Treatment of Extra-Uterine Pregnancy After the Fifth Month

Abstract

The incentive for this study was a case of full term extra-uterine pregnancy which I had the good fortune to treat in the Long Island College Hospital last fall:Mrs. C. C., aged 32, primipara, married nine years, menstruated regularly every twenty-eight days. Her last menstruation began Jan. 18, 1918, and continued for three days. No bloody vaginal discharge was noticed at any time during the pregnancy prior to the day before admission to the hospital. In the second month, the patient suffered from pain in the right lower quadrant of the abdomen. Occasionally, this was severe enough to necessitate her remaining in bed, but at no time required the services of her physician. After about two weeks, the pain disappeared, and she resumed her usual household duties. No further symptoms were observed until the last month, when the fetal movements became very active and painful. Oct. 4, 1918, intermittent pains and a bloody vaginal discharge led the patient to believe that she was in labor, and a mid¬ wife was called. After two days of suffering, the patient was brought to the hospital. On admission, examination re¬ vealed a marked distention of the abdomen. The fetal head was felt very close to.the ex¬ amining fingers in thé left lower quadrant. Neither con¬ tractions nor the round liga¬ ments could be palpated. Per¬ cussion revealed an irregular area of tympany, which ex¬ tended from the ensiform to slightly below the umbilicus.The fetal heart was heard on the right side below the um¬ bilicus. From these atypical abdominal findings, the fetus was thought to be free in the abdomen.Because of the extreme dis¬ tention, it was deemed advis¬ able to postpone operation until after an attempt was made to Chart 1.-Cases in which patients were moribund at the time of operation. relieve this complication, as the patient was otherwise in good condition. Gastric lavage and colonie irrigations were used to good advantage, and on the following morning, Oct. 8, 1918, the patient was prepared for a laparotomy.Vaginal examination under anesthesia disclosed a soft thick cervix, which admitted two fingers easily. The uterus was distinctly felt on the right side and was about the size of a four months' pregnancy. Digital exploration of its cavity revealed it to be empty, and the walls were found to be free from rupture.The abdomen was opened through a midline incision which extended from the symphysis to the umbilicus. After the sac had been incised, a well developed child was extracted. The placenta was found to be widely attached to the right broad ligament and sigmoid and extended anteriorly along the parietal peritoneum almost to the midline. By the use of clamps and ligatures the placenta was removed. A vigorous hemorrhage now took place from the friable areas through which some of the ligatures had torn. Pressure was made over the abdominal aorta, thus partially arresting the flow of blood, while the bleeding points were secured with three clamps. These were surrounded by a Mikulicz drain, and the wound was closed, except in its lo...

Advanced Extrauterine Pregnancy

“…Beck (1919) thought the optimal time for intervention was between the sixth and seventh months of pregnancy, and we consider that the diagnosis will seldom be made earlier than that. But what if the foetus is alive ?…”

“…Tait believed that the placenta should be removed whenever possible and only rarely left in situ. Beck (1919) agreed that removal of the placenta was best, but maintained that ligation of the vessels supplying the placental site should precede all attempts at removal ; when this could not be achieved the placenta should be left undisturbed. Of more recent writers some advocate removal of the placenta in every possible case (Barrett, 1952;Hibbard, 1957), while a few are convinced that removal of the placenta is so dangerous that it should never be attempted (Cross et al, 1951;Barber and Rathbun, 1958).…”

The Paediatric Aspects of Advanced Abdominal Pregnancy

“…. Charlewood and Culiner (1955) Yahia and Montgomery (1956) Beacham et al (1962) . , Tan, Goon and Wee (I 969) .…”