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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    cases which have been operated by myomectomy but have escaped abortion and have come to term. Yet, in spite of all theoretical objections, the operation enjoys wide vogue. Tumors of fifteen, sixteen or seventeen pounds have been successfully removed (NetzeFs, Schorenz’s and Edgar’s cases). Many operators have reported its successful employment even where the incision reached nearly to the membranes. Surprisingly few cases are recorded where failure resulted from hemorrhage. More- over, abortion has been reported in less than one-fifth of cases: thus Turner, 17.5 per cent, aborted in forty-four cases jJiSqo-iqoo); Thumin, 22.5 per cent, aborted in 102 cases (1885-1900), and Carstens, 14.6 per cent, aborted in 150 cases, to 1908. Again, the maternal mortality is lower than that for hysterectomy in the earlier series, while in the later tables they appear about equal. This is undoubtedly due to the fact that myomectomy usually has been restricted to the most favorable cases. Yet in spite of the results shown by the tables, I believe that the field of myomectomy will be restricted with the diffusion of knowledge concerning fibroids and pregnancy, that is when it becomes generally known that the great majority of such cases can be let alone during pregnancy. The tables are as follows: Myomectomy Mortality Hysterectomy Maternal Mortality Maternal Fetal Turner to 1900, 44 cases 9% 37 cases 13-5 % Thumin, 1885-1901, 102 cases 7-8% 28.4% 89 cases II.I % Le Maire 1892-1901, 93 cases 8.7% 26.4% 67 cases 7.4 % •Unterberger to 1904, 144 7% 91 cases 10.9 % cases Carstens, to 1909, 150 cases.. 8.6% 29-1% 204 cases 9-3 % Troell, 1900-1909, IS7 cases.. 3-9% 23-9% 133 cases 3 % When operation is indicated, on the other hand, supravaginal hysterectomy appeals to me as the choice, whenever practical. With the betterment of our knowledge concerning the complications, and the consequent recognition of definite indications for operative treat- ment, the death rate should be markedly decreased. The operation, however, will always be attended with considerable risk, from the increased chance of thrombosis and embolism, possibly even beyond that indicated by Baldy in the nonpregnant condition. *The series of Unterberger is composed ofThumins series, together with cases of Olshausen, Abuladse and Unterberger. +The great maiority of the hysterectomies were supravaginal operations.