. The science and art of midwifery. in the puerperalstate. When interstitial myomata are developed in the cervical tissuesthey almost invariably offer a mechanical impediment to delivery, andare rarely capable of being displaced above the superior strait. If, how-ever, they have become intra vaginal and their base be not too exten-sive, they are often readily amenable to appropriate surgical interfer-ence. In default of the latter, fatal compression may be exerted uponthe fetal cranium, or the vesico-vaginal septum may be lacerated dur-ing labor0 * SpiegelberCt, Lehrbuch, p. 509. ABNORMALITIES
. The science and art of midwifery. in the puerperalstate. When interstitial myomata are developed in the cervical tissuesthey almost invariably offer a mechanical impediment to delivery, andare rarely capable of being displaced above the superior strait. If, how-ever, they have become intra vaginal and their base be not too exten-sive, they are often readily amenable to appropriate surgical interfer-ence. In default of the latter, fatal compression may be exerted uponthe fetal cranium, or the vesico-vaginal septum may be lacerated dur-ing labor0 * SpiegelberCt, Lehrbuch, p. 509. ABNORMALITIES OF THE SEXUAL ORGANS. 539 Subserous myomata are ordinarily developed in the posterior uter-ine wall. If connected with the body of the uterus and located abovethe retro-uterine reflexion of the peritonaeum, they may be spontane-ously extruded from the pelvic into the peritoneal cavity. They origi-nate, however, most frequently in the cervical tissues, and, extendingdownward, become retro-vaginal, more or less completely occupy the. Fig. -Showing myoma of lower portion of the uterus and cervix interfering with de-livery. (Dol^ris.) pelvic cavity, and offer, provided their size be at all considerable, aninsurmountable obstacle to parturition. This variety has been desig-nated as the incarcerated uterine myoma.* The prognosis is grave, afatal termination having been noted in one third of the mothers, andin more than one half of the children. Treatment.—Interstitial corporeal myomata, as a rule, do not inter-fere with the expulsion of the child. Dr. A, Kessler has reported acase which I saw with him in consultation, where, after the expulsionof a four months foetus, it was found impossible to reach the latter occupied an inaccessible position near the right cornu, far* Spiegelberg, Arch. f. Gynaek., Bd. v, 1873, p. 100. 540 THE PATHOLOGY OF LABOR. out of reach of the fingers, while the convexity of the tumor was suchas to interfere with the working of curettes
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Keywords: ., bookcentury1800, bookdecade1890, bookidsci, booksubjectobstetrics
