MYOMECTOMY DURING 
PREGNANCY. 
BY 
ALBERT L. STAVELY, 
Resident Gynaecologist, Johns Hopkins Hospital. 
Reprint from The New York Journal of Gynecology 
and Obstetrics. [Reprinted from the New York Journal of Gynaecology and Obstetrics 
for June, 1894. 
MYOMECTOMY DURING PREGNANCY. 
By Albert L. Stavely, 
Resident Gynaecologist, Johns Hopkins Hospital. 
We have come to learn by a slow deduction from cases recorded 
in medical literature that operations performed upon the pregnant 
uterus or its annexa during pregnancy are not attended by extreme 
danger. Thus out of forty-one cases subjected to operations on the 
annexa, which I have collected at random from the literature, thirty- 
two went to term and were delivered of living children, while seven 
aborted and two died. Statistics collated by other writers show re- 
sults almost as good. 
Myoma, complicating pregnancy, is rather uncommon on account 
of the tendency of this growth to cause sterility or, in the event of im- 
pregnation, to cause an early abortion. Virchow and Scanzoni state 
that fully fifty per cent, of women with myomata are sterile. 
If pregnancy occurs notwithstanding the existence of myomata, 
the necessity for surgical interference must be considered, and the 
decision will depend upon the individual peculiarities of each case. 
A small myoma may not complicate labor no matter where situated. 
An interstitial myoma of the upper zone of the uterus, even though of 
considerable size, usually offers no mechanical obstruction to labor 
and, unless untoward symptoms arise which render an operation im- 
perative, should not be touched. 
Tumors, which in the early months of pregnancy are situated in 
the lower part of the body ot the uterus, may gradually ascend from 2 
Albert L. Stavely, M. D. 
the pelvis and occupy such a position at term that labor is in no way 
complicated by their presence.* 
A pedunculated myoma, blocking the pelvis and causing severe 
pressure symptoms, may frequently be freed from its confining posi- 
tion by careful manipulation. This is sometimes accomplished more 
readily by placing the patient in the knee-chest position. Occasion- 
ally manipulation fails either on account of the cramped environment 
of the tumor or on account of adhesions which bind it so firmly in 
the pelvis that attempts at displacement may be attended by disas- 
trous consequences. Two cases, cited by Phillips,! aptly illustrate 
some of the dangers of too forcible or too persistent efforts in dis- 
placing these tumors. The first case was operated on by Knowsley 
Thornton J for incarcerated pedunculated myoma. After making the 
abdominal incision the tumor was forced out of the pelvis and such 
profuse bleeding occurred that the patient's life was at first de- 
spaired of. 
In the second case, operated on by Hanfield-Jones, a myoma, the 
size of a foetal head, was impacted and adherent in the pelvis. Be- 
fore the operation-a Porro-Caesarean-persistent efforts were made 
to liberate the growth but without success. Following the operation 
the patient died of peritonitis. At the autopsy the tumor was found 
to be much " bruised " and Phillips who saw the case thought that the 
preliminary manipulation might have had some bearing on the fatal 
termination. 
In considering the advisability of an operation it is necessary to 
weigh the risks of interference and non-interference. 
The dangers from an operation are shock, abortion, haemorrhage, 
intestinal obstruction, and infection. Shock depends in a great meas- 
ure upon the dexterity of the operator and the duration of operation ; 
abortion depends upon the amount of manipulation of the uterus, 
upon the extent of involvement of the uterine wall and upon the 
absence or presence of a tendency to abortion. If the uterine cavity 
is opened, abortion is inevitable. Haemorrhage is to be feared on ac- 
count of the great vascularity of the uterus. This applies only to the 
sessile myomata, and a series of successful operations performed for 
the removal of these growths show that even this fear is somewhat 
exaggerated. 
Abortion and haemorrhage after operation in the majority of in- 
* Phillips. British Medical Journal, 1888, i, p. 1331. 
f Ibid. f Referred to in the table. Myomectomy during Pregnancy. 
3 
stances may be averted by prolonged rest in bed with a judicious ad- 
ministration of morphine. The danger of infection, which may be 
somewhat greater than in ordinary abdominal operations, depends 
upon the thoroughness of the surgical technique. 
The dangers from non-interference with obstructing myomata are 
abortion, haemorrhage, sepsis, rupture of uterus, pressure symptoms 
and intestinal obstruction. When there is a large myoma growing in 
the substance of the uterus the free haemorrhages, frequently induced, 
tend to detach the ovum. Gusserow * thinks it is not yet proved that 
abortion is more frequent where myomata exist. He says, however, 
that abortion may be due directly to the tumor or to its effect on the 
uterine wall. 
It has been stated by several writers that when pregnancy goes to 
term haemorrhage is almost certain to occur in those cases in which 
an interstitial myoma is situated opposite the placental attachment 
and that, when abortion occurs under such circumstances, the haemor- 
rhage is always profuse and sometimes fatal. Although it is claimed 
by some writers that placenta praevia is more frequent in pregnancy 
complicated by myomata, the research of Naussf seems to disprove 
this statement as he only found this anomaly twice in two hundred 
and forty-one cases. 
Playfair J says haemorrhage is not so frequent as might at first be 
supposed and in twenty-six cases collected by Magdelaine no cases 
of this character are reported. In nineteen cases of haemorrhage col- 
lected by Nauss,# eleven of the myomata were submucous, six inter- 
stitial and two subperitoneal. 
During pregnancy myomata, as a rule, grow very rapidly. Cazeaux 
says : " I have known them in several instances to acquire a size in 
three or four months which they would not have done in several 
years in the non-pregnant condition." After labor the myoma, origi- 
nally of low vitality, often passes through a degenerative or absorptive 
process, thus offering an opportunity for entrance and growth of 
pyogenic organisms. 
A case is reported in the Homoeopathic Journal of Obstetrics, for Sep- 
tember, 1892, in which a myoma, the size of an orange, was detected 
in the left side of the fundus uteri. Twelve days after labor, which 
nearly terminated fatally, the patient developed all the symotoms of 
* Gusserow. Neubildungen des Uterus, 1886. 
f Playfair. Midwifery, 1889, p. 363. | Ibid. 
* Gusserow. Neubildungen des Uterus, 1886. 4 
Albert L. Stavely, M. D. 
septic infection. The uterus gradually enlarged to its size at term 
and then suddenly discharged an enormous quantity of pus, contain- 
ing shreds of myomatous tissue. A well-defined instance* has been 
recorded in which a myoma undergoing softening so weakened an 
area in the wall of a uterus already softened by pregnancy that it 
ruptured. 
Peritonitis occasionally occurs during pregnancy apparently as a 
result of myomata f and deaths have been reported from this cause. 
Pressure from a large myoma may cause marked dyspnoea, obstinate 
constipation or suppression of urine, depending upon the location of 
the growth. Pain from pressure is also unendurable in some cases. 
Statistics collected to show the results of non-interference in pregnancy 
complicated with myomata are interesting. One author J reports 
three hundred and seven cases in which thirty-nine abortions and 
fourteen maternal deaths occurred ; another # two hundred and forty- 
one cases with forty-seven abortions. Siisserott || in one hundred and 
forty-seven cases records eight deaths after application of the forceps, 
twelve after version and thirteen after artificial removal of the 
placenta. 
Jetter A records two hundred and fifteen deliveries in one hundred 
and sixty-five mothers with sixty-four maternal deaths. Gusserow {) 
reports two hundred and twenty-eight cases, collected from different 
sources, of which one hundred and twenty-three died. Suturgin J 
states that scarcely one fifth of the cases complicated with myomata 
terminate without surgical assistance and that about one third of the 
mothers and one half of the children die during or soon after 
labor. 
The immediate occasion of the remarks and analysis here pre- 
sented was the occurrence of two cases in the gynaecological wards 
of the Johns Hopkins Hospital. 
In 1892 two patients with myomata complicating pregnancy were 
admitted to the gynaecological wards who were operated upon by Dr. 
Kelly. The following is a synopsis of their histories : 
* Alabama Med. and Surg. Journal, October, 1891. 
f Worship. Obstet. Trans., London, vol. xiv, p. 305. 
| Lefour. Uterine Fibroids in Relation to Pregnancy, Paris, 1880. 
* Nauss. Inaug. Dissert., Halle, 1882. 
|| Siisserott. Inaug. Dissert., Rostock, 1870. 
A Die Neubildungen des Uterus, 1886. 
b) Ibid. 
Annual of Universal Medical Sciences, 1891. Myomectomy during Pregnancy. 
5 
Case I.-Mrs. S., aged twenty-five, admitted March 7, 1892; mar- 
ried eleven months before admission to hospital; menstruated first at 
eleven years of age, never regular, last period December 17, 1891; 
complained of occasional sharp pain in the ovarian and sacral region, 
severe headache and nausea. She was examined under anaesthesia, 
and a diagnosis of myoma of the posterior part of the fundus uteri, with 
pregnancy, was made. The pregnancy was judged to be about two 
and a half months advanced, by the size of the uterus and menstrual 
history. The tumor was about six centimetres in diameter, and its ex- 
tirpation was deemed advisable on account of its probable interference 
with parturition. Operation, March 9th. A median incision exposed 
a firm sessile myoma directly behind the abdominal wall and situated 
on the posterior and right side of the fundus, forming a round boss 
about the size of an orange. An incision was made through the 
capsule of muscular fibers over the tumor, and it was removed with- 
out difficulty by enucleation, three or four silk sutures having first 
been passed under the tumor as it was drawn up out of its bed; these 
were tied immediately after the enucleation and at once re-enforced by 
others, in all ten or twelve. The bleeding was slight and easily con- 
trolled, the abdomen was closed without drainage and the patient 
made an uneventful recovery, and was delivered at term of a living, 
healthy child. 
Case II.-Mrs. W., aged thirty-five, admitted July 23, 1892 ; nullip- 
ara, menstruated first when thirteen years of age, flow regular ; mar- 
ried twice ; first time fourteen years before, second time four months 
before, admission. Last menstrual period occurred three weeks after 
her second marriage. She complained of a lump in the right ovarian 
region, which had been noticed for six weeks and which was growing 
very rapidly. For a week she had suffered with cramplike pains in 
the abdomen radiating into the back and down the right leg. These 
pains were very severe and resembled those of labor. On examination 
the lower part of the abdomen was found to be irregularly distended 
by two masses, evidently the pregnant uterus and a myoma. The 
uterus was rounded in outline, rather soft, extending fifteen centi- 
metres to the right of the median line of the abdomen. The myoma 
was situated to the right and above the plain of the uterus ; it was 
about eight centimetres in diameter, of firm consistence, and grew 
from the cornu of the uterus. Operation advised on account of 
threatened abortion. Operation, July 27, 1892. Incision made along 
the outer border of the right rectus muscle, revealing a myoma situ- 
ated at the right cornu. The capsule was incised and the tumor 6 
Albert L. Stavely, M. D. 
removed by enucleation, and the uterine wound closed by catgut 
sutures. There was free bleeding, until the sutures were tied. This 
patient likewise had an uncomplicated convalescence, and was deliv- 
ered at term of a living child. 
In reviewing the literature on this subject, thirty-one additional 
cases have been found which are tabulated here. Pozzi * reports 
seventeen, Landau f seventeen, and Routier J fifteen cases, each writer 
having duplicated the cases of the others with one or two exceptions. 
Cases are reported * where enucleation was attempted before resorting 
to Porro's operation. Fibroid tumors of the ovary, which may produce 
symptoms identical with those of incarcerated pedunculated myomata, 
have been removed during pregnancy. Operations upon myomata, 
not involving coeliotomy, growing in the cervical portion of the 
uterus, have been performed several times, || but as it is not the object 
of this paper to discuss them, they will be passed without further 
notice. The following table includes only those cases requiring open- 
ing of the abdominal cavity for the removal of myomata per se. 
The indications for myomectomy are not always clear. An incar- 
cerated myoma or one so situated as to cause great pressure upon such 
important structures as the blood-vessels, ureters, nerves, and intes- 
tines, ora myoma which constantly threatens abortion in cases where it 
is extremely desirable for reasons of inheritance that pregnancy should 
continue, or where the life of the patient is endangered from constant 
and profuse haemorrhages, call for an operation. Any one of the fol- 
lowing operations may be resorted to in these cases : The induction of 
abortion or premature labor, craniotomy, symphyseotomy, myomec- 
tomy, the Caesarean, the Porro and the Porro-Caesarean operation. 
Craniotomy, except in case of foetal death, is practically an operation 
of the past. Symphyseotomy is a very safe operation, and is indicated 
in properly selected cases. The Porro and Caesarean operations are 
sometimes called for, where myomectomy would be of no avail. The 
recent results in the last-named operations give them an important 
place in the consideration of the treatment of myomata complicating 
pregnancy. In five years, from 1885 to 1890, one hundred and fifty- 
* Gynaecology, vol. i, p. 424, London, 1892. 
f Sammlung klin. Vortrage, N. F., No. 26; Gyn,, No. 9, p. 217. 
Bull. Soc. Chirurg., November, 1889. 
* British Med. Journal, 1888, vol. i, p. 1331. 
Munde, Trans. Am. Gyn. Soc., 1884; Hicks, Obs. Trans., xii, 1871, p. 273; 
Lomer, Zeitschr. f. Geburt. et Gynak., 1883, ix, p. 302 ; Sims, Uterine Surgery, p. 
117; Schroder, Gusserow's Die Neubildungen des Uterus, 1886, etc. Myomectomy during Pregnancy. 
7 
seven Porro operations were performed, with forty-eight maternal 
deaths (30 + per cent.) and a foetal mortality of twenty-five (15.9 
per cent.). In 1887 there were fifty-three Caesarean operations, with 
a maternal mortality of 20.8 per cent., and in 1888 seventy-nine 
operations, with a mortality of 24 per cent. The infant mortality in 
the one hundred and thirty-two cases was 5.3 per cent. 
An analysis of the following table shows a maternal mortality of 
24.25 per cent, or eight deaths in thirty-three cases. Of these deaths 
two were due to haemorrhage, one to " long-standing aortic disease " 
and one to peritonitis. Three died after the occurrence of abortion, 
probably from infection, and in one case the cause was not specified. 
Twenty-four of these cases have been reported since 1884 or near- 
ly 80 per cent, of the whole number. Eliminating the cases operated 
upon before 1885 there remains a mortality of 16.66 per cent. Since 
1889 seventeen cases have been reported or over one half of the 
whole number, with a death-rate of n.75 Per cent. The excellent 
results obtained in the later cases is unquestionably due to improved 
surgical technique. An investigation of the foetal mortality shows a 
death-rate of 30.30 per cent, or nine abortions and one miscarriage. 
Twenty women were delivered at term of living children and one had 
a premature delivery in the eighth month, nearly six months after the 
operation. In three cases where the mothers died, no statement is 
made concerning abortion. Sixteen myomata are reported as pedun- 
culated ; with these four deaths occurred, including the patient with 
aortic disease. One case aborted and one gave birth to a stillborn 
child, after which she died. In fifteen cases of sessile myoma six 
abortions occurred and four patients died. Nine were operated on 
in the last eight years with two deaths and one abortion, the abortion 
occurring in one of the cases that died. 
From this analysis it is evident that operations performed during 
the last eight years have been attended with much better results 
than in former years, that operations for sessile myomata are more 
disastrous to the foetus than are those for pedunculated tumors and 
that in properly selected cases myomectomy for pedunculated or ses- 
sile myomata is comparatively safe and thoroughly justifiable. 8 
Albert L. Stavely, M. D. 
No. 
of 
case. 
Name of 
operator. 
Date of operation or 
reference to report 
of case. 
Advance- 
ment of 
pregnancy 
at time of 
operation. 
Characteristics 
of tumor. 
Exact location. 
Result to 
patient. 
Result to 
foetus. 
Further remarks. 
I 
Pean. 
Operation, Dec. 
15, 1874. Lemons 
de clin. chir., vol. 
i, p. 679. 
5 months. 
Large fibro-cystic 
tumor, containing 
ten litres of serous 
fluid, the solid 
portions weighing 
7,300 grammes. 
Situated on the 
upper and ante- 
rior part of uterus. 
Recovery. 
Abortion on 
the day fol- 
lowing the 
operation. 
Patient a widow nine 
years,pregnancy not 
suspected. Only a 
small portion of the 
sac was removed, the 
rest being stitched 
in the abdominal 
wound to shut out 
infection. 
2 
Thornton. 
Trans. Obstet. Soc. 
June 4, 1879. 
7 months. 
Large peduncu- 
lated myoma. 
Wedged in the 
pelvis. 
Died on 
the seventh 
day. 
Stillborn on 
the following 
day. 
Tumor had thick ped- 
icle, and was adhe- 
rent to intestines 
and Douglas's cul- 
de-sac. 
3 
Schroder. 
Operation, Nov. 
16, 1879. Die 
Laparotomie in 
der Schwanger- 
schaft, Zeitschiift 
f. Geburt. und 
Gyndkol., Bd. v. 
4 months. 
M ultiple peduncu- 
lated myomata, 
one sessile myoma. 
Three large myo- 
mata, situated on 
the fundus; two 
pedunculated, 
one sessile. 
Recovery. 
Delivery at 
term. 
Forceps delivery. 
4 
Hegar. 
Operation, 1880. 
Op. Gynak., 3d 
ed., p. 475. 
3 months. 
Soft peduncu- 
lated myoma, with 
broad pedicle. 
Not specified. 
Died. 
Not stated. 
Death from peritoni- 
tis on third day. 
.5 
Martin. 
Operation, March, 
1881. Landau, 
Sammlung klin. 
Vortrage, N. F., 
No. 26. Gyn., 
No. 9, p. 217. 
4 months. 
Multiple myoma- 
ta, with broad 
bases. 
Not specified. 
Died on 
the sixth 
day. 
Abortion day 
after opera- 
tion. Myomectomy during Pregnancy. 
9 
6 
Martin. 
Operation, March, 
1881. Landau, 
5 months. 
Subserous myoma, 
with base size of 
Situated on fun- 
dus. 
Died on 
the fifth 
Abortion. 
Enucleation. Time 
of operation sixty- 
Sammlung klin. 
hand; smaller one 
day. 
five minutes. Pa- 
Vortrdge, N. F., 
below and to the 
tient had respira- 
No. 26. Gyn., 
No. 9, p. 217. 
right. 
tory trouble. 
7 
Langenbuch. 
Operation, July, 
4 months. 
Subserous myoma, 
with broad base 
Situated on the 
Recovery. 
Abortion. 
Tumors all enucle- 
1882. Berlin, klin. 
anterior surface 
ated. 
Wochenschrift, 
covering surface, 
of the uterus. 
1886, quoted by 
size of hand ; two 
Langner. 
others, one size of 
Studsgaard. 
hen's egg, the 
other size of 
pigeon's egg. 
8 
Operation, Dec. 
3I months. 
Pedunculated 
Not specified. 
Recovery. 
Delivery at 
19, 1882, quoted 
by Hegar. Op. 
Gynak., 3d ed. 
myoma. 
term. 
9 
Uzziel Ogden. 
Operation, Nov. 
" Uterus 
Myoma with a 
Attached to the 
Recovery. 
Twin preg- 
The growth was sup- 
5, 1884. Canad. 
consider- 
thick pedicle 
right side of the 
nancy, abort- 
posed to be ovarian 
Practitioner, 
ably en- 
about an inch 
uterus and in- 
ed on twelfth 
tumor. Operation 
April, 1885. 
larged." 
long. Weight, 
closed in the 
day after 
consisted in clamp- 
Berlin, klin. 
four pounds. 
broad ligament. 
operation. 
ing and cauterizing, 
then ligation on ac- 
count of bleeding. 
IO 
Landau. 
3 months. 
Two subperi- 
Larger one situ- 
Recovery. 
Delivery at 
Large myoma enucle- 
* 
Wochenschrift, 
toneal myomata ; 
ated at right cornu 
term. 
ated by circular in- 
No. 13, 1885, 
one size of child's 
uteri, small one 
cision around base. 
P- 195. 
head, weighing 
three pounds, the 
at left cornu. 
other of a hen's 
Martin. 
Berlin, klin. 
.egg. 
ii 
6 months. 
Sessile myoma. 
Situated on the 
Died on 
Abortion. 
Died of haemorrhage 
Wochenschrift, 
fundus. 
the seventh 
following abortion. 
No. 3, 1885. 
day. 
Cuneiform incision 
of fundus. Albert L. Stavely, M. D. 
10 
Advance- 
No. 
of 
case. 
Name of 
operator. 
Date of operation or 
reference to report 
of case. 
ment of 
pregnancy 
at time of 
operation. 
Characteristics 
of tumor. 
Exact location. 
Result to 
patient. 
Result to 
foetus. 
Further remarks. 
12 
Barnes. 
Operation, 1885. 
3 months. 
Pedunculated 
Not specified. 
Died. 
Not stated. 
A nnal. de gynec, 
myoma. 
March, 1890. 
Delivery at 
13 
Martin. 
Operation, No- 
3| months. 
Myoma with thick 
Located on fun- 
R ecovery. 
vember, 1885. 
pedicle, size of 
dus. 
term. 
Berlin, klin. 
Wochenschrift, 
No. 29, 1886. 
hand. 
14 
Martin. 
Operation, No- 
4 months. 
Subserous 
Located on fun- 
Recovery. 
Delivery at 
vember, 1885. 
Landau, Samrn- 
myoma. 
dus. 
term. 
lung klin. Vor- 
trage, N. F., No. 
26. Gyn., No. 9, 
15 
Frommel. 
p. 217. 
Munch, med. 
Wochensch rift, 
5 months. 
Myoma size of 
child's head ; 
Recovery. 
Delivery at 
term. 
Peritonitis at time of 
operation. Tumor 
No. 52, 1886. 
broad base. 
shelled out of bed 
in uterus and wound 
closed with several 
rows of sutures. 
l6 
Martin. 
Operation, Nov. 7, 
3 months. 
Interstitial and 
Not specified. 
Recovery. 
Abortion. 
Enucleation. 
1888. Sammlung 
subserous myo- 
klin. Vortrdge, 
N. F., No. 26. 
Gyn., No. 9, p. 217. 
Boston Med. 
mata. 
Enucleation. 
17 
Gordon. 
3 months. 
Sessile myoma, 
Situated at middle 
Recovery. 
Delivery at 
Jour., October, 
size of orange. 
of anterior sur- 
term. 
1889. 
face of uterus. Myomectomy during Pregnancy. 
11 
i8 
Routier. 
Bulletin soe. chir., 
November, 1889. 
3 months. 
Pedunculated 
myoma weighing 
five pounds, and 
shaped like a 
kidney. 
Situated on fun- 
dus. 
Recovery. 
Delivery at 
term. 
Before operation a 
portion of tumor 
was removed by 
puncture, following 
which she had se- 
vere pains, and be- 
came delirious. 
19 
Homann. 
Bulletin mldicale, 
1889. 
3 months. 
Myoma weighing 
fifteen pounds. 
Not specified. 
Recovery. 
Abortion ten 
days later. 
20 
Bergh. 
Hygeia, 1889, vol. 
li, p. 292. 
4 months. 
Two sessile myo- 
mata, larger size 
of two fists. 
Recovery. 
Delivery at 
term. 
Enucleation. 
21 
Frommel. 
Operation, 1891. 
Munch, med. 
Wochenscht ift, 
No. 14, 1893. 
6 months. 
Numerous myo- 
mata with broad 
bases pushing up 
the diaphragm. 
Uterus studded 
with the tumors. 
Died on 
the third 
day. 
Abortion. 
Only the two largest 
removed. Death 
due to haemorrhage 
and exhaustion. 
22 
Croom. 
Edinburgh Med. 
Jour., October, 
1892. 
2| months. 
Pedunculated 
myoma, size of 
child's head. 
Springing from 
left cornu uteri. 
Recovery. 
Pregnancy 
continued to 
eighth month. 
Pedicle ligated. 
23 
Croom. 
Ibid. 
2 months. 
Large, soft 
pedunculated 
myoma. 
Connected with 
left side of uterus. 
Died. 
No record. 
Patient succumbed to 
long-standing aortic 
disease immediately 
after operation. 
24 
Croom. 
Ibid. 
5 months. 
Soft, vascular 
pedunculated 
myoma, size of 
cocoanut. 
Posterior part of 
uterus. 
Recovery. 
Delivery at 
term. 
25 
Flaischlen. 
Centralblatt fur 
Gyndkologie, 
p. 185, 1892. 
3 months. 
Two myomata, 
one, pedunculated, 
size of child's 
head; the other, 
sessile, size of 
apple. 
First springing 
from posterior 
wall of uerus ; 
second, from an- 
terior wall. 
Recovery. 
Delivery at 
term. 
Ligation of pedicle ; 
enucleation. 
26 
Guinard. 
Operation, 1892. 
A nnales degynecol. 
et d'dbstdtiique, 
1893- 
3 months. 
Myoma of broad 
ligament, size of 
foetus at term ; 
thick pedicle. 
Situated in right 
broad ligament. 
Recovery. 
Delivery at 
term. 12 
Albert L. Stavely, M. D. 
No. 
of 
case. 
Name of 
operator. 
Date of operation or 
reference to report 
of case. 
Advance- 
ment of 
pregnancy 
at time of 
operation. 
Characteristics 
of tumor. 
Exact location. 
Result to 
patient. 
Result to 
foetus. 
Further remarks. 
27 
Kelly. 
1892. Abstract 
from history of 
case for this 
article. 
4 months. 
Sessile myoma, 
size of orange. 
Posterior surface 
of fundus uteri. 
Recovery. 
Delivery at 
term. 
Enucleation. 
28 
Frommel. 
Operation, 1892. 
Munch, med. 
Wochensch rift, 
No. 14, 1893. 
4 months. 
Intra-ligamentary 
myoma, size of 
child's head. 
Situated on right 
side of uterus. 
Recovery. 
Delivery at 
term. 
Broad ligament and 
tumor stripped out. 
29 
Kelly. 
1892. Abstract 
from history of 
case for this 
article. 
13 weeks. 
Sessile myoma, 
size of duck's 
egg- 
At right cornu 
uteri. 
Recovery. 
Delivery at 
term. 
Enucleation. 
30 
Price. 
Personal com- 
munication. 
5 months. 
Pedunculated 
myoma, size of 
foetal head. 
Growing from 
posterior and 
lateral surface of 
uterus, blocking 
the pelvis. 
Recovery. 
Delivery at 
term. 
Ligation of pedicle. 
31 
Price. 
Personal com- 
munication. 
5 months. 
Pedunculated 
myoma, size of 
foetal head. 
Growing from 
posterior and 
lateral surface of 
uterus, blocking 
the pelvis. 
Recovery. 
Delivery at 
term. 
Ligation of pedicle. 
32 
Frommel. 
Operation, 1893. 
Munch, med. 
Wochenschrift, 
No. 14, 1893. 
5 months. 
Pedunculated 
myoma, size of 
hen's egg. 
Situated on ante- 
rior surface of 
uterus. 
Recovery. 
Delivery at 
term. 
Ligation of pedicle. 
33 
Price. 
Personal com- 
munication. 
4 months. 
Large pedicu- 
lated myoma. 
Growing from 
posterior surface 
of uterus. 
Recovery. 
Delivery at 
term. 
Incision through pos- 
terior vaginal for- 
nix, clamping of 
pedicle.