THORNTON, K. A case of removal of both Ovaries during Pregnancy. _Trans. Obstet. Soc._, London, xxviii. 41. =Ovariotomy during labour.= When an ovarian tumour is discovered during labour and it impedes delivery, ovariotomy should be performed. In this condition it follows that the tumour lies in the pelvis; when the tumour is tightly impacted by the contracting uterus it has happened that the surgeon has been unable to reach the tumour until he has emptied the uterus by Cæsarean section. Several operators have had this difficulty, myself among them. I have added a list of reported cases drawn from British sources. For this I hope not to be accused of what is sometimes perhaps facetiously called ‘insularity’. The enormous population of these islands should furnish material enough to settle the principles of treatment which should govern these terrible cases of obstructed labour. One of the commonest conditions met with in ovariotomy during pregnancy and labour is to find that the cyst has undergone axial rotation and twisted its pedicle. The technique in these circumstances is very simple. OVARIOTOMY FOR TUMOURS OBSTRUCTING LABOUR AT TERM -----------+--------+--------+---------+------------------------------ |_Nature |_Result |_Fate | _Operator._| of | to | of | _Reference._ |Tumour._|Mother._| Child._ | -----------+--------+--------+---------+------------------------------ Williams |Cyst | R. |No record|_Trans. Obstet. Soc._, xxvi. | | | | 203. Spencer |Dermoid | R. | Lived |Ibid., xl. 14. Boxall[1] |Dermoid | R. | Lived |Ibid., xl. 25. Bland- |Dermoid | R. | Lived |_Lancet_, 1901, i. 382. Sutton[1]| | | | Sinclair[1]|Cyst | R. | Lived |_Lancet_, 1901, i. 158. Favell[1] |Dermoid | R. |No record|_Brit. Med. Journal_, 1901, i. | | | | 894. -----------+--------+--------+---------+------------------------------ [1] In these cases it was necessary to perform Cæsarean section in order to extract the tumour from the pelvis. [Illustration: FIG. 22. A UTERUS DISTORTED BY FIBROIDS. It contains a fœtus of four months’ development. Removed by the subtotal operation from a primigravida, aged 42. Half size.]