INTRA-PELVIC TECHNIC (Manipulative Surgery of the Pelvic Organs)
Indications and Contraindications

Intra-pelvic technic is particularly valuable in the treatment of displacements, lessened mobility of the uterus, subinvolution, metritis, ovaritis, salpingitis, passive pelvic congestion and many cases of inflamed or obstructed ureters, and in fact any case of subacute or chronic inflammation within the pelvis not accompanied by malignant or tubercular involvement or pus accumulation.

In pregnancy to relieve pressure symptoms or to give relief from obstinate vomiting good results are often obtained.

It is contraindicated by malignancy, tubercular inflammation, particularly if purulent, the presence of confined pus, and ectopic pregnancy.

It is easily apparent that no manipulation should be attempted in malignant diseases of any of the pelvic organs. No possible benefit would accrue and harm would undoubtedly result. Inflammation and metastases elsewhere would naturally be expected. The same is true to a lesser extent of tuberculosis of the pelvic viscera.

In most cases of acute inflammation the pain caused by the manipulation of the affected part would prevent the treatment being used. In acute inflammatory conditions intra-pelvic technic should not be attempted until several weeks have elapsed since the subsidence of all acute symptoms, and even then it sometimes happens that treatment is followed by a slight return of the acute symptoms. These must be allowed to subside before the treatment is repeated.

Confined pus, if the microorganisms are still active, and this is a difficult matter to determine, is a contraindication. Old collections of pus are said to become sterile, but even so, it is not wise to risk the rupture of a pyo-salpinx or the expression of pus through the fimbriated extremity of the uterine tube. So if pus be suspected in a tube the treatment should be given with extreme care. All manipulations should be made toward the uterus so as to drain the tube in that direction and reactions after treatment as to pain and. temperature should be carefully watched. In cases of a well-developed pelvic abscess surgical drainage is the indicated treatment.

In an ectopic pregnancy any manipulation might cause serious hemorrhage until after the death of the foetus and the organization and encapsulation of the extravasated blood and damaged tissues. After this has occurred the disappearance of the mass is often facilitated by intra-pelvic technic carefully and properly applied.

Menstruation is not a contraindication but an indication for great care and gentleness. Ordinarily the intra-pelvic technic is suspended during the periods, but in some cases of dysmenorrhoea, and in stubborn cases of displacements caused by adhesions, more can be accomplished at this time than at any other, the adhesions seemingly being less resistant than between periods.

Fever, unless clearly due to acute inflammation about the pelvis, is not a contra-indication but is also an indication for extreme care and gentleness and a close scrutiny of reactions after each treatment. If the treatment is followed by a slight rise of temperature or a marked increase of discomfort these must be allowed to subside for several days before the treatment is repeated.

Fig. 1. The Uterus in Normal Position.
(Findley, Diseases of Women.)