A textbook of obstetrics . the tumor grows on the anterior wall of the uterus, the firstfew labor-pains and the contraction of the fibers ofthe cervix may dislodge it above the pelvic brim, though it hadbeen impossible to do this before by manipulation. The authorhas seen one such case. It is also possible for tumors on theanterior wall of the cervix to be pushed out of the vulva in front ANOMALIES IX THE FORCES OF LABOR. of the presenting part, thus making room for the escape of thelatter. If, however, the tumor is situated laterally or posteriorly, its artificial displ
A textbook of obstetrics . the tumor grows on the anterior wall of the uterus, the firstfew labor-pains and the contraction of the fibers ofthe cervix may dislodge it above the pelvic brim, though it hadbeen impossible to do this before by manipulation. The authorhas seen one such case. It is also possible for tumors on theanterior wall of the cervix to be pushed out of the vulva in front ANOMALIES IX THE FORCES OF LABOR. of the presenting part, thus making room for the escape of thelatter. If, however, the tumor is situated laterally or posteriorly, its artificial displacement upward into the abdominal cavity, sothat the child may escape past it, is often impracticable (). On the contrary, the attempt at descent of the presentingpart in labor must fix it more firmly in the pelvic Inthis case, if attempts under anesthesia to dislodge the tumor andto push it above the pelvic brim fail, a Porro-Cesarean operationshould be performed, even though the tumor is not of so great a. Fig. 366.—Large fibroid blocking the pelvis (Spiegelberg). size as absolutely to prevent the delivery of the child. Thephysician must consider the effect upon it, owing to its lowvitality, of the pressure to which it will be subjected by draggingthe child past it ( Fig. 367 ).fection are likely to follow Sloughin gangrene, and fatal in- This was the historv of the case 1 It is barely possible that a tumor low down on the posterior wall of the cervix,the most unfavorable of all positions, may be suddenly elevated alter many hour- oflabor, and thus allow a spontaneous delivery ; but this event is not to be counted onin practice. ;oo THE PATHOLOGY OF LABOR. illustrated in figure 367, communicated to the author by Dr. J. , of South Carolina. If the fibroid is submucous andgrows from the cervix, it may be enucleated when labor bed of the tumor should be packed with gauze after is, unfortunately, a common error to overlook a fibroid
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