2. =Uterine and extra-uterine pregnancy running concurrently to term.=
(Compound pregnancy.) This may be described as the most dangerous
combination to which child-bearing women are liable. In order to show
what a disastrous conjunction it is to women with two ‘quick’
children--one intra- and the 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 fœtus occupied the ovary and ran nearly to
term. When the woman came into labour, the ovarian pregnancy was
regarded as an obstructing tumour, and preparations were made for
performing cœliotomy. The intra-uterine child was born in the meantime.
When the supposed tumour was extracted, to the surprise of all it
contained a living fœtus. The mother and both children survived.
3. =Uterine pregnancy complicated with a sequestered extra-uterine
fœtus.= This is a very rare condition, but some cases have been very
carefully recorded (Leopold, Stonham, Worrall).
The physical signs are those of a pelvic tumour incarcerated by a gravid
uterus. The nature of the swelling may be sometimes accurately inferred
before operation, as in Worrall’s remarkable case. The sequestered fœtus
should be removed by cœliotomy.
After the death of the fœtus the operative treatment of extra-uterine
gestation is, as a rule, a simple proceeding, the fœtus and placenta can
be easily and safely removed. We have no certain means of deciding when
an extra-uterine fœtus is dead, nor do we know exactly how long after
the death of the fœtus the placental circulation ceases, but we do know
that in course of time, if the fœtus is retained, the placenta
disappears, because in cases where the fœtus is in the condition known
as lithopædion there is usually no placenta. When a retained
extra-uterine fœtus is wholly or partially converted into adipocere, the
tissues have a strong tendency to adhere to the walls of the sac. This
is especially marked in connexion with the hairy scalp.
Although a sequestered extra-uterine fœtus is uncommon, yet a surgeon
may stumble on one when he least expects it: these bodies may remain
undisturbed in the pelvis many years, even 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
instances the pus makes its escape at the umbilicus, and as the sinus
persists the surgeon explores it, and, on laying it open, is surprised
when he extracts the fœtus, sometimes entire.
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Elsewhere in the archive
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account