The field of myomectomy is at present a limited one. Single subperitoneal and interstitial fibroid tumors are rare. Even though the secondary nodules may be small at the time of operation, they will grow after the removal of the chief mass. Hysterectomy has been required at a second operation in a woman on whom myomectomy had been first performed. The operation is still on trial: its limitations and remote results have not yet been determined. It should be performed only by the experienced abdominal surgeon. Many fatal cases of post-operative hemorrhage and of sepsis have occurred. Though successful cases have been reported by men of unusual skill and experience, in which large numbers of uterine fibroids have been removed from the uterus at one operation, yet these cases must be looked upon as rare surgical triumphs which it is to be hoped will become more frequent in the future. On the ground of safety, hysterectomy is to be preferred to myomectomy. The details of the operation of myomectomy are described in a subsequent chapter. When the fibroid tumor is complicated by pregnancy it may be necessary to perform Cesarean section, followed by hysterectomy. This is not justifiable, however, unless the fibroid is so situated that the passage of the child by the natural way is impossible. The fibroid usually increases more rapidly in size during pregnancy, but may diminish a good deal with the involution of the uterus. [Illustration: FIG. 134.--Fibroid polyp producing partial inversion of the uterus.]