Combined intra- and extrauterine pregnancy

MARTEN

AND MmER.:

INTRA- AND EXTRAUTERINE PATHOLOGIC

PREGNANCY

1071

REPORT

Gross.-Somewhat asymmetrical appearing uterus with areuation, total length 14 em., transverse diameter 14 cm., indentation 8 mm.; the left side has a thickness of 5.5 cm., the right 6.75 cm. The cut edge had an ovoid opening, with a transverse diameter of 7 cm. and an anteroposterior diameter (in its present condition) of 2.5 cm. There was a sagittal septum which measured about 3 mm. in thickness; after stretching the septum it measured 5.5 em. The serosa appeared normal except for some distended veins and a few small, firm, slightly protruding, grayish-white spots (small myomas?). The ligaments were cut short. In the upper portion the specimen was rather soft with little difference in consistency between the both sides. The lower portion was moderately firm. On the left side the inside of the uterine cavity was diffusely light brownish red with numbers of small, soft coagula, partly lying loose on the surface, partly adherent. Numbers of distended thrombosed veins were seen in the wall, notably in the middle of the fundus. On the right side a placenta was inserted, occupying the upper half of the specimen. Otherwise the surface looked as described from the other side. The placenta separated easily. The cut edge on this side did not show thrombosed veins, but some very wide empty ones. A flat fairly soft, inelastic piece 5 by 2.5 cm., purplish-gray, without distinct markings showed on microscopic section a probable decidual origin.

COMMENT This case either was one of superfetation, with the fertilization of the two ova in the same or different menstrual cycles, or simultaneous impregnation of two ova, one from each ovary, with nidation of each in a separate compartment of the septate ovum having its own corpus luteum. Because of the half uterus ; each fertilized pound difference in size of the fetuses, the first supposition, superfetation, is probably the correct one. 515 PARK

AVENUE

COMBINED

INTRA-

M. EDWARDMARTEN, (From

the

AND

EXTRAUTERINE

M.D., ANDLEO Department

PREGNANCY

M. MEYER, M.D., BROOKLYN,N.Y.

of Pathology,

Samaritan

Hospital)

C

OMBINED uterine and tubal pregnancies have been recorded relatively frequently (7 cases in the first half of the year 1937). Frank, in his textbook, states that extraand intrauterine pregnancies occurred once in 105 ectopics. Teacher makes only casual mention of the subject in his book. In 1913 Neugebauer collected 243 cases of combined pregnancies. Novak reviewed the literature from 1913 to 1926 and added 32 more cases, and discussed fully the incidence, clinical characteristics, diagnosis and treatment of this unusual condition. Hefferman and Faxon, in 1935, summarized the literature up to that year and found a total of 282 cases.

CASE REPORT Mrs. C. I., white, age 26 years, para i, gravida iii, was admitted to the Gynecological Service on Oct. 8, 1937, complaining of cramp-like pains in the lower abdomen These abdominal pains were associated with vomiting, of one week:9 duration. dizziness and weakness. Her past history indicated a spontaneous full-term deSubsequent to this the patient had a livery three years prior to the present illness. miscarriage followed by a curettage five months prior to her admission to the hospital. The patient last menstruated on Aug. 12, 1937. Up until this date her periods had been regular every twenty-eight days lasting two to four days. No history of vaginal bleeding was associated with the present attack of abdominal