. The diagnosis of diseases of women . e ovum develops in theampullary portion of the tube and with about equal frequency inthe interstitial and fimbriated portions. CLASSIFICATION OF ECTOPIC PREGNANCY. I. Ampullar Tubal Pregnancy, in which the gestation beginsin the ampullar end of the tube. Ampullar tubal pregnancy ^ Australian Medical Gazette, August 20, 1902. 2 Wien, klin. Wochenschr., No. 47. 3 American Journal of Obstetrics, March, 1904. 150 SPECIAL DIAGNOSIS may persist as such, or the gestation sac may rupture from thetube. 1. Persistent. In rare instances the gestation in the ampullam
. The diagnosis of diseases of women . e ovum develops in theampullary portion of the tube and with about equal frequency inthe interstitial and fimbriated portions. CLASSIFICATION OF ECTOPIC PREGNANCY. I. Ampullar Tubal Pregnancy, in which the gestation beginsin the ampullar end of the tube. Ampullar tubal pregnancy ^ Australian Medical Gazette, August 20, 1902. 2 Wien, klin. Wochenschr., No. 47. 3 American Journal of Obstetrics, March, 1904. 150 SPECIAL DIAGNOSIS may persist as such, or the gestation sac may rupture from thetube. 1. Persistent. In rare instances the gestation in the ampullamay go to full term. The gestation sac is pedunculated, movable,incarcerated, or fixed by adhesions. When confined to the pelvisthe uterus and ovary are crowded to the opposite side; when largeand lying in the abdominal cavity the uterus may not be a rule, the gestation sac lies at the side of or behind the uterus,rarely between the bladder and uterus. Adhesions may firmlybind the tube, uterus, and ovary- together. Fig. 42. Ectopic pregnancy located in the uterine end of the tube. This might be called a tubo-interstitial pregnancy, inasmuch as the uterus formed a part of the gestation sac. Thepregnancy had advanced about eight weeks. Rupture had not occurred. 2. Rupture may occur early. The most likely exit is betweenthe layers of the broad ligament, though not infrequently it rupturesinto the free peritoneal cavity. (a) Suhperitoneoabdominal gestation, in which the ovum escapesthrough the lower segment of the tube between the layers of thebroad ligament. Here the ovum may perish or go on to fulldevelopment. Rupture usually takes place not later than the four-teenth week. The escape of the foetus and blood may be gradualor abrupt. So gradual may the process be that no general disturb-ance will be caused, and, on the other hand, the foetus and bloodmay be discharged in such a manner as to occasion profound the gestation sac enlarges the layers of the broad l
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