A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Science
A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Medicine -- Practice
The prognosis when complicated with pregnancy is of course more grave,
but experience has demonstrated the practicability of complete and
normal gestation. Conception will not often occur where these growths
have attained any great size, but may sometimes. Of the nine cases
which I have met and had an opportunity to follow, not one has been
attended with abortion or premature labor. In one the pregnancy seems
to have been protracted at least four weeks. The foetus was in a state
of decomposition, and had probably been dead four or five weeks before
labor began. What is not less remarkable also is that labor did not
seem to be seriously affected in but one case, and in that the
difficulty was easily overcome by turning.
Until lately there were several supposititious sources of danger at the
time of confinement--viz. inefficient uterine contractions, and
consequent tedious or impracticable labor, and after expulsion or
artificial removal of the foetus dangerous hemorrhages from the same
cause; also, the possibility of the placental connection being made at
the site of the tumor, with the imperfect closure of the sinuses that
was supposed to follow.
Reports of cases occurring within the last few years, while they have
not completely swept away the grounds for such apprehensions, prove
that the accidents so greatly feared do not in fact occur. Chadwick
reports a case where the placenta was attached to the mucous membrane
over the tumor, yet the placenta was spontaneously expelled and there
was no considerable hemorrhage. The efficiency of the expulsive efforts
were not materially affected in any of the cases I have attended. And
this is what we might expect, because conception and gestation would
not be perfect where there is not a sufficiency of healthy mucous
membrane, upon which a normal decidua could be formed, and of fibrous
structure to permit the hypertrophy of gestation.
The apprehension of obstruction from the tumor lying in such a position
as to intercept the expulsion of the foetus is not often realized; for
those in the cervix, either pendulous or otherwise, are pressed out of
the external parts in advance of the head, while those in the body and
fundus are lifted up into the abdominal cavity, where there is plenty
of room. It must indeed be rare that the tumor becomes impacted in the
pelvis so as to interfere with the passage of the foetus.
Neither does the puerperal condition seem to be rendered materially
more dangerous in consequence of the presence of these tumors.
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