If the child is viable it must be delivered as quickly as possible. If it is dead and the head is developed, craniotomy should be done to hasten extraction. When the abruptio takes place before the seventh month of gestation the fetus will die in about ten minutes, whether in the uterus or outside it; no matter what method might be adopted to empty the uterus, the child would be dead before delivery. The diagnosis would have to be made and instruments prepared, and this would take up more than the ten minutes of life left to the fetus. It is necessary to get the fetus out to stop the bleeding of the open sinuses by contraction of the uterus.
The removal of the fetus here is not like an artificial abortion. In abortion the abortionist separates the placenta from the uterine sinuses and so kills the fetus; the removal from the uterus is secondary to that separation which kills. The common notion of moralists that death is caused in abortion by taking the child out of the uterus is inexact--tearing loose the placenta is the real cause. In a removal of the fetus after an abruptio placentae the death of the fetus is not caused by the physician at all, but by the force that effected the abruptio. As the child will be dead before sufficient dilatation of the cervix to deliver it can be attained, there is no objection to beginning the delivery as soon as the diagnosis is clear.
Tumors in or near the uterus may be obstacles to delivery or they may through malignancy endanger the woman's life. The commonest tumors complicating pregnancy are fibroids, cancers, and ovarian tumors, especially cysts and dermoids, but tumors of other kinds are not frequently met. Schauta, in 111,112 pregnant women, found fibroids in 86, one in 1292 cases; Pinard, in 13,915, found 84, one in 165 cases; Pozzi, in 12,050, had 83, one in 133 cases; in St. Petersburg, in 13,076 deliveries, there were only 4, one in 3269 cases; and in the Charité in Berlin, 6 in 19,052 births, one in 3175 cases. The ovarian cyst in pregnancy is rarer than the fibroid--5 in 17,832 births, one in 3566 cases, in the Berlin Frauenklinik. Cancer of the cervix also seldom appears--once in about 2000 cases. Other very rare conditions, related to these, are polyps of the cervix, enlarged and prolapsed kidneys, extrauterine pregnancy combined with intrauterine, echinococcus cysts, parametric abscesses, cancers of the rectum, rectal strictures, tumors of the bladder, stones in the bladder, tumors of the pelvic bones or cartilages, and tumors of the vagina or vulva.