Gynecological diagnosis . ached to theendometrium in the neighborhood of the orifices of the tubes. Theuterus grows faster than the ovum at first, and the ovum withits envelopes does not fill the uterine cavity until the end of thethird month, when the decidua reflexa joins the decidua vera. The first change in shape noted in the gravid uterus consists ina slight enlargement of its transverse diameter; then it becomeslengthened and fatter as the ovum increases in size, especially in 424 NORMAL UTERINE PREGNANCY the anterior part of the body of the uterus; this anterior bulgingbeing quite chara
Gynecological diagnosis . ached to theendometrium in the neighborhood of the orifices of the tubes. Theuterus grows faster than the ovum at first, and the ovum withits envelopes does not fill the uterine cavity until the end of thethird month, when the decidua reflexa joins the decidua vera. The first change in shape noted in the gravid uterus consists ina slight enlargement of its transverse diameter; then it becomeslengthened and fatter as the ovum increases in size, especially in 424 NORMAL UTERINE PREGNANCY the anterior part of the body of the uterus; this anterior bulgingbeing quite characteristic in many cases. Asymmetry is causedby the development of the ovum in one cornu, a not uncommonhappening. Uterine enlargement may be detected by the practisedhand as early as the sixth week; in the third month there can beno doubt about it, even to the tyro. The softening of the uterusvaries in different individuals and at different times in the sameindividual. It is less in primiparse than in multipara, but under. Fig. 178.—Six-weeks Pregnant Uterus with Elongation of Cervix, ShowingExtent to which its Cavity Is Occupied by the Ovum. , external os; ,internal os; , decidua vera; , decidua serotina; , decidua reflexa;Emb., embryo; P., placenta. (Williams.) the influence of pregnancy there is always an increase in elasticity ofthe organ. Even as early as the first weeks the rhythmical contrac-tions which go on throughout pregnancy may be felt by patientbimanual palpation. They involve the entire uterus and are ex-cited by any manipulation of the organ, therefore the bimanualexamination should last from five to ten minutes so that sufficienttime may be afforded for contractions to take place. Ellice Mc-Donald (Amer. Jour. Obstet., LVIL, 1908) observed intermittent FIRST THREE MONTHS OF PREGNANCY 425 contractions in 88 out of 100 cases of early pregnancy examinedwith reference to diagnosis. The lower uterine segment is theportion of the uterus where th
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