Hardouin, after describing a case of obstruction of the pelvic cavity by a fibroid in the anterior wall of the uterus, which necessitated an operation for enucleation, followed by recovery and the birth of the child at term, goes on to state that it is not always necessary to operate on patients who have fibroids when pregnancy occurs.
In many cases the fibroid is so placed that the pregnancy can continue without interruption and no obstruction to labor will occur. Torsion of the pedicle of the tumor or an intraperitoneal polypus will necessitate immediate operation. Suppuration of the fibroid and compression of other pelvic organs are the other dangerous symptoms.
Abortion for uterine fibroids is no longer considered justifiable, since the mortality has been excessive. Myomectomy is relatively without danger. Hemostasis is difficult but it can be accomplished. The possibility of producing abortion is not great since the uterus is tolerant to a great degree.
The enucleation of the growth produces a dissociation, not a section of the uterine fibers, and the opening is easily closed so as not to weaken the uterine wall. Myomectomy may be considered the operation of choice, being without danger for mother or child. Hysterectomy may be necessitated, abdominal or vaginal.
If it becomes impossible to enucleate the tumor hysterectomy must follow a laparotomy. Another important question is whether we should discourage marriage in virgins who have fibroids. The author believes that we should encourage them to have the tumor removed before marriage. During labor spontaneous birth may be awaited if there is no dangerous symptom and the fibroma is high up.
If it partly closes the pelvis an attempt may be made to crowd the growth upward above the symphysis. If this is impossible a Cesarean section must be done, generally followed by a supravaginal hysterectomy. —Arch. Gen. de Chir.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.