3. _Uterine pregnancy is complicated by the presence of a quiescent (sequestered) extra-uterine fœtus._ Many cases have been reported in which a fœtus of this character has occupied the pelvis, yet the woman conceived and the child was safely delivered at term; but a sequestered fœtus may constitute an impassable barrier and require removal (Operations for Compound Pregnancy, see p. 33). =Pregnancy complicated by tumours growing from the pelvic walls.= When the pelvis is occupied by a chondroma, osteoma, or a sarcoma growing from the innominate bones or the sacrum, or from the fascia of the pelvis and displacing the gravid uterus, the proper course is to perform subtotal hysterectomy. If the obstruction is not detected until the child is viable, and there is no especial call for urgency, interference should be postponed until near term; the child can then be saved by Cæsarean section, and the uterus removed. The operation in such circumstances calls for the exercise of judgment, but it is rarely difficult. Among interesting tumours complicating labour and obstructing delivery, special mention may be made of dermoids and teratomata lying in the hollow of the sacrum. Skutsch has collected the chief German records. Echinococcus cysts (hydatids) have grown in the pelvic connective tissue and obstructed labour. Cases have been reported by Knowsley Thornton, Küstner, Blacker, and others. REFERENCES BLACKER, G. F. Clinical Lecture on Uterine Fibroids complicating Pregnancy. _The Clinical Journal_, 1908, xxxi. 309. KÜSTNER. Kaiserschnitt wegen eines Echinokokkus im Becken. _Zentralbl. f. Gynäk._, 1907, xxxi. 1390. SKUTSCH, F. Ueber die Dermoidcysten des Beckenbindegewebes. _Zeitsch. f. Geburts. and Gynäk._, 1899, xl. 353. THORNTON, J. K. Removal of Hydatids of the Omentum and from the Pelvis. _Medical Times and Gazette_, 1878, ii. 565. OPERATIONS FOR PUERPERAL SEPSIS (METASTATIC BACTERIÆMIA) Acute septic infection (puerperal) of the uterus, too frequent even in this antiseptic epoch, is a desperate condition, but attempts have been made to deal with it by two methods--either hysterectomy, or the ligature and excision of the thrombosed ovarian veins. So far as hysterectomy for this condition is concerned, it may be stated that it has been tried, but with no encouraging measure of success; it is a very desperate proceeding, and has been occasionally successful by the abdominal, as well as by the vaginal route. It is possible that vaginal hysterectomy may now and then be a wise operation in acute puerperal infection, but better results have been attained by ligature of the thrombosed pelvic veins, and by drainage of the pelvic cavity. Some interesting operations, with brilliant results, have been published by Trendelenburg, Michels, Cuff, Bumm, and others.