62 



ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



It is probable that the 59 per cent of the pathological ova would have disinte- 

 grated and disappeared in some way if they had not been removed by the surgeon. 

 It is also probable that most of the specimens containing pathological embrj-os 

 would also have disappeared. Then comes the question as to the fate of the 16 

 per cent of normal embryos. A glance at table 5 shows that most of them rup- 

 ture or abort, but no doubt the few that remain within the tube may continue to the 

 end of gestation, although some of them die and are aborted. In fact, Werth gives 

 a case in which the skeleton of a very small fetus about the size of a bean was 

 found encapsulated within the tube lumen at the end of thirteen years. 



I have attempted to express in table 11 the redistribution of this 16 per cent 

 in cases in which the fetus continues to grow to the end of pregnancy, using, as a 

 guide, the proportion of anomalies in tubal pregnancy at term as given by Von 

 Winckel. Of course this would not always be their fate, because most of this group 

 die long before the end of gestation, but if this redistribution is made it is found 

 that of 100 tubal pregnancies 3.3 per cent would have reached birth, the patholgical 

 embryos would be raised from 25 per cent to 35.5, and there would be added about 

 2.2 per cent of monsters. This row of figures can now be compared with the percent- 



TABLE 11. SO specimens of tubal pregnancy which had not been examined before beinij sent to the laboratory. 



age of specimens obtained from 100,000 uterine pregnancies. If this is done it is 

 apparent that the pathological action in tubal pregnancy is far more severe than 

 upon the pathological ova obtained from the uterus. In tubal pregnancy the embry< > 

 is quickly destroyed, the ovum is easily detached and becomes necrotic, and is 

 absorbed or aborted. A normal embryo eats through the tube wall, and many of 

 them are also aborted. The appearance of a pathological embryo from the tube 

 is much like that of one from the uterus, but the destruction of tissue is more severe. 

 All this points more towards complete strangulation in the tube. The uterus ap- 

 pears to be a more favorable site for pathological embryos which continue to live. 

 This variety is less frequently found in the tube. It is probable that all small 

 monsters and pathological ova that remain in the tube disintegrate. 



There is a marked difference between early and late monsters from the tube 

 and those from the uterus. In the former there is a marked gap between these two 

 varieties. In the uterus there is a finer gradation from one to the other. The con- 

 clusion of our study of tubal pregnancy regarding this point is that there is a break 

 within the pathological group in the tube; thus we have the early stages in which 

 the changes are very severe, and later stages which show special varieties but which 



