xn. B. 1 GtuLzon: Case of Advanced Pregnancy 35 



The bleeding, which was considerable, was stopped partly by 

 pressure and partly by means of ligatures. The raw surface 

 of the uterus was covered up, and the abdomen was closed with- 

 out drain. 



The patient had no postoperative complications and was dis- 

 charged in good condition two weeks after the operation. 



PATHOLOGIC EXAMINATION OF THE PLACENTA AND OTHER TISSUES 



REMOVED WITH IT 



A careful examination of the specimen showed that a portion 

 of the placenta was firmly attached to the fallopian tube and 

 ovary. The case can be interpreted, therefore, as one of tubo- 

 ovarian pregnancy at the beginning, which became intralig- 

 amentous later, following a rupture into the folds of the broad 

 ligament. 



DISCUSSION 



The case related here and other similar cases of ectopic preg- 

 nancy are generally admitted as relatively uncommon gynecolog- 

 ical affections. Because of their infrequence and lack of definite 

 pathognomonic symptoms, they are not easily diagnosed and 

 are very often mistaken for other pathologic conditions. 



If it is true that, in the reported case, menstruation had been 

 absent for about five months, the same condition may also occur, 

 however, in an ovarian cyst, although such is not the rule. Be- 

 sides, the patient is almost at the period of menopause, being 

 38 years of age. 



The enlargement of the breasts alone, without the presence of 

 other signs accompanying an ordinary pregnancy, may take place 

 also in certain genital tumors. 



The oedematous appearance of the cervix might have been 

 caused, just as well, by pressure from the tumor mass, which 

 displaced the uterus to one side. This same pressure and dis- 

 placement producing passive congestion may also cause enlarge- 

 ment of the uterus. 



Auscultation was not employed in the case, but as the foetus 

 was delivered apparently dead, its result would have been prob- 

 ably negative. 



However, in diagnosing a case of ectopic gestation, we must 

 take into account that the symptoms and signs usually found in 

 an ordinary pregnancy are frequently obscure or wanting in the 

 former affection, and for this reason it is advisable not to neglect 

 any findings that may be obtained from history or from physical 

 or laboratory examination which may point to the suspicion of 

 such a condition. 



