. The Principles and practice of gynecology : for students and practitioners. duced could survive. If rupture occurs very early in pregnancy, hemorrhage may beless severe ; but after the first month it is apt to be formidable andmay cause death in a few hours. If the hemorrhage is slight, wehave the common type of retro-uterine hsematocele, which, if notaggravated by repeated bleedings, is generally encysted and graduallyabsorbed. In isthmic and ampullar gestation the rupture is often 478 TUMORS, TUBAL PREGNANCY, MALFORMATIONS. downward between the layers of the broad ligament. The blood isthe
. The Principles and practice of gynecology : for students and practitioners. duced could survive. If rupture occurs very early in pregnancy, hemorrhage may beless severe ; but after the first month it is apt to be formidable andmay cause death in a few hours. If the hemorrhage is slight, wehave the common type of retro-uterine hsematocele, which, if notaggravated by repeated bleedings, is generally encysted and graduallyabsorbed. In isthmic and ampullar gestation the rupture is often 478 TUMORS, TUBAL PREGNANCY, MALFORMATIONS. downward between the layers of the broad ligament. The blood isthen poured out into this confined space. The natural tendency ofthis confinement is to check the hemorrhage. The blood thus accum-ulated is called a broad-ligament hsematocele. The more gradual therupture and the more slight the hemorrhage, the less will be the gen-eral and local disturbance. Under such conditions the embryo and itsenvelopes and placenta will have a better chance to adapt themselvesto their enlarged and enlarging quarters, and may go on to term. FiGTJKE Secondary abdominal presrnancy after term: primarily tubal. The orig-inal attachmentof the placenta may be seen in the ruptured tube. After rupture the embryo developed out-ward, and became ailherent to the peritoneum. Operation at St. Lukes Hospital by lapa-rotomy. Macerated child removed. The contents of the gestation-sac were purulent andextremely fetid. The incision was made directly through the abdominal wall into the sacwithout invading the general abdominal cavity. Recovery. If the escaped embryo develops in a cavity formed by the twolayers of the broad ligament and the outer wall of the tube, the preg-nancy is called tuboligamenfous. As the foetus develops it pressesaside and displaces other organs, the layers of the broad ligamentbecome compressed or thickened and form adhesions to surroundingparts, the peritoneum is pressed upward and stripped from thebladder and abdominal wall, the uterus is displ
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