The Ethics of Medical Homicide and MutilationO'Malley, Austin
Religion
The Ethics of Medical Homicide and Mutilation
O'Malley, Austin
Medical ethics
Ovarian tumors in pregnancy are, as has been said, rarer than
myomata. Such tumors are mostly cysts and dermoids. In 862 cases
collected by MacKerron, 68 per cent. were cysts, 23 per cent.
dermoids, 5 per cent. malignant tumors, and a few were myomata. Cysts
and dermoids do not, like the myomata, grow bigger during pregnancy,
but they may hinder delivery or grow gangrenous and septic. When
treated early the mortality in pregnancy is from 2.1 to 5.9 per cent
for the women, but delay gives a maternal mortality of from 31 to 39
per cent. The fetal mortality in Heiberg's statistics of 271 cases
was 66 per cent.
Most obstetricians advise the removal of an ovarian tumor in
pregnancy as soon as diagnosed, provided it is of a size to cause
difficulty in parturition, but such a removal causes abortion in
over 20 per cent. of the cases. The expectant treatment causes
abortion in about 17 per cent. If the child is viable, Fehling,
Martin, Norris, and De Lee are in favor of the expectant treatment.
Late operators leave weak scars at labor. When there are symptoms
of torsion of the pedicle of the tumor, infection, incarceration
in the pelvis, involvement of the uterine broad ligament, or
overdistention of the belly, the tumor must be removed immediately.
Whether vaginal puncture or laparotomy is the better method is to be
decided particularly. Dermoid cysts are likely to bring on sepsis
if they are broken in enucleation, and the diagnosis and operation
must be carefully made. When it is necessary to save the life of the
woman to remove an ovarian tumor, the risk of abortion may be taken
permissively.
Cancers of the cervix uteri are always malignant and cause death if
they are not removed before they have gone on to metastasis. As this
tumor commonly appears after the child-bearing age, it is rare in
pregnancy; the ordinary ratio is one in 2000 deliveries, but De Lee
saw only one in Chicago in 16,000 consecutive labors. Abortion occurs
in from 30 to 40 per cent. of the cases. Spontaneous rupture of the
uterus may happen, and placenta praevia is frequent relatively.
Pregnancy hastens the growth and spread of cancer very much. Eight
per cent. of the women die undelivered, and 43 per cent. die during
labor or immediately afterward. Of all uterine cancers, 80 per cent.
are cervical.
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