary oedema and syncope by arrest of the heart's action, sometimes immediately after labor and sometimes several weeks later. The physician should, therefore, oppose the marriage of women suffering from heart disease, and advise abstinence in those already married. When serious cardiac symp toms arise in the course of gestation, which cannot be controlled by ordinary measures, the pregnancy should be ar rested by artificial means. This indica tion is especially urgent when there is dyspncea, (edema, or weakness of the heart. The results of induced abortion in such eases are more satisfactory than formerly. Chloroform may be used if the degree of prostration is not too pro nounced. These conclusions are also ap plicable to cases of pulmonary tubercu losis, which is always aggravated by pregnancy. Leyden (Zeit. f. klin. Med., Nos. 1 and 2, '93).
Early stages of valvular disease do not seriously complicate pregnancy, which, on the other hand, does not aggravate the heart affection. Twenty-nine cases showed mitral incompetence in 6 cases, mitral obstruction, 11; mitral incompe tence with obstruction, 7; aortic incom petence, 1; complex (aortic and mitral} lesions in 3. Out of 29 eases of preg nancy involved, no further mischief in 18_ In 2 patients influenza occurred, yet both were delivered at term. One pa tient had symptoms of melancholia and was delivered prematurely. In 4 there was marked oedema of the legs. Nearly all the 29 had varicose veins. In only 4 was the complication serious, yet all recovered. In only 8 of the whole 29 cases was labor premature; 2 of the were twin pregnancies. Vinay (Cen tralb. f. Chir., Nov., '93).