Endometrial adenomata in abdominal scar following cesarean section

readily accepted by the average family if it understands that ccsarenn srction carries with it a definite one chance in ten of It is questionable if the obstetrician has not a moral ohligation information iu every contemplated cesarean section.

Gauss: Pro Wchnschr.

and Contra 55:

817,

a Wider 19%.

Indication

the alternative a dead mother. to impart this

for Cesarean Section.

Deutsehe

med.

A statistical study is offered based on the literature of the last fiftceu years and The advantage the author’s own experience. (University Hospital Wuerzburg.) of the cesnrrnn section is admitted for cases of anomalous placeuta, narrow pelvis Thr 0prr”tive and eehtmpsin, in which it will reduce the mortality of the child. ~)rocedure, however, introdurcs new dangers for t.hr mother. There is no statistical proof that any one of the three methods, cervical, cxtraperitoneal, or transThe only imprnvemrnt in this respect perit~oural, was followed by a lower mortality. could he expected by making the iudicntion for oprration at. an earlier time, which means at a timo when a sufficiently founded indication often really cannot he made. The inevitable consequence of such haste iu finding justification for oprration would be a most undesirable increase of obstetric operations, often unnecessary and harmful to the patient, the family, and the nation. To evaluate fully all the scquclae of cesnrcnn section one must consider also the morbidity folIowing the operation : bronrhopnrumonia, thrombosis, embolism, wound infection, peritonitis, ilcus, eudometrioma, bladder stone, cte. A further drawback is the diminished safety for suhscqurtlt deliveries or the voluntary or necessary sterility subsequent to thr section. The author strongly advocates the rontinuntion of present conservativc in~licntions for obstetric operations.

Zangemeister W.: 77: 100, 1927.

Early

Cesarean

Section.

Monatachr.

f.

Gchurtsh.

II. Gpnlk.

Ln spite of nil aseptic precautions, deaths from infection occur occasionally after eesarean section. A study of these cases reveals that the danger in such cases increases not only after rupture of the membranes but also with the increase Because iu the duration of labor, eveu nhcn no internal examinations are made. of t,his, and the good results obtained by performing aesarean sectiou during pregnancy in cases of crlampsia and placenta prerin, Zangemeister has for years performed cesarenn sections early, that is at the heginning of labor and in some instnnees at the end of pregnancy. His experience has taught him that the danger of infection is murh less and that the fear of lochial retention and hemorrhage from the placental site are unfounded. Zangemeister has devised an instrument for dilating the ecrrical canal in the eases where the cervix is closed, because he believes a free lorhial flow is a preventive of infection. J. P. GREENHILL.

German, William J.: Endometrial Adenomata in Abdominal sarem Section. Hurg. Gynee. Obst. 47: 710, 1928. Endometrial adenomas uterus, have been reported cases are added.

in

the abdominal in 13 cases.

The most frequent symptom Local excision is sufficient for

scar, following These cases are

is pain in the scar removal of the tumor.

during

Scar Following

Ce-

opening of the pregnant here reviewed and 2 new the

menstrual

periods.

453

REVIEWS AND ABSTRACTS The of this Inw

implantation theory group of endometrial

The occurrence following type of uterine incision

would seem ndenomas. cesarean as the

to give

seetiou cold lining in that

the

best

explanation

of

Histologic

Gcburtsh.

Study of the Uterine

u. Gynilk.

93:

435,

origin

suggest the preferable use of the regiou is rhicfly cervical mucosa. WM.

Bach:

the

Wall After

c.

Several Cesareans.

fTE?iSRE.

Ztwhr.

f

1928.

The uterine wound after cesnrenn s&ion will heal either with a complete regeneration of the muscle fibers, with the formation of a scar or with transplantation of pieces of endometrium into the wound. In the nnthor’s case the uterus was removed at the third cesarenn. fiections taken of the areas where the former incisions were made showed regeneration of the muscle in spite of her haring hnrl fever after the second operation. He thinks the temperature K:IR due to thrombosis in pelvic veins. FR.INK

A.

PEMBERTOS.

Rellmuth: Spontaneous Rupture of Uterine Scar After Intraperitoneal Cesarean Section. Is Extension of the Indications for Abdominal Advisable? Miinchen. med. Wchnschr. 75: 1626, 1928.

Cervical Delivery

Hellmuth believes that after cervical cesarean section there is eonsidernblc danger of later rupture of the scar. Including the recent report of Vogt 2nd Willkomm, there are in the literature 16 cases of spontaneous rupture of the lo~c,r uterine ‘l’hrec additional cases arc segment srar in subsequent pregnancies and labors. reported. In the first case, two previous cervical sections had been done because There had been a slight rise iu temperature during of moderately contracted pelvis. At term iu the third pregnancy, the first postoperative week after the second section. after sixteen hours of weak pains without progress, il~lOtllI2r section n-as done. Except for the peritoneum, a complete rupture of the previous scar was found. In the second case, rupture occurred eight days before term in a third pregnancy, the first having ended in spontaneous delivery, and the second terminated by low section for placenta previa. The placenta was extruded through the wound. There KLS a In the third case, the slight rise in temperature for two days after the first section. first section was done because of a moderately contracted pelvis. There was slight temperature during the first postoperative week. At term in a second pregnancy, the scar ruptured after one hour of severe pains. The placenta prrsc,nted at the sit,e of rupture. The author concludes that every patient who has had an abdominal delivery, whether classical or cervical, is a candidate for rupture of the uterus. This is especially so if the convalescence has been marked by any rive of temperature. He emphasizes the possibility that the placenta may be implanted over the site of incision and that if this occurs, rupture is very likely. It is to be suspected if hemorrhage occurs before term in such cases. A first cesareau section should onl: he done for very pressing indications, even though the choice of other measures may be at the cost of the child’s life. In placenta preria, resarcnn section does not improve the prognosis of the mother as much as it does that of the child. In cases of moderately contracted pelvis, later children may often be spontaneously de livered, even though the first was lost. In deciding to do a cesarean section one should consider the danger of rupture of the scar in subsequent labors, the dangers of regularly repeated section, and the possibility of incisional hcrni:], peritone:ll adhcsious, secondary sterility, etc. The author :rgrrcLs with Pcham th:ct “ WCII