OVARIAN PREGNANCY.
We apply this term to that form where the ovum is developed in the ovary, and the tubes at the outset are not involved For a long time this variety of pregnancy was declared impossible by many authors—as, for instance, Velpean and Max Mayer, a student of Bischoff's. The latter was entirely opposed to the idea of ovarian preg nancy, because for the impregnation of the ovule it appears necessary that an unobstructed contact of the spermatozoa with the ovule should take place, and because a mucous membrane of peculiar structure and rich in vessels is a necessary accompaniment to development, and because, further, the reported cases of so-called ovarian pregnancy are lacking in sufficient anatomical data. He found a preparation described by Summering as "graviditas in ovario sinistro," but on close examination proved it to be tubal pregnancy. Mayer claimed a similar origin for all abdominal preg nancies; also Kiwisch held, in his day, that ovarian pregnancy could not be accounted for.
Ovarian pregnancy has always had its opponents, as William Campbell, and also later authors have considered its existence unproved. Of the well-known cases of ovarian pregnancy Spiegelberg found only nine that he could be sure of. One case that he himself described as ovarian preg nancy lacked in the first place the requisite ovaries; 2, ovarian elements were found in the ovum sac; 3, the ovum sac was connected with the uterus by the ovarian ligament; 4, the tube appeared the same as in larger ovarian cysts. Lately Vulliet and Beaueamp have written of cases where pregnancy occurred, according to the first in a tubo-ovarian cyst, accord ing to the latter in a tube that was adherent to the ovary. Landau has described and illustrated a case where the ovum was situated on the inner surface of the ovary. The starting-point of all these cases might have been at the abdominal end of the tube. The supposed early varieties of ovarian pregnancy were described by Patenko and Hildrek Cambridge.
We are of the opinion that the origin of ovarian pregnancy is easily accounted for—that after the bursting of a follicle the ovule does not escape, but remains in the ovary, by some cause becomes impregnated, and is prevented from following its proper course. Schroder believes that when an impregnated ovum remains in the Graafian follicle it may develop in two ways.
If the Graafian follicle remains open the developing ovum may grow through the laceration, and while the situation of the ovum changes the placental point remains ovarian. P. M. Walter has described a case of this variety of development, and the same was anatomically explained by Bidder. A tumor six inches long, four wide and three thick was situated on the lengthened and thickened ligament of the ovary, which on its posterior surface had a flat surface that extended from a cavity on the surface of the ovum, ragged pieces were located on the edge of the latter and extended into the abdominal cavity. The remaining upper portion of the tumor consisted of thick unorganized fibrous material upon which was a sharply defined placenta-like structure, on cutting which a large amount of blood escaped. The substance of the ovary was entirely taken
up by this formation, and consisted of a net-work, the cavities of which were filled with blood and villi of the chorion. The tube with its fimbrim on the same side was normal in appearance. Prof. Kundrat made a necropsy on a remarkable case of cure in which the sac of a four months' ovum burst, and the embryo continued to develop in the free abdominal cavity, and the case will later be described under the head of secondary abdominal pregnancy.
The second variety of development is where the rupture of a Graafian follicle takes place over an impregnated ovum, followed by closure and continued development of the same within the ovary. The same occur rences take place around a developing ovum, as in the formation of an ovarian cyst. Some consider it possible for an ovule to become impreg nated without rupture of the Graafian follicle, as it is doubtless possible for spermatozoa to pass through the thinned wall of the follicles.
Since early instances of development of this variety of pregnancy do not exist, and by advanced growth the relation of the ovaries to the developing ovum is not easily made out on account of adhesions with the surroundings, especially with one or the other tube, so in many cases we fall back on the ideas of glob, who considered cases belonging to this variety as instances where all parts of the ovum-sac had entirely escaped from the ovary, and also where parts of the tube remained in its con struction.
J. Hess wrote of a marked case of this variety that occurred in Gusserow's clinic, which terminated fatally at the end of the seventh month of pregnancy. The ovisac formed a round tumor nine inches in diameter, similar to an ovarian cyst, the upper surface of which contained large venous vessels, the cyst itself being attached by broad adhesions to the broad ligaments, intestine and abdominal wall; the last third of the tube on the same side was lost in the adhesions of the cyst; the remainder of the ovaries could not be found. The walls of the cyst were of an inch in thickness, composed of conglomerate tissue, the cavities of which were filled with villi of the chorion. Exteriorly there was a placenta-like covering, containing large vessels, which was easily removed; internally was the chorion and amnion; on the thinner portion, where the three last layers alone were found, the villi of the chorion projected into the veins of the outer layer.
It is very difficult in advanced extra-uterine pregnancy to determine from which point the development of the ovum takes place; and in only one preparation in the Vienna Pathological Museum, No. 2124, do we find the statement that the ovum probably developed in the right ovary. It concerned a seven months' ovum-sac on which the right tube is spread out and in which portions of the right ovary could be detected.