ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



79 



No. 597. 



(Professor Brodel, Baltimore.) 



Normal embryo, 9 mm. long. Last period about G 

 ks ago. Began bleeding about 10 days ago and stopped 

 on day of operation. The ovum, about 20 mm. in diame- 

 ter, was about to abort from the uterine tube into the 

 abdominal cavity. Fragments of an ovum and embryo 

 are embedded in the blood clot. The villi are numerous 

 and branch two or three times. Apparently they are 

 all of the same size. The embryo is normal in form, but 

 its head is broken. It is about the stage of No. 163. 

 Its greatest length is 9 mm. There are numerous marked 

 changes in the walls of the chorion, and curious cells in 

 their mesenchyme. The villi are not robust and the tro- 

 phoblast is scanty. The chorion is almost entirely sepa- 

 rated from the tube wall by a mass of blood. The embryo, 

 which is not cut, is perfectly smooth and apparently 

 normal. Many degenerating villi are found in the clot. 

 At certain points the villi butt up against a mass of leu- 

 cocytes and here there are degenerative changes in the 

 trophoblast. It is often scanty and wanting, and in the 

 latter case the leucocytes are invading the mesenchyme. 



No. 602. 



(Dr. Sperry, Baltimore.) 



(Plate 6, fig. 5.) 



At operation the tube was found to be bleeding from its 

 free end an apparently beginning tubal abortion. The 

 tube measured 50X25X2.5 mm. After being hardened 

 in formalin, it was cut into blocks and a collapsed ovum, 

 13 mm. in diameter, was found within. Sections through 

 this show that it is filled with blood and separated from 

 most of the tube wall by a fresh clot. At one point the 

 villi are blended with a fold of the tube. The collapsed 

 ovum is a mass of degenerating villi, many leucocytes and 

 red corpuscles, as well as a most active trophoblast, 

 so active that it often ramifies away from the villi into the 

 clot, giving the appearance of connective tissue. At 

 certain points the syncytium is enormous, the nuclei 

 often making a continuous mass. Follicular salpingitis in 

 fimbriated end of tube. 



No. 612. 



(Dr. Nichols, Baltimore.) 



(Plate 6, fig. 2.) 



Embryo, 8 mm. Patient, age 34, mother of a healthy 

 8 months old child. No miscarriages. Ruptured tubal 

 pregnancy (left), operated upon by Dr. F. K. Nichols 

 (St. Agnes) at 1 a. m. October 4. Sac opened at operating 

 table, when embryo was seen. Put at once into 4 per cent 

 formalin. Changed at 5 p. m. into 10 per cent formalin 

 by Dr. Evans. The sac containing the embryo was 

 sewed up at once. Two pieces were cut off and put into 

 fresh 10 per cent formalin. October 8, 1912. The tube 

 was cut open; it contained a beautiful white body, prob- 

 ably a distorted normal (?) embryo. The distended tube 

 is about 30 mm. in diameter, with a cavity lined w r ith a 

 smooth membrane, 10 mm. in diameter. In it is the body 

 of an injured embryo, the sections of which look like those 

 of a crushed normal specimen. The section of the chorion 

 would pass for one from a normal ovum in the tube. 

 All of the processes seem active. The tissues of the 

 embryo are pretty well disorganized, but stain well. I 

 was inclined to believe them normal, but Dr. Evans 

 thought otherwise. The tissues are probably dissociated. 

 The embryo is injured too much to determine its form 

 and stage of development. The villi are beautifully 



developed, having a transparent mesenchyme in which 

 are delicate blood-vessels. The trophoblast is very 

 extensive, with large syncytial masses. It is nccrotic where 

 it comes in contact with masses of leucocytes. The tro- 

 phoblast has eaten nearly through the tube wall and at 

 some points has eroded the blood-vessels. In places the 

 extensive trophoblast shows beautiful vacuolation. 



No. 634. 



(Dr. Hetfiekl, Brooklyn, New York.) 



Embryo, CR 10, AR 14 mm. The patient, '_':> \<>;irs old, 

 missed her period 4 weeks before the ectopic pregnancy was 

 recognized. The embryo is somewhat distorted, but to all 

 appearances is normal. Only the embryo was sent to 

 the laboratory. 



No. 640. 



(Dr. Lowsley, New York.) 



A ruptured tube (60X40X30 mm.) ami ovary were 

 sent. Sections of the tube show a mass of villi with an 

 extensive trophoblast. Many villi are degenerating, but 

 many others appear to be normal. The villi have blood 

 vessels filled with blood. Although they appear to be 

 quite active, it is possible that the tube ruptured some 

 time before the operation. The main chorionic wall could 

 not be seen in any of the sections. 



No. 657. 



(Dr. Elting, Albany, New York.) 



(Plate 7, fig. 4.) 



Normal embryo, CR, 25 mm. 



On April 20, 1913, Dr. Elting writes: 



"The patient is a woman aged 36, who has been married 

 twice. She is white, has one child 17 years of age, has 

 never had any miscarriages previously, and has always 

 enjoyed the best of health. Her menstruation has always 

 been regular. What she regards as her last menstruation 

 and which she says occurred at the regular time, began 

 3 or 4 days before she entered the Albany Hospital, March 

 12, 1913. She had no idea at that time that she was 

 pregnant. On admission to the hospital she was flowing 

 moderately. There was some enlargement of the uterus, 

 and a small mass on the left side was made out. No posi- 

 tive diagnosis of extra uterine pregnancy was made, 

 although such a condition was considered and thought 

 possible. Aside from the specimen, there was practically 

 no other pathology evident at the time of operation. 

 The patient made a very satisfactory recovery and is at 

 the present time perfectly well." 



The whole uterus with both ovaries was received in 

 formalin. A window cut into the distended tube revealed 

 a beautiful normal embryo. This tube measures 90 X 

 50X50 mm. The ovaries are very fibrous on the opposite 

 side of the tubal pregnancy containing the corpus luteum. 

 The space between the chorionic membrane and the tube 

 wall, some 8 to 10 mm. in thickness, is composed of a clot, 

 much of which is fresh. Through the clot ramify the villi, 

 many of them reaching the tube wall, where they are covered 

 with a rich and active trophoblast. This invades the 

 tube wall as villi in its folds, showing that a firm attach- 

 ment has been made. Many of the villi are degenerating, 

 and in the older portion of the clot there is an active 

 invasion of the leucocytes. The chorionic wall is quite 

 thin in places, but in general it appears to be normal. 

 Many of the villi are necrotic and are being invaded by 

 leucocytes. In places the folds of the tube unite at their 

 tips, forming pockets. In general they have been pretty 



