A System of Operative Surgery, Volume IV (of 4)

ion for this condition was performed in 1883. Tait wrote that he conceived and carried out this operation in obedi

tempt the operation in those early stages of tubal gestation in which the tube bursts, or expels (tubal abortion) the products of conception through the c?l

f extra-uterine gestation depends main

pture, the operation is practically that

art of the surgeon to prevent the patient dying from h?morrhage, and although the operation in these circumstances is really an o?phorectomy, it

rough it. The patient was in the seventh week of her tenth pregnancy when she was seized with abdomi

neal h?morrhage from a gravid tube, and few operations are attended with such brilliant results. Surgeons are often astonished

t involves the wall of the uterus the opening will require the application of a mattress suture for its complete closure. In some rare instances of the interstit

cribed on p. 9. When the shock due to the bleeding and operation has been great, it is sometimes judicious

early stages are submitted to operation at periods varying from a

grave symptoms as to demand surgical aid. The consequence is that the patient sometimes remains for several weeks under palliative treatment (

emoved as in o?phorectomy. When there is much free blood care must be taken that no clots are left in the iliac foss?. When the blood has remained in the belly for several we

eration consists in exposing the parts by a median subumbilical incision, and then opening the gestation-sac, turning out the f?tus, placenta, and clot, and controlling the bleeding by firmly packing the cavity

the embryo, placenta and gestation-sac on the same plan as an ovarian cyst. This is occasionally possible even when the gestation runs to term, but in the majority of cases, when the gestation

taining Twins. (McCann's case. Museu

ent. Moreover, in operating for tubal pregnancy, the opposite tube should be carefully examined, because both tubes may be gravid, though, as a rule, the pregnancies are of different dates. To spare a woman a recurrence of tubal pregnancy it has been urged that the surgeon should remove the opposite tube, but men of ripe experience and judgment are averse to such a proceeding, for it is an established fact that uterine p

ith the tissues of the broad ligament, which may be thick in some parts and very thin in others. To the walls of the sac, coils of the intestine, and particularly the rectum, adhere. Experience decides that the safest plan, after exposing the gestat

lly (ventral pregnancy), the gestation-sac, with its contents, has been

ation, with a quick placenta, is the most dangerous in the whole range of surgery. About two-thirds of the patients die. The greatest danger is h?morrhage, and the other is sepsis when the placenta has been left to slough. It cannot be urged with too much force that when it is fairly evi

ten necessary; there is, however, a variety of this form of pregnancy in which the fully developed cornu may be spared, namely, that in which the r

sometimes so torn that it is difficult to arrest the h?morrhage: in

y. The operative treatment of this condition

upture or abortion (Fig. 7); in the majority of the reported cases operation has been undertaken with the impression that the trouble was simply due to t

uterus as little as possible. In many instances such an operation has been followed by brilliant consequences, for th

riage and other untoward results, but, speaking genera

other extra-uterine-I have arranged some recorded cases in the table on p. 35. Fortunately this form of compound pregnancy is rare, but a rarer combination has been recorded by Menge, in which the extra-uterine f?tus occupied the ovary and ran nearly to term. When the woman came into labour,

erine f?tus. This is a very rare condition, but some cases h

e nature of the swelling may be sometimes accurately inferred before operation, as

do we know exactly how long after the death of the f?tus the placental circulation ceases, but we do know that in course of time, if the f?tus is retained, the placenta disappears, because in cases where the f?tus is in the condition known as lithop

n fifty, and be only discovered in the post-mortem room, but they are always liable to be infected from the adjacent bowel or bladder; then suppuration is inevitable. In some insta

r: the woman recovered, and the account of this remarkable case ends thus: 'She had a navel rupture, owing to the ignorance of the man in not applying

fistul? may open into the rectum, bladder, vagina, uterus, or some spot on the anterior abdominal wall below or near the umbilicus. The treatment is simple, and consists in dilating the sinus and extracting all the fragments. If this be thoroughly

on a woman in whom a lithop?dion had caused intestinal obstruction. The f?tus had probably been retained 1

ars inclusive, 116 operations were performed for extra-uterine gestation in the Chelsea Hospital for Women. During this period all the varieties of tubal pregnancy were encountered (ampullary, isthmial, tubo-uterine), including the rare condition of a full-time living f?t

ra-uterine Pregnancy (Compound Pregnancy) running

r. Year

Intra-

Extra

il

63 Died

1 Died L

80 Died D

881 Died

1893 Died

894 Lived Li

96 Lived

1905 Liv

7 Lived L

nto its thorax. The patient had two subsequent confinements without difficulty. In 1898 the 'lum

month. Extra-uterine f?tus died, set up septic cha

ere

ithop?dionbildung von 35-j?hriger Dau

nde. Vide Fr?nkische Gesellschaft für Geburtshülfe and F

et. and Gyn. of the Britis

on, Trans. Path. Soc.

ormal Pregnancy. Abdominal section. Recov