Transactions of the American Association of Obstetricians, Gynecologists, and Abdominal Surgeons for the year ... . lie BLEEDING IN ECTOPIC PREGXAXCY 117 in the cleft between the folds of the tubal mucosa and thus rests uponthe surface of the tube wall, at once eroding itself into the muscularcoat. In this case the mucosal folds unite over the embedded ovum andform a false reflexa. In the centrifugal implantation, the ovum sinks into the wall of thetube and the villi invade the muscular wall and vessels, including allstructures, even the serosa. The pseudoreflexa is formed by the sidewalls mad
Transactions of the American Association of Obstetricians, Gynecologists, and Abdominal Surgeons for the year ... . lie BLEEDING IN ECTOPIC PREGXAXCY 117 in the cleft between the folds of the tubal mucosa and thus rests uponthe surface of the tube wall, at once eroding itself into the muscularcoat. In this case the mucosal folds unite over the embedded ovum andform a false reflexa. In the centrifugal implantation, the ovum sinks into the wall of thetube and the villi invade the muscular wall and vessels, including allstructures, even the serosa. The pseudoreflexa is formed by the sidewalls made up of the muscularis and the mucosa, into which the ovumhas sunk. The invasion of the blood vessels by the villi causes hemorrhage intothe intervillous spaces. The villi may extend up to and through the. Fig. 1.—Cross section of uterus showing decidual development in a case of three months ectopic gestation. serosa; rupture usually takes place through penetration of the tubewall at the placental site, as a result of this erosion by the villi. One observation has been constant, no matter what form of implanta-tion has taken place, , there is always an excessive amount ofhemorrhage about the ovum, owing to the fact that there is no truedecidua to protect the tubal vessels from erosion. The constant ero-sive action of the trophoblast causes considerable hemorrhage. Mallstates that the blood in immediate apposition to the trophoblast doesnot clot, and thus continues to contribute towards the sustenance ofthe ovum. Our observations are in accord with Malls and Litzenbergs that,whenever we have found an early unruptured pregnancy, the ovumwas very small and separated from the tubal wall by a definite layerof blood. 118 JOHN 0. POLAK AND THURSTON S. WELTON The tubal and uterine placent
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Keywords: ., bookcentury1900, bookdecade1920, booksubje, booksubjectobstetrics
