VOLUME 9.

Original Communications.

FIBROID TUMORS AND PREGNANCY.

BY LOUIS FRANK, M.D.,

Professor of Abdominal Surgery and Gynecology in Kentucky University, Medical Department; Consultant and Visiting Surgeon to the Louisville City Hospital, etc., etc.

LOUISVILLE, KY.

To judge from text-book literature, we would believe that pregnancy, complicated by uterine fibroids or pregnancy in fibro-myomatous uteri, was a very dangerous condition, not only to the child, but also to the mother. We should remember, however, that the opinions expressed in standard textbooks have been based largely upon the outcome of cases observed during the period of pre-antiseptic obstetrics and surgery, rather than upon present day statistics.

Again, as only the worst cases have been reported, or those in which in all probability operative measures had been carried out, and that there has remained unreported and unpublished many cases in which no trouble was met with during or subsequent to the accouchement, or in which the condition was present and probably overlooked, as is true in this as well as in other diseases, it is not difficult to understand the conclusions which were arrived at.

That the condition is entirely free from danger no one would attempt to say, but my opinion is that this danger is not nearly so great as we have been led to believe. Fortunately those uteri

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beset with fibromata which would give rise to the greatest danger and trouble during pregnancy and delivery are the ones the least apt to become the seat of the fructified ovum, and in a consideration of the dangers which may arise. during the course of pregnancy or at term, the location of the tumors, not only in their relation to the structure of the uterus (its mucosa, muscularis and peritoneum), but their relation to the fundus and body and cervix must be borne in mind. The conditions met with may require active surgical intervention, therefore these cases are of interest not only to the obstetrician, but to the general practitioner and surgeon as well.

I will not trouble you by a citation of the various localities which may be occupied by fibromatous tumors of the uterus, nor the various classifications of these growths, except to say that tumors occupying the lower portion of the uterine segment, or occupying the sub-mucous structures, are to be classified as the most dangerous. The dangers from these tumors, and the accidents which may occur, should be considered from the standpoint of the child as well as the mother. The dangers to the child are those due to premature labor, placenta previa, abnormal presentation, Cæsarian section or other operative procedure which may become necessary for its delivery. The dangers arising to the mother are from accidents which may occur, such as abortion, hemorrhage, sepsis due to sloughing of the tumor from pressure, from rupture of the uterus, or op