Cesarean section . is free in the abdominal cavity it should be removed promptly,at any time previous to the last month of pregnancy, and even then ifit is causing any symptoms, since it is a constant menace to the is not an indication for cesarean section, unless it is so situated as tointerfere with labor, though symptoms of twisted pedicle may arise 56 CESAREAN SECTION either during labor or during the puerperium, which will necessitate im-mediate laparotomy. In some cases, however, the tumor becomes pro-lapsed into the pelvis in front of the presenting part in such a manneras to
Cesarean section . is free in the abdominal cavity it should be removed promptly,at any time previous to the last month of pregnancy, and even then ifit is causing any symptoms, since it is a constant menace to the is not an indication for cesarean section, unless it is so situated as tointerfere with labor, though symptoms of twisted pedicle may arise 56 CESAREAN SECTION either during labor or during the puerperium, which will necessitate im-mediate laparotomy. In some cases, however, the tumor becomes pro-lapsed into the pelvis in front of the presenting part in such a manneras to effectually prevent the entrance of the presenting part and thusrender a pelvic delivery impossible, unless a reposition of the tumor canbe effected. In some cases postural treatment by means of the kneechestposition will prove successful, and the tumor will become replaced abovethe pelvic brim. This often fails, however, and the removal of thetumor is necessary to free the pelvis. Some authorities recommend that. Fig. 27.—Dystocia from Ovarian Cyst. the patient be allowed to go into labor, laparotomy being performed andthe tumor removed when the cervix is nearly fully dilated, and deliverythen being effected by forceps or version. In some cases, however, thetumor will rupture with disastrous results, if submitted to the pressureof labor, and the wisest course would seem to be to deliver the patientby cesarean section at the time of election and remove the tumor at thesame time. A considerable proportion of these tumors are either dermoidcysts or of a malignant nature, and to subject the patient to the dangerof rupture of such tumors is distinctly unwise. For the same reasonpuncture through the vagina is absolutely contraindicated. Since laparotomy is indicated for the removal of the tumor, the most NON-PELVIC INDICATIONS FOR CESAREAN SECTION 57 satisfactory treatment for all ovarian tumors which are so situated as tointerfere with delivery is cesarean section and ovariotomy
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