Fibroid tumors complicating pregnancy and labor / by Frank W. Lynch.

  • Lynch, Frank W. (Frank Worthington), 1871-1945
Date:
1913
Catalogue details

Licence: In copyright

Credit: Fibroid tumors complicating pregnancy and labor / by Frank W. Lynch. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    yet if there are many tumors, others may bulge into the cervix and still offer obstruction, in spite of the elevation of the larger growths into the pelvis. Instances of such complications have been recorded by Cullingworth, Kreutzman and Routh. In general, an early Cesarean in the most threatening cases will save many complications, especially if the tumor mass is of size sufficient to demand a Porro. I am perfectly aware that this method will prevent some spontaneous births, and consequently urge it only for the rare cases presenting tumors in advance of the head at time of labor, and for those in which the uterus is so studded with tumors that ultimate hysterec- tomy is inevitable. Such treatment enables us to avoid many of the complications of the puerperium elsewhere indicated. The frequency of infection during the puerperium in cases which have been delivered through the natural passages is indicated by the twenty-two cases collected by Berger which showed evidence of gangrene and suppura- tion, and by six similar cases of Lobenstein and three of Fry. Yet the dififculty of prognosis during pregnancy as to the outcome of actual labor is well shown by my own experience. Four times in my service and that of others have I seen cases during pregnancy which I was certain could be delivered only by Cesarean. Yet labor proceeded so rapidly in three of these that they were unable to reach the hospital before spontaneous delivery, due doubtless to the fact that the tumor became elevated above the pelvic brim subsequent to my examination. Cases presenting tumors which lie above the pelvic rim should be treated expectantly, provided there is no doubt as to the diagnosis. Dangers from uterine inertia and hemorrhage must be kept in mind, together with the chance of rupture of the uterus in case conditions change and the labor becomes blocked. Nor are such cases free from the possibility of sepsis following trauma of the tumors from labor. Early interference is advisable in cases presenting multiple growths and infectious processes during the puerperium. The literature is filled with cases illustrating the folly of waiting. As a rule hysterec- tomy is indicated as soon as the growth is known to be infected. BIBLIOGRAPHY. Allen and Corson. Histological Changes in Uterine Myomata in their Transformation into Fibroid Tumors. Univ. of Penn. Med. Bulletin^ 1906, March, 1911. Amand. Nouvelle Observations sur le Pratique des Accouche- ments. II Ed., Paris, 1715, p. 156. Baldy. Mortality in Operations upon Fibroid Tumors. Amer.
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