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.

    19/28 (page 17)
    recent series. Thus, in spite of the complications elsewhere enu- merated in the series of Lobenstein, reported in 1911, eighty-five cases came to term, and absolutely spontaneous labor ensued in three-quarters of them, a percentage which is increased to eighty- seven if we include deliveries made with low and mid-forceps. The entire series, including eight cases operated during four weeks post- partum, gave a mortality of but 4 per cent. The fetal mortality o the eighty-five cases at or near term is comprised only of six cases, all dead on admission. Pinard’s series, 1895-1901, shows equal results. Intervention was necessary during pregnancy in four of his eighty-five cases, and during labor in twenty-four cases. Spon- taneous delivery ensued in fifty-four cases. The maternal mortality was 3.6 per cent, for the series; and sixty-five children lived, the other nineteen being less than 2500 grams in weight. Spontaneous delivery ensued in 64 per cent, of Pinard’s series of 1901-1904, and in 68 per cent, of Troell’s series. With statistics like these in the literature it seems necessary to require indications for operations during pregnancy. Yet complications may arise demanding operative treatment dur- ing pregnancy. For the most part these arc due to pressure, hemorrhage or degenerathjns. When the symptoins arise from impaction, effort should be made to elevate the growth, under anes- thesia if necessary. When all simple treatment has failed and oper- ation becomes necessary, what operation is demanded? Myo- mectomy or hysterectomy? Much depends upon the surgeon and the conditions within the abdomen. Myomectomy appears to iiiajiy as a surgical curiosity with a rather narrow field. It is most difficult to [)erform successfully in the class of cases in which interference is most frequently demanded (pelvic impaction). It is best adapted for pedunculated growths, yet these seldom demand operation, save for pain. It caii be best performed in the earlier months before the trcincndous iiicrcase in the vascularity of the uterus. Yet interference is seldom demanded until the later months of pregnancy. Moreover, adhesions seem to be a necessary accompaniment of any conservative opera- tion requiring the placing of sutures in a vascular pelvis. Infec- tion furthermore is frequent in this class of cases, and the wound is likely to burst open if labor ensues shortly after operation. Nor are all tumors usually removed during myomectomy. Small growths which have escaped removal may later hypertrophy and occasion symptoms by reason of their presence. Finally the reis the ever- present possibility that the scar may rupture during labor in the