Talk:Book - Extra-uterine pregnancy - 1921

Publication date 1921

https://archive.org/details/extrauterinepreg00schu

Illustrations

910. ii.

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13 14.

IS 16.

1718. 19.

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21. 22. 23 24.

25 26. 27. 28. 29. 30.

31.

32.

33

Text of Albucasis' case

The lithopedion of Sens

Mauriceau's case

Pierre Dionis' case .

Sites of ectopic gestation

Polypoid chondrofibroma of the fallopian tube, associated with tubal pregnancy

Chondrofibroma of fallopian tube

Chondrofibroma of fallopian tube

Ruptured tubal pregnancy

A tubal mole ....

A tubal mole, the fetus still intact, but undergoing degeneration

Section of a tube showing incomplete tubal abortion

A tube removed a few hours after complete tubal abortion had taken place

Rupture of a pregnant tube subsequently to the development of tubal abortion ........

Section through uterine portion of tube

Section through isthmic portion of tube .

Section through ampullar portion of tube .

Tubal pregnancy caused by diverticula of fallopian tube

Cross section of fallopian tube of the coati

Section of fallopian tube of duvanceli, showing the straight and simpl Rugae ........

Trophoblast cells between muscle bundles of tube walls

Rupture of a gestation sac within the tube lumen

Beginning rupture of an isthmial pregnancy on the inner posterior aspect of the tube

Late rupturing tubal pregnancy

A gestation sac with large surrounding blood clot found lying free in the peritoneal cavity .....

Uterine changes consequent on ectopic pregnancy (I)

Uterine changes consequent on ectopic pregnancy (II)

Uterine changes consequent on ectopic pregnancy (III)

Decidua of uterus in case of tubal pregnancy .

Microscopic section of decidual cast

Decidua cells ........

Schematic representation of an interstitial pregnancy of four months

A mole pregnancy in the right uterine cornu .....

3

8

9 20

27 28 29 30 35 35 36

36

38 48 48

49 50 51

52 56 57

58 60

61 64 64

65 66 68 69

7i

72

FIGURE

34. An interstitial pregnancy which had ruptured, literally blowing the

anterior uterine wall into fragments .

35. Ovarian pregnancy: Posterior view (I) .

36. Ovarian pregnancy : Macroscopic section (II) .

37. Ovarian pregnancy: Microscopic section (III) .

38. Ovarian pregnancy : Microscopic section (IV) .

39. Ovarian pregnancy: Microscopic section (V) .

40. Ovarian pregnancy: Microscopic section (VI) .

41. Pelvic hematocele following tubal abortion

42. Blood mass surrounding ruptured tube

43. Microscopic section of primary chorio-epithelioma of tube

44. Decidual tissue in the appendix . .

45. Decidual tissue in a parovarian cyst

46. Fetal bones taken from abdomen after rupture of pregnant uterus

47. Lithokelyphopedion .......

48. Lithopedion from sac shown in Fig. 47.

49. True lithopedion .......

50. Lithopedion lying undisturbed in the abdominal cavity

51. Lithopedion removed from the abdominal cavity four years after

false labor . • .

52. Twin ectopic pregnancy .....

53. Triplet ectopic pregnancy ....

54. Cervical pregnancy with rupture into abdomen

55. Cervical pregnancy .....

56. A hematoma of the tube .....

57. Uterus crowded down below gestation sac

58. Uterus pushed down by gestation sac

59. Section through attachment of villi to tube wall

60. Section through veins in tube wall .

61. Section through vacuolated syncytium

62. Syncytium covering a typical villus .

63. Villus undergoing fibrous degeneration

64. Section through ovum adjoining tube wall

65. Tip of a fibrous villus .....

66. Section through a necrotic villus

67. Section of vacuolated syncytium filled with leukocytes

68. Extreme degeneration of the syncytium .

69. Group of villus cells growing into mesenchym .

70. Blood supply of fallopian tube ....

71. The details of salpingectomy for the removal of a tubal pregnancy

Index

Abderhalden reaction in ectopic pregnancy, 126

Abdominal lesions, not connected with the ectopic pregnancy when (under operation, management of, 168

Abdominal pregnancy, complicated by eclampsia, no

— ■ extraperitoneal, 82

— following normal uterine implanta tion, after rupture of uterus, 83

— primary, causes of, 31

— secondary, following tubal rupture

or abortion, 42

— secondary to primary ovarian

pregnancy, 44

— symptomatology and diagnosis of,

146

— termination of, 82

Abdominal symptoms in extra-uterine pregnancy, 133

Adenomyoma of the uterus, ectopic pregnancy occurring in gland spaces of, 112

Adhesions, peritubal, causing extrauterine pregnancy, 23

Adipocere, diagnosis of, 147

Amenorrhea, in ectopic pregnancy, 122, 123

Anemia, post-operative treatment of, 171, 172

Anteflexion of uterus, 132

Apoplexy, ovarian, 113

Appendicitis, case of, in combination with an unruptured tubal pregnancy, 109

Blood picture, in extra-uterine pregnancy, 133

Blood pressure in extra-uterine pregnancy, 134

Breast changes, in ectopic pregnancy,

125 Broad ligament pregnancy, 39, 40

Cardiac failure, post-operative treatment of, 172

Casts, decidual, of extra-uterine pregnancy, See Decidual casts.

— ■ — of membranous dysmenorrhea, 67

— menstrual, 67

Cervical pregnancy, criteria of, in

— definition and classification of, in

— frequency of, in

— 'primary and secondary, in

— terminations of, in

Cervix, softening of, in ectopic pregnancy, 125

Cholecystitis, differentiated from ectopic pregnancy, 155

Chorioepithelioma of tubes, resulting from tubal pregnancy, 84

Combined intra- and extra-uterine pregnancy, 19, 108

Cornual pregnancy, See Interstitial

Decidua, formation of, from extrauterine pregnancy, 85

— — in tubes, 53, 54

— importance of, in producing a nor mal implantation, 88 — 'passage of, in diagnosis of ectopic pregnancy, 132

— use of term, 54

Decidua vera, development of, in uterus, due to extra-uterine pregnancy, 62

— relation of decidual casts and, to

extra-uterine pregnancy, 63 Decidual casts, of extra-uterine pregnancy, description of, 66

— — -diagnostic errors from examina tion of, 65 — ■ — 'passage of, in diagnosis of ectopic pregnancy, 64, 132

— of membranous dysmenorrhea, de scription of, 6y Decidual masses in the omentum, etiology of, 85

Decidual reaction in tubes, as cause of extra-uterine pregnancy, 25, 50

Ecchyesis, See Extra-uterine Pregnancy

Eclampsia, complicating extra-uterine pregnancy, no

Ectopic pregnancy, See Extra-uterine Pregnancy

Electricity, in treatment of ectopic gestation, 15

Embryo, death of, with formation of tubal mole, as termination of ovarian pregnancy, 35

— fate of, in extra-uterine pregnancy,

87 ■ — -normal and pathological, 88

— percentage that goes on to full term,

88 Extra-uterine pregnancy, abdominal,

complicated by eclampsia, no

extraperitoneal, 82

— ■ — following normal implantation of

ovum, after rupture of uterus, 83

primary, causes of, 31

'secondary, 42

secondary to primary ovarian

pregnancy, 44 — ■ — symptomatology and diagnosis of,

146 termination of, 82

— advanced, common forms of, 80 pathology of, 79

placental attachment in, 82

— i — question as to whether fetal development may continue uninterrupted, 81

treatment of, 173

'when fetus is known to be

dead, 176

— age incidence of, 19

— anatomicopathological groups for

diagnosis of, 119

— before any bleeding takes place into

the tubal wall or the peritoneal cavity, symptomatology of and difficulties of diagnosis, 120, 121

— with beginning tubal abortion or a

minute rupture, permitting a minute quantity of free blood to come in contact with peritoneal surfaces, diagnosis and symptomatology of, 121

Extra-uterine pregnancy, bimanual examinations for, importance of care and gentleness in, 132

— broad-ligament, 39, 40

— ■ causes of, accessory tubes, 25

anomalies of tubal lumen, 25

constriction resulting from pressure of a tumor of neighboring structures, 24

decidual reaction in tubes, 25,

50

■difficulties in arriving at, 22

— ■ — external migration of the ovum,

27, 51

gonorrhea, 24

— ■ — identical in both tubes, 101

— ■ — inflammatory, 30

— ■ — interference, 23

— ■ — of interstitial pregnancy, 70

— ■ — mechanical or postinflammatory obstruction to ova, 29, 50

monstrous or deformed ova,

29

— ■ — 'obstruction of tubal lumen from within, 24

■ obstruction of tubal lumen from

without, 23

— ■ — of ovarian pregnancy, 31

' peritubal adhesions, 23

■ pre-existing pelvic disease, 129

— ■ — previous operations, 130

— ■ — ■ previous conservative gynecological operations, 23

of primary abdominal, 31

— — salpingitis, 24

— ■ — ■ Schil's theory, failure of unstriped muscle fibers of tube to contract, 29

secretion by tube of substances

toxic to ovum, impairing its vitality and ability to progress, 29

sterility, 127

'Summing up of, 29

■ tubal polyps, 28, 50

— ■ — -tumors of the tube, 27

— cervical, in criteria of, ill

'definition and classification of,

ill — ■ — frequency of, 111

■ primary and secondary, in

— ■ — -terminations of, in

INDEX

181

Extra-uterine pregnancy, co-existing with intra-uterine, 19, 108

— - comparative results with normal and with pathological embryos, 88

— complicated, 109

diagnosis of, 147

by eclampsia, HO

by fibroid tumors of uterus, 109

by inflammatory disease, 109

by toxemias of pregnancy, no

— cornual, See Interstitial

— decidual cast of, description of, 66 diagnostic errors from examination of, 65

passage of, in diagnosis, 64,

132

— definition of, 17

— diagnosis of, abdominal pregnancy,

146

adipocere, 147

amenorrhea, 122, 123

anatomicopathological groups for,

119 in beginning tubal abortion or

with a minute rupture, permitting

a minute quantity of free blood to

come in contact with peritoneal

surfaces, 121 in cases without any leakage of

blood into the abdominal cavity,

difficulties and symptomatology of,

120 ■ from character of menstrual flow,

122, 123

in complicated cases, 147

concomitant signs of pregnancy,

124

Abderhalden reaction, 126

anteflexion of uterus, 126,

132

breast changes, 125

■ — enlargement of uterus, 125,

132

frequency of urination, 126

increased pigmentation, 125

morning nausea and vomiting,

125

softening of cervix and enlargement of uterus, 125, 132

difficulties of, 118, 119

— ■ — evidences upon which correct conclusion may be reached, 121

Extra-uterine pregnancy, diagnosis of,

findings on general examination

of patient, 131 — ■ — ■ — abdominal, 133

— ■ blood picture, 133

blood pressure, 134

— • — ■ — -enlargement of uterus, 125,

132

— ■ -Hegar's sign, 132

— ■ — ■ — -passage of decidua or decidual

casts, 132

■ — pelvic mass, 131

— pulse, 133

— ■ temperature, 133

first steps in, 118

— ■ — -with frank rupture of sac or tubal

abortion, 136

— asthenic group, 136

— ' — ■ — sthenic group, 138

— ■ — -hemorrhage, character of, 122 124 -histological, 157

— — -history, 122

— — ■ importance of care in bimanual

examinations, 132

— — interstitial, 143

— -long existing and untreated ectopic gestation, 141

■ — hematocele, 141

■ — lithopedion or adipocere, 147

— ■ — ■ — tubal mole, 142, 143

■ — other than tubal, 143

'Ovarian pregnancy, 145

-pain of interstitial forms in contradistinction to that of tubal, 1 43 .

pain in pelvis as most important

and constant sign of, 126

by palpation, 121

previous history, 127

— ■ — ■ — general health and medical history of patient, 130

-pre-existing pelvic disease, 129

— — ■ — previous operations, 130 — sterility, 127

tubal mole, 141

— differential diagnosis of, from acute

salpingitis, 151

general divisions for, 119

from hemorrhage from tube or

ovary, not in relation to pregnancy, 148 from ovarian cysts, 152

182

INDEX

Extra-uterine pregnancy, differential diagnosis of, from retroversion of the normally pregnant uterus, 153

— . — from ruptured gastric ulcer, renal colic, cholecystitis, etc., 155

from uterine abortion, 148

— , — various forms indistinguishable after rupture, 145

— 'extraperitoneal abdominal, 82

— fate of embryo in, 87

— fate of fetus in, summarization of,

96

— fetuses that develop to full term,

deformities of, 88, 89

— — normal, 89

— frequency of, age incidence, 19

'Constantly increasing, 17

— explanation of, 18

figures showing absolute relation

of extra- to intra-uterine pregnancy, 18

of interstitial, 69

.old statistics, 17

— • — of ovarian cases, 83

race incidence, 19

.relative, of various forms, 21

— frequency of recurrence of, 101

— histological diagnosis of, 157

— history of, Bain's operation, for

long-retained fetus (1540), 5

Campbell's Memoir (1842), 11

'Case of Albucasis (nth century),

1, 2 — . — case of Bard, America (1759), 9

'case of Baynham, 10

case of Calvo, France, 1714, 6

case of Cornax ( 16th century) , 4

case of Felix Platerus (1594), 7

case of Mauriceau (1669), 7

case of Nufer (1500), 4

case of Primrose (1594), 6

— . — case of Riolan (1604), 6 case of Schmitt, interstitial pregnancy, 10 — — cases of, in America, from 1791

to 1846, 10 first absolutely definite case

(1594), 6

first case of tubal gestation with

rupture, 1604, 6

first recorded case (nth century), 1

in America (1759), 9

Extra-uterine pregnancy, history of, increased interest in, in America, from 1846, 10

-lithopedion of Sens (16th century), 3

— > — monograph of Dezeimeris (1837), 10

— ■ — 'Ovarian pregnancy, 12

— ■ — 'Parry's work (1876), 11

Pierre Dionis on (1718), 9

Tait's work, 12

— ■ — 'Unknown to ancients, I

'varieties of, 10

— ■ — 'Werth's studies, 12

— history of treatment for, 12

— ■ — 'in early rupture of tubal pregnancy, 12

— ■ — 'electricity, 15

gastrotomy, 14

.laparotomy dating from 1500,

12

— 1 — Parry on, 12

— ■ infected and suppurative cases of, treatment of, 176

— 'interstitial, diagnosis of, 143

etiology of, 70

— ■ — first recorded case of, 10

— ■ — frequency of, 69

groups of, 70

— ■ — illustrative cases of, 71

— ■ — ■ pain of, in contradistinction to that of tubal pregnancy, 143

— 1 — pathology of, 69

— • — 'rupture of, 143

— — ■ symptomatology and diagnosis of,

143 terminations of, 70

— — — by gradual growth of fetus

into uterine cavity, 41 treatment of, 172

— intraligamentary, 44

— mortality of, 177

— onset of, general form of, 134

— ovarian, causes of, 31 — 1 — diagnosis of, 145 duration of, 76

first case diagnosed as, 12

frequency of, 73

pathology of, 73

placentation in, 75

rupture of, 77

terminations of, 34

treatment of, 173

INDEX

183

Extra-uterine pregnancy, ovarioabdominal, 44

— placentation in ovarian pregnancy,

— primary abdominal, causes of, 31

— prognosis of, 177

— question of removal of non-pregnant

tube as routine procedure in operation for, 102

— race incidence of, 19

— recurrent, cause of, 102

frequency of, 101

interesting case of, 103

for third time, instances of, 103

— relation of uterine decidua and de cidual casts to, 63

— repetition of, 19

— results of fetal death, without sur gical removal, lithokelyphopedion,

92

lithokelyphos, 92

lithopedion, 91

skeletonization, 89

suppuration, 89

— ruptured, diagnosis of, 136

due to bimanual examinations

without sufficient care, 132 simulated by hemorrhage from

ovary or tube, 113 simulated by hemorrhage from

rupture of an apparently normal

graafian follicle, 113

— ruptured tubal, delayed surgical in tervention, 15

electricity in treatment of, 15

first American operation for, 15

gastrotomy in treatment of, 14

hemorrhage from ovary or tube

simulating, 113

history of treatment for, 12

immediate laparotomy the rule

today, 16 .Parry's work on, 12

— secondary abdominal, 42

— symptomatology of, abdominal, 133

of abdominal pregnancy, 146

amenorrhea, 122, 123

in beginning tubal abortion or

with a minute rupture, permitting a minute quantity of free blood to come in contact with peritoneal surfaces, 121

blood picture, 133

Extra-uterine pregnancy, symptomatology of, blood pressure, 134

.in cases without any leakage of

blood into abdominal cavity, 120

— — character of menstrual flow, 122,

123 — ■ — concomitant signs of pregnancy,

124

Abderhalden reaction, 126

breast changes, 125

. — enlargement of uterus, 132

— . ■ frequency of urination, 126

— ■ increased anteflexion of uterus,

126

increased pigmentation, 125

morning nausea and vomiting,

125

softening of cervix and enlargement of uterus, 125

— . — evidences upon which a correct conclusion may be reached, 121

— . — with frank rupture of sac or tubal abortion, 136

generally one of a subacute disease rather than one of fulminant type, 134

hemorrhage, character of, 122 124

of interstitial forms, 143

in long existing and untreated

cases, hematocelej tubal mole, lithopedion formation, etc., 141

pain in pelvis most important and

constant sign, 126

— ■ — passage of decidua or decidual casts, 132

pelvic mass, 131

— —pulse, 133 .temperature, 133

— terminations of, 135

■ in abdominal cases, 82

of cervical, in

by death of embryo with the formation of tubal mole, 35

end results, hematocele, 44, 77

'resorption of products of gestation, 44

— . 'terminal changes, 46

• — tubal mole, 44

gradual growth of fetus into uterine cavity, in cases of interstitial pregnancy, 41

Extra-uterine pregnancy, termination of, growth and development of fetus to full term, while still confined in tube, 41

hematocele, 44, yy

in interstitial cases, 70

primary, 33

by rupture of the pregnant tube,

37 between the folds of the broad

ligament, 39

into the peritoneal cavity, 37

secondary, abdominal pregnancy,

secondary to primary ovarian

pregnancy, 44

intraligamentary pregnancy, 44

■ — ovario - abdominal pregnancy,

44

secondary abdominal pregnancy, 43

tubo-abdominal pregnancy, 42

tubo-ovarian pregnancy, 43

— ■ — by tubal abortion, 35

tubal rupture, 57

— 'tissue changes resulting from, 84

chorioepithelioma, 84

— • — decidua formation, 85

— 'treatment of, in advanced cases, 173

when fetus is known to be

dead, 176

after rupture of sac or tubal abortion, with intra-abdominal hemorrhage, 162

— ■ — after rupture, when surgical facilities are available, closure of the incision, 168

■ — expectant plan of treatment,

163, 164

indications for delayed surgical intervention, 173

in interstitial cases, 172

management of abdominal

lesions not connected with the ectopic pregnancy, 168

— ■ management of the affected

tube, 166

management of free blood and

clots in the abdominal cavity, 166

management of the remaining

tube, 167

■ operation, regardless of condition of patient, 163, 165

operative procedure, 165

Extra-uterine pregnancy, treatment of, after rupture, in ovarian cases, 173

postoperative, 171

— technic of the laparotomy, 169

two indices of patient's condition, 165

— "vicious catch phrases" used in

determining, 164

— ■ — ■ before rupture has occurred, 161

by electricity, 15

by gastrotomy, 14

for hematocele, 176

history of, See History of treatment of

in infected and suppurative cases,

176

— ■ — management of certain phases of the condition, 161

— triplet, 106

— case of Mauriceau (1669), 7

— — case of Riolan (1604), 6

causes of, external migration of

ovum, 51 mechanical or postinflammatory obstruction to ova, 50

Pierre Dionis on (1718), 9

Regnus Graaf and others, 8

comparative results with normal

and with pathological embryos, 88

■ complicated, 109

decidua in, formation of, 54

decidual reaction causing, 52

first reported case of (1604), 6

history of treatment of, 12

mode of implantation of ovum in

tubes, 52 — ■ — 'pain of interstitial in contradistinction to that of, 143

— — ■ placentation in, 55

process of, in advanced cases, 59

See also Tubal Pregnancy and

Tubal Rupture

— tubo-abdominal, 42

— tubo-ovarian, 43

— twin, 104

diagnosis of, 105

— 1 — 'unilateral, characteristic case of,

105

— unique forms of, cervical, in in gland spaces of an adenomyo ma of the uterus, 112

— uterine changes produced by, de velopment of decidua vera, 62

Extra-uterine pregnancy, uterine changes produced by, increased size, 62

involution, 62, 63

uterine bleeding, 62

— varieties of, 10, 17, 19

Kelly's table showing changes of

primary to secondary forms, 21

primary, 20

relative frequency of, 21

secondary, 20

Fallopian tubes, accessory, causing extra-uterine pregnancy, 25

— action of trophoblast, 54

— active peristaltic powers of muscu lar layers of, 48

— anatomy of, 47

— boundaries of gestation sac, 55

— chorioepithelioma of, resulting from

tubal pregnancy, 84

— decidua in, formation of, 53, 54

— decidual reaction in, as cause of ex tra-uterine pregnancy, 25, 50

— direction of current produced by

cilia of, 47

— implantation of ovum in, always ac companied by excessive amount of

hemorrhage, 54

centrifugal, 54

columnar, 53

intercolumnar, 54

mode of, 52

resulting processes, 56

— place of meeting in, of spermato zoon and ovum, 53

— processes of infection in, 48

— situation of, 47

— susceptibility of mucosa of, to in vasion and damage by infective processes, 48

— trophoblast cells, 55

— tumors of, causing extra-uterine

pregnancy, 27, 50 Fetuses in extra-uterine pregnancy, deformities of, 88

— fate of, 96

— normal, 89

— results of death of, without surgical

removal, lithokelyphopedion, 92, 93 lithokelyphos, 92

— — lithopedion, 91 skeletonization, 89

Fetuses in extra-uterine pregnancy, results of death of, without surgical removal, suppuration, 89

— summarization of fate of, 96 Fibrinoid substance, formation of, 54 Fibroid tumors of uterus, complicating

tubal pregnancy, 109 Follicular hemorrhage, 113

— cause of, 115

Gastric ulcer, ruptured, differentiated from ectopic pregnancy, 155

Gastrotomy, for ruptured tubal pregnancy, history of, 14

Gestation sac, boundaries of, in tubes, 55

Gonorrhea, causing extra-uterine pregnancy, 24

Hegar's sign, 132

Hematinemia, as diagnostic sign of

ruptured ectopic pregnancy, 138 Hematocele, definition of, 78

— etiology of, 77

— infected, 45

— pathology of, jy

— real gravity of, 79

— resulting from extra-uterine preg nancy, 44

— secondary rupture of, 79

— size of, 78

— solitary, 45

— symptomatology and diagnosis, 141

— treatment of, 176

Hematoma, ovarian, 113

Hemorrhage, of extra-uterine pregnancy, amount of, in tubal abortion, 61, 62

character of, 122-124

— from graafian follicle, 115

apparently normal, 113

^causes of, 115

— from ovary, causes of, 113

diagnosis of cause of, 115

occurrence of, 113

pathology of, 115

from ovary or tube, simulating

ruptured ectopic pregnancy, 113

— relative amount of, in cases of tubal

rupture and tubal abortion, 39

— from tube, causes and occurrence of, • 114

diagnosis of cause of, 115

Inflammatory disease, complicating

extra-uterine pregnancy, 109 Interstitial pregnancy, diagnosis of,

143

— etiology of, 70

— first recorded case of, 10

— frequency of, 69 relative, 70

— groups of, 70

— illustrative cases of, 71, 72., 143

— pain of, in contradistinction to that

of tubal pregnancy, 143

— pathology of, 69

— rupture of, 143

— symptomatology and diagnosis of,

143

— terminations of, 70

by gradual growth of fetus into

the uterine cavity, 41

— treatment of, 172 Intraligamentary pregnancy, 44

Jaundice, as diagnostic sign of ruptured ectopic pregnancy, 138

Laparotomy, for ruptured ectopic pregnancy, history of, from 1500, 12

— ■ — technic of, 169

Lithopedion, age of, 93

— definition of, 91

— diagnosis of, 147

— frequency of, 92

— length of time carried, 92

— size of, 93

— typical case of (Maier's), 95

— ultimate result of formation of, 93 Lithokelyphopedion, 92

— genesis of, 93

— typical case of, 94 Lithokelyphos, 92

Membranous dysmenorrhea, decidual cast of, description of, 67

Menstrual casts, description of, 67

Menstrual flow, diagnosis of ectopic pregnancy from character of, 122, 123

Morning nausea and vomiting, in ectopic pregnancy, 125

Nausea and vomiting in ectopic pregnancy, 125

Ovarian apoplexy, 113 Ovarian cysts, differentiated from ectopic gestation, ruptured, 152 Ovarian hematoma, 113 Ovarian hemorrhage, causes of, 113

— diagnosis of cause of, 115

— occurrence of, 113

— pathology of, 115

— simulating ruptured ectopic preg nancy, 113 Ovarian pregnancy, causes of, 31 — ■ diagnosis of, 145 — - duration of, 76

— first case diagnosed as, 12 — > frequency of, 73

— 'pathology of, 73

— * placentation in, 75

— -f rupture of, 77

—^terminations of, 34

death of embryo with the formation of tubal mole, 35

by resorption of the ovum, 34

secondary, abdominal pregnancy,

secondary to primary ovarian pregnancy, 44

ovario-abdominal pregnancy, 44

tubal abortion, 35

— treatment of, 173

Ovarian rupture, followed by ovarioabdominal pregnancy, 44 Ovario-abdominal pregnancy, 44 Ovum, external migration of, 51 — ' — causing extra-uterine pregnancy, 27

— implantation of, in tubes, results of,

56 always accompanied by excessive

amount of hemorrhage, 54

centrifugal, 54

columnar, 53

intercolumnar, 54

mode of, 52

— mechanical arrest of, causing extra uterine pregnancy, 29, 30

— monstrous or deformed, causing ex tra-uterine pregnancy, 29

— normal uterine implantation of, fol lowed by rupture of uterus and abdominal pregnancy, 83

— place of meeting of spermatozoon

and, 53

— resorption of, as termination of

ovarian pregnancy, 34

Pain, of interstitial pregnancy, in contradistinction to that of tubal, 143

— in pelvis, most important and con stant sign of ectopic pregnancy, 126

Palpation in diagnosis of extra-uterine pregnancy, 121

Pelvic mass, in extra-uterine pregnancy, 131

Peritubal adhesions, causing extra-uterine pregnancy, 23

Pigmentation, increased, in ectopic pregnancy, 125

Placentation, in ovarian pregnancy, 75

— in tubal pregnancy, 55 Pseudo decidua, 76

Renal colic, differentiated from ectopic pregnancy, 155

Retroversion of the uterus, normally pregnant, differentiated from ectopic gestation, 153

Ruptured ectopic pregnancy, diagnosis of, 136

— due to bimanual examinations with out sufficient care, 132

— electricity in treatment of, 15

— first American operation for, 15

— gastrotomy in treatment of, 14

— hemorrhage from ovary or tube

simulating, 113

— hemorrhage from rupture of an ap parently normal graafian follicle,

113

— Parry's work on, 12

— treatment of, 162

— ' — immediate laparotomy the rule today, 16 Ruptured interstitial pregnancy, 143 Ruptured ovarian pregnancy, JJ

— followed by ovario-abdominal preg nancy, 44

Salpingitis, acute, differentiated from

ectopic gestation, 151 — causing extra-uterine pregnancy, 24 Shock, postoperative treatment of, 171 Spermatozoon, place of meeting of

ovum and, 53 Sterility, history of, in ectopic pregnancy, 127

Temperature in extra-uterine pregnancy, 133

Tissue changes resulting from extrauterine pregnancy, chorioepithelioma, 84

— decidua formation, 85

Toxemias of pregnancy, complicating

extra-uterine pregnancy, no Triplet tubal pregnancy, 106 Trophoblast, action of, 54

— cells of, 55

Tubal abortion, amount of hemorrhage in, as compared with tubal rupture,

39

— complete, 61

— due to rupture, 57

— followed by secondary abdominal

pregnancy, 42

— incomplete, 62

— relative frequency of tubal rupture

and, 37 Tubal abortion, similarity of, to rupture of tube, 37

— as termination of ovarian preg nancy, 35

— 'treatment of, 162

Tubal hemorrhage, causes and occurrence of, 114

— diagnosis of cause of, 115

— simulating ruptured ectopic preg nancy, 113 Tubal lumen, anomalies of, 25

— obstruction of, from within, 24 from without, 23

Tubal mole, due to rupture, 58

— resulting from death of embryo, 35

— symptomatology and diagnosis of,

141 Tubal polyps, causing extra-uterine

pregnancy, 28 Tubal pregnancy, case of Mauriceau

(1669), 7

— case of Riolan (1604), 6

— -causes of, external migration of

ovum, 51 ^mechanical or postinflammatory

obstruction to ova, 50

Pierre Dionis on (1718), 9

'Regnus Graaf and others, 8

— comparative results with normal and

with pathological embryos, 88

— complicated, 109

by fibroid tumors of uterus, 109

Tubal pregnancy, decidua in, formation of, 54

— decidual reaction causing, 50

— first reported case of (1604), 6

— history of treatment of, 12

— mode of implantation of ovum in

tubes, 52

— pain of interstitial in contradistinc tion to that of, 143

— placentation in, 55

— process of, in advanced cases, 59

— question of removal of non-pregnant

tube as routine procedure in operation for, 102

— 'terminations of, in advanced cases, 60

considerations affecting, 60

by death of embryo with the formation of tubal mole, 35

growth and development of fetus

to full term, while still confined within the tube, 41

hematocele, jy

— ■ — by resorption of the ovum, 34

rupture, 57

— ■ between the folds of the broad

ligament, 39

followed by abortion, 57

followed by tubal mole, 58

into the peritoneal cavity, 37

secondary, intraligamentary pregnancy, 44

— secondary abdominal pregnancy, 43

tubo-abdominal pregnancy, 42

tubo-ovarian pregnancy, 43

by tubal abortion, 35

— tissue changes resulting from,

chorioepithelioma, 84

— triplet, 106

— twin, 104

diagnosis of, 105

— ' — unilateral, characteristic case of,

105

Tubal rupture, amount of hemorrhage in, as compared with tubal abortion, 39

— 'between the folds of the broad ligament, 39

— causes of, coitus, 41

plugging of large intervillous

veins, 59 spontaneous, 40

Tubal rupture, causes of, trauma, 40 vaginal examinations, 40

— extratubal, 58

— followed by intraligamentary preg nancy, 44

— followed by secondary abdominal

pregnancy, 42

— resulting in tubal mole, 58

— ■ followed by tubo-abdominal pregnancy, 42

— mechanism of, 57, 58 acute, 58

described by Miki Kiutsi, 58

— more frequently due to normal than

to pathological embryo, 88

— into the peritoneal cavity, 37

— ■ relative frequency of tubal abortion and, 37

— resulting in tubal abortion, 57

— secondary, 38

— similarity of tubal abortion to, 36 Tubes, fallopian, See Fallopian Tubes Tubo-abdominal pregnancy, following

tubal rupture, 42 Tubo-ovarian pregnancy, 43 Tumors, pressure from, resulting in

extra-uterine pregnancy, 24

— of the tube, causing extra-uterine

pregnancy, 2.y

— uterine, fibroid, complicating tubal

pregnancy, 109 Twin ectopic pregnancy, 104

— diagnosis of, 105

— unilateral, characteristic case of, 105

Urination, increased frequency of, in ectopic pregnancy, 126

Uterine abortion, differentiated from ectopic gestation, 148

Uterine adenomyoma, ectopic pregnancy occurring in gland spaces of, 112

Uterine bleeding, due to extra-uterine pregnancy, 62

Uterine decidua, negative findings not indicative of absence of, 64

Uterine decidua, primary factor in formation of, 87

— relation of decidual casts and, to extra-uterine pregnancy, 64

Uterine involution, due to tubal pregnancy, 62, 63

Uterine involution, due to tubal pregnancy, regressive and reparative stages of, 63

Uterine tumors, complicating tubal pregnancy, 109

Uterus, changes produced in, by extrauterine pregnancy, formation of decidua vera, 62

increase in size, 62

involution, 62, 63

Uterus, changes produced in, by extrauterine pregnancy, uterine bleeding, 62

— enlargement of, in ectopic preg nancy, 125, 132

— increased anteflexion of, in ectopic

pregnancy, 126, 132

— normally pregnant, retroversion of,

differentiated from extra-uterine pregnancy, 153