^0 The Philippine Journal of Science mf 



In the reported case, for instance, such findings as cessation of 

 menstruation corresponding to the period of growth of the ab- 

 donainal swelling, fullness of the breasts, soft, oedematous cervix, 

 and a period of sterility for five years may be taken as sufficient 

 data to arouse suspicion of the disease. But as this affection 

 is not as common as tumors of the ovary and uterus, such as 

 ovarian cysts, fibroids, etc., the exact condition is not as a rule 

 diagnosed. 



I recall that in the surgical service of Doctor Davis, in the 

 Philippine General Hospital about three years ago, there was a 

 case of advanced extra-uterine pregnancy which was diagnosed 

 as tumor before operation. Nearly two years ago Roxas(6) 

 reported to the Colegio Medico-Farmaceutico two cases of 

 abdominal pregnancy (secondary) at full term, from the obste- 

 trical service of Doctor Calderon in the same hospital. One of 

 them was not diagnosed as such, but, apparently, as a case of 

 intra-uterine pregnancy. It is to be observed that both patients 

 came to the hospital calling for delivery. 



The proportion of extra-uterine to intra-uterine pregnancies 

 cannot be exactly determined, as statistics vary according to indi- 

 vidual reports and those coming from the different clinics. Ac- 

 cording to Hirst, (2) it is given by some writers as being 1 

 to 500 approximately. From 1908 to 1915, in our surgical 

 service, we had about 40 cases of ectopic pregnancy which, com- 

 pared with the 5,000 cases of delivery registered in the obste- 

 trical department of the College of Medicine and Surgery, during 

 the same period, will show a proportion higher than that men- 

 tioned above. 



The majority of the cases of ectopic gestation do not reach an 

 advanced stage, (l) as they become ruptured or aborted during 

 the early months of their development, resulting in the destruc- 

 tion of the fertilized ovum. Taking, for example, tubal preg- 

 nancies, which are the commonest types of ectopic gestation, 

 according to Winkle (3) about 6 per cent of them only may 

 proceed to full term. Hirst (4) reported two cases of tubal 

 pregnancy that ruptured in two weeks. In our series of 65 cases, 

 2 progressed to full term (Calderon and Roxas), and there are 

 2 others that reached only the age of four to five months (Davis 

 and Guazon). 



In regard to treatment of advanced ectopic pregnancy, some 

 gynecologists advise not to interfere until full term or until the 

 stage of viability has been attained; while others do not dis- 

 tinguish any condition and operate as soon as the diagnosis is 

 suspected or established. I see no objection to an early inter- 



