. An American text-book of obstetrics. For practitioners and students. pro-portion of such cases will prove to be pyosalpinx or hydrosalpinx, but an erroris not serious, as in either instance operation is indicated. 2. At the Time of Rupture.—If called at the time of rupture, the surgeonmust exercise considerable judgment in his decision whether or not to operateimmediately. If the patient is in collapse, the pulse weak and rapid, andthe skin blanched and clammy, an immediate examination should be madeto discover if possible whether rupture has occurred into the broad liga-ment or is intraperi
. An American text-book of obstetrics. For practitioners and students. pro-portion of such cases will prove to be pyosalpinx or hydrosalpinx, but an erroris not serious, as in either instance operation is indicated. 2. At the Time of Rupture.—If called at the time of rupture, the surgeonmust exercise considerable judgment in his decision whether or not to operateimmediately. If the patient is in collapse, the pulse weak and rapid, andthe skin blanched and clammy, an immediate examination should be madeto discover if possible whether rupture has occurred into the broad liga-ment or is intraperitoneal. If the rupture has taken place into the broadligament, a lateral tumor-mass closely connected with the uterus will be THE PATHOLOGY OF PREGNANCY. 289 detected. The mass is circumscribed and fluctuating, and rectal examinationshows the cul-de-sac to be free of fluid. In such a case the method of treat-ment is an expectant one, the possibilities being that the hemorrhage will sooncease if it has not already done so, and that the patient will recover, leaving. Fig. 159.—Diagram of intraperitoneal rupture of tubal pregnancy. Free blood in Douglass cul-de-sacand among the intestines (Dickinson): S, symphysis ; R, rectum. a hematocele to be dealt with later if necessary. If examination reveals freefluid in the cul-de-sac (Fig. 159), and there are no signs of improvement inthe patients condition, the natural inference is that the rupture is intraperi-toneal, and an immediateoperation is indicated, asevery moment detracts fromthe chances of recovery(Fig. 160). Preparation for Opera-tion.—The chances for re-covery following operationin extra-uterine pregnancydepend upon the carefulobservation of all the de-tails of antiseptic and asep-tic technique. For thisreason a precipitate opera-tion is always attended withgreater danger, as of necessity care in details must be sacrificed. The surgeonshould always have a complete set of abdominal instruments and accessoriessterilized
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