Six hundred and twenty-six cases of ectopic gestation analyzed, the collective mortality of which exceeded 41 per cent. In a spontaneous course it reached a mortality of MS per cent. The most common form of ectopic gestation is that of tubal pregnancy. Schauta (Centralb. f. die mcd. Nissen., Oct. 31, '90).
Eighty-three ectopic pregnancies noted in eight thousand labors. The dangers or causes of death may be haemorrhage, septicemia, peritonitis, or perforation of important viscera by bone. Of these, hemorrhage is the most frequent. Joseph Price (Amer. Jour. of Obstet., Dec., '92).
In extra-uterine pregnancy the mor tality in cases of pelvic haemorrhage de pends, first, upon the amount of blood lost and, secondly, upon the profundity of the shock. Death due to loss of blood alone is extremely rare. For some rea sons the extravasations from a ruptured fcetal sac are attended by a shock which is out of all proportion to the amount of blood lost. In such instances the patient suffers not only from the loss of blood, but also from the extensive wounding of the peritoneum: the so-called peritoneal shock. In fatal cases of this kind death takes place in the course of a few hours. Mortality in deliberate operations upon well-prepared patients in good condition, at the hands of an experienced operator, is very small, indeed; that of operations of urgency considerable. Early operation is always desirable in doubtful as well as in certain cases. M. H. Richardson (Annals of Surg., Dec., '04).
Treatment.—The only remedy for the complication which is under considera tion consists in the complete removal of the offending mass at the earliest pos sible moment after it has been discov ered, and this may sometimes be done without interruption of the utero-gesta tion, especially if the tube and ovary on the uninvolved side are healthy and do not require removal. If the appendages on both sides must be removed the diver sion of so large a portion of the nutrient blood-supply of the uterus will almost inevitably result in the premature ter mination of the uterine gestation.
Fifty-three cases of ectopic gestation treated with electricity, with four deaths; subsequent health of patients good. Risk of rupturing the sac of an extra-uterine pregnancy, causing death from internal hemorrhage, is slight.
Electropuncture condemned in all cases. Under galvanism or faradism, early extra-uterine pregnancy can be checked in its growth, caused to disap pear or shrivel up. A. Brothers (Amer.
Jour. of Obstet., Feb., '90).
[While treatment in the earlier months by electricity for the destruction of the foetus has been ably advocated by Lusk, Skene, and others, it has been as ably opposed by Baldy, Tait, and others; first, because of the difficulty in deter mining the diagnosis of extra-uterine pregnancy before rupture of the sac; second, from the danger of the suppura tion of the ketal sac; third, because the means are in many cases ineffectual to bring about the results desired. E. E. MONTGOMERY, Assoc. Ed., Annual, '91.] In treatment of extra-uterine gesta tion, where there is free intraperitoneal while heart - stimulants, notably strychnine, should be freely em ployed hypodermically, infusion of nor mal salt solution is strongly indicated; this, how-ever, should never be infused into the circulation until the bleeding vessels have been secured. Removal of the tube and cleansing of the peritoneal cavity can then be done. C. N. Smith (Ann. of Gyn. and Ped., Aug., '06).
Thirteen cases of vaginal section of extra-uterine pregnancy, with good re sults. Cases suitable for this mode of treatment are those that rupture in the early months. Vaginal puncture and drainage are not suitable in an unrupt ured extra-uterine pregnancy. Most suitable cases are those in which a suc cession of ruptures has occurred. H. Kelly and F. Henrotin (Amer. Gyn. and Obst. Jour., Aug., '96).
In every case of extra-uterine preg nancy where the foetus lives after the rupture it is owed to its being pro tected by an unruptured amniotic sac.
Primary rupture in 99 per cent. of all cases, even in those which go to term, is into the peritoneal cavity, and not into the cavity of the broad ligament. This statement rests on examination of over 200 cases. The most dangerous variety is the interstitial. In any form of tubal pregnancy operation should be performed as soon as the diagnosis is made. Before sixth month the placenta is generally easily removed, but from the seventh month on with a living child its removal is generally impossible. In such a case the placenta must be cleaned, the cord cut, and the abdomen closed, or the abdomen can be left open and the placental surface packed with gauze until the placenta comes away. Morde cai Price (Univ. Med. Mag., July, '98).