Toward the end of gestation the enlargement becomes more symmetrical in the abdomen, and resembles closely that of normal pregnancy. In tubal gestation, on account of the higher position of the tube, bulging of the abdominal wall is likely to appear somewhat earlier than in normal pregnancy. The abdominal enlargement in tubal pregnancy does not follow the same uniform progress that is characteristic of uterine pregnancy. Fetal movements take place, and fetal heart-sounds are heard as in normal pregnancy. Bimanual examination made before rupture of the tube will reveal the tubal enlargement, the shape of the tube depending, of course, upon the position of the tubal pregnancy. The tubal enlargement is said by Veit to have a characteristic soft feel, distinct from the hard or fluctuating enlargements of other forms of tubal disease. After rupture the distinct tubal tumor disappears, and the examiner feels a mass lying to one side of or behind the uterus. The enlarged tube may be felt merged in this mass. If pregnancy continues after rupture, the fetal movements may be felt and ballottement may be obtained. The cervix is found to be somewhat softened; the os may be patulous; the uterus is soft and enlarged. The uterine enlargement, however, is not of the same rounded shape as the pregnant uterus, and the size is much less than that of corresponding periods of normal pregnancy. It is of great importance to study the symptoms of the accidents of tubal pregnancy. As has already been said, it is usually the accident of rupture that first directs the woman’s attention to the abnormal condition. The symptoms depend upon the seat of rupture. Rupture of the tube into the broad ligament is a much less serious accident than rupture into the peritoneal cavity. If the rupture into the broad ligament is sudden, the woman complains of sudden acute pain in the affected side. The pain may extend to the back and throughout the pelvis. The intensity and extent of the pain depend on the amount of blood that escapes. Sometimes only a small hematoma is found in the broad ligament; at other times the blood burrows around the rectum, and symptoms of pressure may arise. Difficult defecation may follow. Retention of urine may occur. The woman suffers from shock, and may become somewhat anemic. Bimanual examination reveals the condition. The broad ligament will be found filled with a tense mass that bulges into the vagina. The uterus is pushed to one side. The mass may extend behind the uterus and surround the rectum. The upper outlines felt by the abdominal hand are ill defined. The loss of blood from simple rupture into the broad ligament is not often sufficient to cause death. The fetus may continue to develop, however, and secondary rupture into the peritoneal cavity may occur. Rupture of the tube or of the gestation-sac into the peritoneal cavity is a very fatal occurrence. In the majority of cases death from hemorrhage occurs within twenty-four hours.