Gynecological diagnosis and pathology . ows a tubalpregnancy which has ruptured; fig. 4, the decidual cast expelled from thesame case. The tube is cut longitudinally; and, above the embryo, is seenthe rupture. The patient had symptoms of intra-peritoneal haemorrhageafter amenorrhea; and on opening the abdomen it was found full of blood,but the patient made a good recovery. 148 GYNECOLOGICAL PATHOLOGY When the ovum has reached the age of five or six weeks, it producesin the tube a distinct swelling which can be palpated on bimanualexamination. The detection of such a swelling to one side of the
Gynecological diagnosis and pathology . ows a tubalpregnancy which has ruptured; fig. 4, the decidual cast expelled from thesame case. The tube is cut longitudinally; and, above the embryo, is seenthe rupture. The patient had symptoms of intra-peritoneal haemorrhageafter amenorrhea; and on opening the abdomen it was found full of blood,but the patient made a good recovery. 148 GYNECOLOGICAL PATHOLOGY When the ovum has reached the age of five or six weeks, it producesin the tube a distinct swelling which can be palpated on bimanualexamination. The detection of such a swelling to one side of the uterus,together with an increase in the size and in the softness of the uterusitself, ought always to make us suspect the possibility of a tubal pregnancywhen there is a history of amenorrhcea followed by intermittent pain andhaemorrhage. It is, however, only rarely that we see the case at thisstage. Usually the patient does not seek advice until symptoms due torupture are present. If the rupture occurs very early, we have to rely for. Fig. 146.—Wall and Contexts ok a Hsmato-salfinx. The blood extravasation in the upper part is not due to tubal pregnancy. Thefolds of mucous membrane in the lower part look like chorionic villi, but morecareful examination shows that they are mucosa. our diagnosis on symptoms alone. The swelling in the tube may not besufficiently large to be palpable. The presence of even a large quantityof blood in the abdomen is not always easy to detect. Blood does notshow the same tendency as serous effusion to gravitate towards the flanksand lower part of the abdomen. It becomes clotted and entangled amongthe coils of intestine, and thus there is often no dulness in the flanksor above the pubes. On vaginal examination there may be a bulging inthe pouch of Douglas, but if there are no adhesions this sign also may beabsent. Such cases are diagnosed from the symptoms of internal haemor-rhage following amenorrhcea, the sudden onset, the collapse and pallor of
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