Transactions of the American Association of Obstetricians and Gynecologists for the year ... . gina aswell as from the anterior wall of the cervix and uterus, and inthis fashion in practically every case the vesicouterine fold ofperitoneum is readily exposed. The value of these anterior incisions lies in the fact that weare enabled, when desired, to open the peritoneum, to enter the 142 SAMUEL W. B A X D L E R, peritoneal cavity, to make a digital intraperitoneal examination,to bring the uterus and adnexa into the vagina and to performthe operation at the same time if all conditions are favora
Transactions of the American Association of Obstetricians and Gynecologists for the year ... . gina aswell as from the anterior wall of the cervix and uterus, and inthis fashion in practically every case the vesicouterine fold ofperitoneum is readily exposed. The value of these anterior incisions lies in the fact that weare enabled, when desired, to open the peritoneum, to enter the 142 SAMUEL W. B A X D L E R, peritoneal cavity, to make a digital intraperitoneal examination,to bring the uterus and adnexa into the vagina and to performthe operation at the same time if all conditions are favorable conditions we mean the absence of rapid freshbleeding. When only dark thick clotted blood or clots arepresent, there is little difficulty in bringing the uterus into thevagina and exposing the tube by digital touch. The size ofthe tube is ascertained, and adhesions of the tube to the hem-atocele or to surrounding structures are readily loosened, andin this manner the tube is readily brought into view. If thesize of the tube is great, if the tube is quite long, if the meso-. FiG. 4.—Shows the smaller lumen increasing in diameter while the one containingthe ovum is becoming smaller. salpinx is very friable, if the lig. infundibulo-pelvicum is short,attempts at vaginal removal must not be carried further. Atany rate the whole procedure up to the point of determiningwhether the vaginal operation is feasible, takes at the most fiveto eight minutes. As stated before, if the anterior or vesico-uterine culdesac is simply exposed or if a slight opening is madein it for diagnostic purposes, the whole procedure takes lessthan from three to five minutes. In twenty cases of ectopic gestation since the first of lastOctober, I made use of this procedure seven times, using theanterior route six times and the posterior route once. Theoperation was completed vaginally four times. Five times I have made the anterior incision and found noectopic gestation, the conditions then be
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