Licence: In copyright
Credit: Pregnancy, labour and child-bed with ovarian tumour / by R.G. McKerron. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![should be performed immediately, or within a few hours, after delivery. (3) Where the tumour has been subjected to con- siderable pressure before reposition, and is believed to be a dermoid, its removal should be effected at the end of the first week of the puerperium. (4) Where reposition has been successful early in labour, or where puncture reveals the tumour to be a simple cyst, expectant treatment should be adopted, but the supervention of severe inflammatory symptoms should at once be followed by laparotomy. These recommendations were made from a study of pelvic cases only. A more extended survey, whiclr includes the puerperal history of a very large number of cases, convinces me that the rule which in ordinary circumstances applies to ovarian tumours, namely, to remove them as soon as possible, should apply with equal, if not with even greater, force to those which complicate the puer])erium. The following considerations will, I think, confirm this view ; (1) Under an expectant treatment acute symptoms are to be anticipated in 1 out of every 2 cases. (2) Where operation has to be undertaken in the presence of some complication of the tumour its dangers are admittedly much increased. (3) There is no proof that operations in the puerperium are attended with any additional risk, provided the confinement has been conducted with strict aseptic precautions; but, even granting a somewhat increased risk, the danger is less than that which delay, with the possibility of complica- tions, would involve. The whole evidence at our disposal points to the truth of these propositions, and, if they are admitted, it is the duty of teachers to lay down as a definite rule that, when an ovarian tumour is discovered towards the end of labour or during the puerperium, it should be removed without unnecessary delay. Extirpation is the best safeguard against possible complications. In connection with those cases in which the tumour is first detected during labour the question naturally arises as to what.](https://iiif.wellcomecollection.org/image/b21964476_0258.jp2/full/800%2C/0/default.jpg)
