The aim of the surgeon is to save the life of the child as well as that of the mother. To this end, when the operation is carried out and the uterus exposed the child is extracted by Cæsarean section. Then in the majority of cases total or subtotal hysterectomy is performed. This is sometimes clumsily termed Cæsarean hysterectomy. In some instances the operator has been content merely to perform Cæsarean section in the hope that the patient may wish to reconceive.
In order to afford some notion of the frequency with which fibroids cause trouble to pregnant and parturient women, I have collected thirty-six cases which have been reported to the London Obstetrical Society from 1900 to 1908 (both years inclusive), and arranged them in the subjoined tables: they show in an unmistakable way that pregnant women with fibroids do often require aid from surgery, and that such efforts are rewarded with success. There is no condition which simplifies hysterectomy so much as pregnancy.
A Table of Cases in which Abdominal Hysterectomy was performed for Pregnancy complicated with Fibroids
These cases are recorded in the Transactions of the Obstetrical Society, 1900–8, both years inclusive.
| Recorder. | Age of Patient. | Period of Pregnancy. | Result to Mother. | Reference to Volume. |
|---|---|---|---|---|
| Horrocks | ? | 5th month | ? | 1900, xlii. 242. |
| Routh | 33 | 33 weeks | R. | Ibid., 244. |
| Doran | 40 | 5th month | R. | 1901, xliii. 178. |
| Donald | 43 | 9th month | R. | 1901, xliii. 180. |
| Donald | 34 | 4th month | R. | Ibid. |
| Donald | 34 | 4th month | R. | Ibid. |
| Donald | 41 | 4th month | R. | Ibid. |
| Routh | ? | 8½ months | R. | 1902, xliv. 41. |
| Doran | 39 | ? | R. | 1904, xlv. 119. |
| Doran | 30 | 4th month | R. | Ibid. |
| Doran | 30 | ? | R. | Ibid. |
| Boyd | 42 | 8th month | D. | Ibid., 106 |
| Boyd | 40 | 3rd month | R. | Ibid. |
| Fairbairn | 22 | 5th week post partum | R. | Ibid., 194. |
| Doran | 38 | 4th week post partum | R. | 1904, xlvi. 274. |
| Taylor | 33 | 3rd month | R. | 1905, xlvii. 333. |
| Andrews | ? | 3rd day post partum | R. | Ibid., 4. |
| Lea | 39 | 7th week post partum | R. | Ibid., 1 |
| Boyd | 42 | 4th month, total | R. | 1907, xlix. 49. |
| Bland-Sutton | 39 | 4½ months | R. | 1907. |
| Dauber | 31 | 3rd month | R. | 1908. |
| McCann | 25 | 4½ months | R. | Ibid. |
| Spanton | 33 | 2½ months | D. | Ibid. |
Table of Cases in which Abdominal Myomectomy was performed during Pregnancy
From the Transactions of the Obstetrical Society, 1900–8, both years inclusive.
| Recorder. | Age of Patient. | Stage of Pregnancy. | Result. | Reference. |
|---|---|---|---|---|
| Donald | 31 | 3rd month | R. | 1901, xliii. 194. |
| Walls | ? | ? | R. | Ibid., 195. |
| Routh | ? | 5th month | R. | 1904, xlvi. 279. |
| Spencer | 41 | 9th month | R. | Ibid., 122. |
| Malcolm | 32 | 7th week post partum | R. | Ibid., 15. |
| Doran | 28 | 2nd month | R. | 1905, xlvii, 426. |
| Vaughan | ? | 4th month | R. | Ibid., 427. |
| Vaughan | ? | 3½ months | R. | Ibid. |
| Swayne | 40 | 5th month | R. | 1908, l. |
| Swayne | 35 | 4½ months | R. | Ibid. |
| Williamson | 32 | 7th month | R. | Ibid., 73. |
| Scharlieb | 37 | 4½ months | R. | Ibid. |
| Scharlieb | 39 | 3½ months | R. | Ibid. |
Pregnancy complicated with cancer of the cervix. When a pregnant woman comes under observation with cancer of the neck of the uterus in an operative stage in the early months, hysterectomy should be performed: in some instances the cervix has been amputated without disturbing the pregnancy.