1. Sew up the incision in the uterus.
2. Perform Cæsarean section.
3. Remove the uterus (subtotal hysterectomy).
Several cases have been reported in which injury to a gravid uterus during ovariotomy has terminated fatally, especially when the surgeon followed the plan of sewing up the wound in the uterus.
A careful consideration of the reported cases indicates that the best results follow for the patient when the surgeon performs Cæsarean section, as the following record shows:—
Sir Spencer Wells had removed a large, multilocular ovarian cyst from the left side of the patient, when he felt what was supposed to be a cyst of the right ovary. When tapped it was found to be a gravid uterus, in which pregnancy had advanced to near the fifth month. Cæsarean section was at once performed and the patient recovered.
Injuries of this kind are rarely likely to happen now, for the clumsy ovariotomy trocar is passing out of use.
Fig. 24. Diagram representing a Gunshot Injury of the Uterus. The woman was aged 28, and in the seventh month of pregnancy. The bullet was extracted from under the skin on the left side, four inches behind the anterior superior spine of the ilium. The line A B represents the track of the bullet. (British Medical Journal, 1896, vol. i, p. 332.)