TUBO-ABDOMINAL PREGNANCY.
Extra-uterine gestation is so named when the ovum develops in the outer portion of the tube, the membranes often remaining. By further growth they become surrounded by a part of the tube and by false mem branes, which separate the ovum sac from the surrounding abdominal organs. • The fringed extremity with the dilated end of the tube becomes more or less extended, and the markedly lengthened fimbrix, strengthened by false membrane and by the layers of the broad ligament, end in the cavity of the ovum. The tubal wall often does not follow the developing ovum, but becomes thinned, and bursts at one or another point, at which place inflammatory exudations occur; and occasionally the effused blood forms a secondary capsule for the ovum.
Localized peritonitis and the resulting inflammatory products cause adhesions of the outer covering of the ovum with the neighboring struc tures, broad ligaments, ovaries, omentum, intestine, bladder, and uterus. Also by constant formation of false membranes and repeated rupture of the same, in the gradual development of the ovum, it becomes adherent to distant organs, spleen, kidney, liver. The placenta is usually found in the pelvic portion of the abdominal cavity.
Occasionally the tube and the ovary share to the same extent in the formation of the outer covering of the ovum; and from becoming im bedded in false membrane, and flattened out in the ovum cavity, there may remain no trace of the ovaries, and it may not be possible to deter mine with certainty the starting-point of the development of the ovum.
In these cases we also speak of a " graviditas tubo-ovarica." This gradual pathologico-anatomical formation of the outer covering of the ovum explains why pregnancy lasts longer in these cases, even occasionally to term, or the child may be carried beyond the normal time. Four pre parations of the Vienna Pathological Museum seemed to belong to this form of extra-uterine pregnancy: No. 2767 in the catalogue, marked right tube-ovarian pregnancy, ended in death after the fifth month; in No. 1351, the tubal opening was lost in the sac of the ovum and only traces of the ovum itself existed, death occurred at the seventh month; in Nos. 2291 and 1103, the tubes ended on the ovum saes, the foetuses of which were carried thirteen and sixteen month Tho first two instances, on account of their early unfortunate termi nation, hardly allow extended observation, unless in the form where the ovum has developed on the end of the fimbrim. When it has reached a certain size it sinks down in the pelvis behind the uterus, gives rise to numerous early troubles and causes the woman to seek the physician or clinic. Of six cases which we have had the opportunity to see, three at the clinic of Prof. Braun, three elsewhere, five belonged to this variety of pregnancy ; and of these two were operated upon at the fifth and seventh month respectively. One terminated at the seventh month, one in the second month, and one at term (fatal).