A textbook of obstetrics . alhistory of ectopic gestation isabsence of menstruation until thedeath of the embryo or ruptureof the sac, when the mensesreturn with the discharge ofthe decidua. The metrorrhagiawhich thus begins may continuefor a long time. The other changes in thematernal organism may varywith the situation of the develop-ing ovum. Clinical History and Pathology of Tubal Pregnancy Usually the woman has had children, but a long time haselapsed since the birth of the last child. The most frequentsituation of an extra-uterine gestation is the outer third of thetube (the ampulla1). I
A textbook of obstetrics . alhistory of ectopic gestation isabsence of menstruation until thedeath of the embryo or ruptureof the sac, when the mensesreturn with the discharge ofthe decidua. The metrorrhagiawhich thus begins may continuefor a long time. The other changes in thematernal organism may varywith the situation of the develop-ing ovum. Clinical History and Pathology of Tubal Pregnancy Usually the woman has had children, but a long time haselapsed since the birth of the last child. The most frequentsituation of an extra-uterine gestation is the outer third of thetube (the ampulla1). In this position it may grow upward intothe abdominal cavity, distending the tube-wTalls to the point ofrupture, or it may grow downward between the layers of thebroad ligament, and then backward and upward behind theposterior parietal layer of the peritoneum (broad-ligament gesta-tion). The tubal walls grow thicker from the development of 1 Martins statistics of 55 cases of extra-uterine pregnancy give this situationin Fig. 158.—Decidual cast of theuterine cavity in extra-uterine preg-nancy (Zweifel). 262 PREGNANCY. their muscle-fibers, except at spots, especially on the upper andposterior surfaces, where rupture may occur, the woman experi-encing severe cramp-like pain, followed by symptoms of pro-found shock and death from hemorrhage, perhaps, in a few is often seen, sometimes to a high degree, even beforerupture occurs. The usual temperature before rupture is between990 and ioo° F. Exceptionally, the tubal gestation may proceedto full term (six per cent, of tubal pregnancies (Winckel)). Inthese cases the ovule has probably at first grown downward andbackward. If rupture occurs, it usually takes place between theeighth and twelfth weeks, but it may be seen as early as thefourteenth day,1 or after the sixth month. If the tube rupturesupon the upper or posterior aspect of the sac, the sac-contentsare extruded into the peritoneal cavity with an intra-peritone
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectobstetrics, bookyear1
