ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. TV! 



A hemorrhage forms an unusually large clot in No. 777. It lies mostly free within 

 the tube and contains within it some necrotic villi and several detached folds in the 

 tube wall; otherwise the ovum has vanished. A similar condition prevails in No. 

 835. Here also are a few scattered villi, some of which are long and fibrous and 

 permeate the clot. The trophoblast is scanty, but on one side it shows slight 

 activity; here it comes in contact with the tube wall and there is marked leucocytic 

 infiltration. The next step would be a complete destruction of the scattered villi 

 and the gradual absorption of the blood clot. Possibly such a specimen would 

 result in a pure hemato-salpinx, but my material does not carry me into a discussion 

 of this subject. 



SUMMARY. 

 CAUSE. 



A review of those specimens which are accompanied by data bearing upon the 

 cause of tubal pregnancy shows quite definitely that this condition is associated 

 with inflammatory changes, which must have preceded the lodgment of the ovum in 

 the uterine tube. Under normal conditions the tube is lined with a layer of ciliated 

 epithelium, which constantly works in the direction of the uterus and therefore 

 creates in the tube a stream of fluid from the ovaries to the uterus. The fertilized 

 ovum gets caught up by this stream and if the conditions are normal is carried into 

 the uterus. Any change which delays the ovum in its progress will favor tubal 

 pregnancy. It is well known that abnormal diverticula or duplicate tubes may be 

 the cause of tubal pregnancy. Numerous isolated cases have been described in 

 which a blind tube or large diverticulum contained the implanted ovum. In rare 

 cases the blind inner end of the tube left after an operation is subsequently found to 

 contain an ovum which has arisen from the ovary on the opposite side, which con- 

 tained the corpus luteum, whereas only on the opposite side was there a passage 

 free between the uterus and ovary. However, these anomalies are rare and can- 

 not be viewed as the rule in cases of tubal pregnancy. 



Much more commonly associated with tubal pregnancy is a chronic inflamma- 

 tion followed by adhesions and kinking of the tube. This has been repeatedly 

 observed, but it is difficult to associate adhesions on the outside of the tube with 

 the arrest of an ovum within its lumen. A glance at the protocols of our cases brings 

 out this point. Whenever histories are given, it is frequently stated that there were 

 numerous adhesions binding together the pelvic organs. It is also noticed that tubal 

 pregnancy usually takes place in women who have given birth to a child and then 

 have been sterile for a considerable period. This fact is well known to gynecolo- 

 gists, and they are inclined to believe that the occurrence of tubal pregnancy indi- 

 cates that the inflammatory condition in the tube, which prevents pregnancy for a 

 number of years, is gradually disappearing, so that if tubal pregnancy had not taken 

 place, the chances are that the tube would probably have become healed in a few 

 years, thus permitting the fertilized ovum to reach the uterus. This theory receives 

 strong support from the study of numerous cases of tubal pregnancy. If the ovum 

 within the tube contains a normal embryo there is but little adjacent inflamma- 



