Vol. 60, 1909 - University of North Carolina at Chapel Hill

374 THE CHARLOTTE MEDICAI, JOURNAL.
thing as primary abdominal pregnancy ever at the upper portion of the tube. The ovui
occurs. is usually surrounded by the amnion an
The most trustworthy statistics on the the chorion, The latter being fixed by i
subject tell us that eight and one-half per villi to the mucous lining of tlie tube. Ov
cent, of all cases of eccyesis are abdominal ing to the comparatively brief stay of tl
in character. In the primary form the ovum ovum in the tube a true placenta is ni
i
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falls into the peritoneal cavity and becomes
fixed there. The secondary form arises by
usually formed there. A hyperplasia of tlj
tubal tissues forms a sort of pseudo decidij
rupture of a salpingocyesis by which either the uterine extremity of which at times |
the fetus alone or the whole product of con" found open in continuation of the uteriij
ception is thrown free into the abdominal cavity. Bv reason of the loose attachmej
cavity. At the time of occurrence of the of the chorionic villi, they are easily lacer|i
tubal abortion the placental attachment to ted causing hemorrhage which often prj
the tube must remain in whole or at least in duces rupture of the tube. Tubal abortid
part undisturbed until new attachments and is apt to occur before the end of the secoi
a new circulation can be formed.
Etiology.—The specific cause of an indimonth.
The conception product seldoi
escapes from the end of the tube and usual <
vidual case is exceedingly obscure. Gen- is freed by rupture. In a few cases ruptu
erally speaking whatever condition that prevents
the passage of the ovum to the uterus,
does not take place and a fleshy mole
formed similar in nature to that which j
but which does not prevent the passage of sometime formed in the uterus. The y
the spermatozoon to the ovum may bring mary abdominal form occurs when t,'
about this state. Most cases occur between ovum becomes fertilized in the abdoraiiij
the twentieth and thirtieth years of life. To cavity. Occasionally the ovum becoiu;;
classify causative factors we ha^'e malform- implanted on the fimbria ovaries, or it m ;
ational (congenital or otherwise) anH path- become fixed to the bottom of the Cul i
©logical conditions of the tube. Under the Sac or Douglas, either of the iliac fossae !
first class we have diverticuli, etc. Under
the second class are any and all inflammato
the intestines. Tuliolsk^; reports a :|
markable case in which the attachment w
tory states which will result in hyperplastic mainly to the under surface of the liver, t
or neoplastic tissue, these conditions lead- case going nearly to term.
ing to obstructions of the lumen of the tube. The surface of attachment in the beg I
The ciliated epithelial lining of the tube ning is necessarily small but the placet;
may be destroyed and the walls of the tube after it begins to form rapidly radiates a
infiltrated. Inflammation bands of peritoneum
may distort or compress the tube,
becomes attached to numerous points. 1:
peritoneum under the ovum becomes mui
Thick mucus in the lumen or the external congested and thickened, a sort of cyst w j
pressure of an abdominal growth may block is formed which contains many blood v
the way. Recurrent cases are rare, A sels. This surrounds the ovum and for J
large number occur in women who have a false decidus while within the uterus .1
been relatively or completely sterile. The true decidua is formed,
average time elapsed since last pregnancy The secondary form may occur after' il
was four and one-half years. Occurs most rupture of an extra uterine or intra-uter !|
often in multiparous women. It is more pregnancy and the escape of its contents ii*
likely to follow a full term pregnancy than the abdominal cavity, provided the circu-i
a miscarriage or an abortion. It is gener- tioii and nutrition is maintained the embiu
ally conceded that extra uterine pregnancy continues its growth in whatsoever part '!(
is due to mechanical defects of some sort, the abdomen it has lodged. Fetal ms :!
As in many respects abdominal pregnancy branes are developed about the ovum wli]
is but the variant of a general type I will the placentan may or may not change tj
consider the subject of ectopic gestation as site and attachments. In the uterus fi
a whole. changes are much the same as in nori I
Pathology.—Under the primary forms we pregnancy. For the first three or ft!
have (1) ovarian (2) abdominal (3) tubo- months changes of the endometrium ;i|
ovarian (4) tubal which is divided into am- hypertrophy occur after that the uterus
pullar, isthmial and intestial. All in ac- mains practically at a standstill, Absc-i
cordance with the location of the conception tioii is the fate of the fetus that has b'i
product. The ovum develops usually to- extruded into the abdominal cavity un i
ward the outer end of the lumen of the tube, conditions favorable to a continuance of i'
As it grows tiie sides of the tube expanding circulation remain. The escape of the f«»i
become much hypertrophied and assume a from the tube usually happens between 'i
spindle shape. The growth is not regular eighth and twelfth weeks. J
and even, and some parts may be thin and The termination of metacyesis in m
easily ruptured. This usually takes place treated cases when not fatal, as mji
; ! !