Observations on thirteen cases of late extrauterine pregnancy

OBSERVATIONS ON THIRTEEN CASES OF LATE EXTRAUTERINE PREGNANCY H.

HUDNALL WARE, JR.,

M.D.,

RICHMOND, VA.

E

XTRAUTERINE pregnancy of more than twenty·eight weeks' duration is not rare, but the number of cases occurring in any one clinic within a period of a few years is generally limited. Thirteen such cases, eleven of which were operated upon by the author, were observed on the wards of the Medi
Two hundred forty cases of full-term extrauterine pregnancies with living fetuses reported from 1813 to 1907, and 61 additional cases from 1907 to 1923 were reviewed by Bland (1939). He also reported twenty other cases after 1923. Cornell and Lash, in 1933, presented an excellent comprehensive analysis of 226 collected cases of abdominal pregnancy published from 1919 to 1932 and ten additional cases reported for the first time. The maternal mortality rate in the 236 cases was 14.3 per cent. This included cases of early ectopic pregnancy in which the mortality rate is lower than in late abdominal pregnancies. Hellman and Simon (1935) in a paper on "Full Term Intra-Abdominal Pregnancy,'' reported five cases and reviewed 311 other cases reported in the literature between 1809 and 1933. Cases reported after 1906 were included in the series only if the pregnancy was of twenty-eight or more weeks' duration. A review of ''Abdominal Pregnancy'' was published by Beacham and Beacham (1946) with a report of twenty cases treated at the Charity Hospital of Louisiana during an eight-year period ending June 30, 1945. In this report there were nine cases of pregnancy of eight to nine months' duration. The frequency of late extrauterine pregnancy is impossible to estimate. Whi_le several reviews cover about one and one-fourth centuries, there is necessarily much duplication between them, and none are related to any total of cases. The author has charted 249 cases of extrauterine pregnancy of more than seven months' duration reported in the literature since the review of Hellman and Simon in 1935 (Table I). In this series thirty-seven mothers died, a mortality of 14.85 per cent; eleven of these mothers left living babies. Of 251 babies, including two sets of twins, only 60 lived (24 per cent); 140 were stillborn, and fifty died within a few hours or days, a total mortality of 75.6 per cent. Three of the twins were stillborn, and one died soon after birth. One hundred and fifty-two babies were born at term, twenty-three were over term, and seventy-six premature. One fetus was carried for nine years (reported by Umnova, 1934); one :for six years (reported by Denoon, 1944) ; and one for twenty-six years (reported by Mathieu, 1939). These mothers delivered living children in the interim. One ten-month Read at the Fifty-Eighth Annual Meeting of the American Association of Obstetricians, Gynecologists, and Abdominal Surgeons, Hot Springs, Va .. Sept. 4 to 6, 1947.

561

Living Living

E'ull tern1

Full rerm

193~

193+

1934

193-J

15. Cornell, E. L .. and

16. Cornell, E. L., and

17. Cornell, E. L .. and Lash, A. F. 1S. Cornell, E. L .. and

--~~~·-:\::..!:: . .

Lash, A. F.

Lash, A. F ..

193+

Full term

R monthF

2,-l-P-4-

;~,288

2,9-±fl

2,:!00

3,000

1,927

Li Yed I ,q hours

2,G51

2,381

:3,288

Died following recent rupture of sac Extremely macer~8 en1. ated · long Living 1,940

"lightly mnceraied. fully formed Living

14. Colvin, E. D.

Lived 3 hours; slightly deformerl Living; normal Lived 20 minutes

1934-

pregnane,\ 2 weeks over term 7 months

tubal

Full-term ruptured

Full term

Full term Full term

:Full term

Lived 24 hours

13. Bronaugh, W.

193~'1

8. Mundell, .T . .J.

Full terru

Recently dead

19:1;{

]9:13

7. Hayes, W. I.

Full term

Macerated

12. Taylor, A. B.

lll33

6. Fernandes, M.

Full term

Asphyxiated

1933

19:3:1

5. Fernandes, M.

8 months

Living

11. Spackman, W. C.

1933

4. Clemente, G.

Full term

1033

193:'1

3. Chanina-Gaidnk, F.

1933

1933

2. Borngen, H.

Living; died in 8 hours 7 to 8 months Dearl

Full term

OF'

l<'E1'US

S~'ATUS

·9. Scipiades, E. 10. Spackman, W. C.

1$183

DURATION OF' PREGNANCY

L.ivrd

Live
Died

Lived

Lived

Lived

Died in Ci days Lived

Lived Lived

Died

Lived

Lived

Died

Lived

Lived

Lived

Lived

Lived

Lived

Died

Lived

Stillborn

Stillborn

Lived

Stillborn

Lived Died

Died

Died

Stillborn

Stillborn

Died

Lived

Stillborn

Died

(If Columbia 2:

Jllinoi' M . .1. 65: 4112 HJH. lfi::+.

Illinois l\1. .T. 65: 462-466, 19i14.

Illinois M .. J. 65: 4132·466. 1!)34.

428, 1[)34. Illinois .I\f. J. 65: 462-466, I ft:i4.

A.M. ,T. 0BST. & GYNEC. 27: 42.1 ·

Ohio State l\L .T. 30: 823-1124. Hl3-L

.\rrh. £. Gynak. 156: 217·221, 193:1. .r. ObBt. & Gynaer. Hrit. Emp. 40: 1220-1223, J 933. .r. Ohst. & Gynaer. Brit. Emp. 40: 1220-1223, 1933. South African M . .r. 7: 4:!7. 1933.

Di~lrid

i\6-90. 193R.

M. Auu.

Monatsehr. f. Gehurtsh. n. Gynak. 94; 22·28. 11"\33. Ann. di ostet. t' gint'r'. 55: 1470140:3. 1933. Arq. de dr. ,. rHtop. 1: Jil.l-1/8. 1933. Arq. de cir. " nrrop. 1: 110-J /8. 1933. M . .T. AuRtralia 2: 17-Pi, :w:l:L

AM, ,], 0BST. & GYN~~C. 25: {;j~. 'iG-4-, 1938. Zentralhl. f. Gvnak. 57: 2968-2071. 193:3. .

REFERENCE

CASES OF EXTR.\l.;TERINE PHEGNAN('\ 128 OR MORE \VEEKS' GESTATION) REPORTED BY VARIOUS AUTHORS (19:-l::l TO 1947)

I. Allen, E.

AUTHOR

'!'ABLE L

~

':-

~

~

l;l:j

>

~

C\

Full term

]'ull term

1934 1934

1934

1934

1934

21. Hosking, A. 22. Hull, E. T.

23. Israel, A., and .Tabre, E.

24. Low, E. B., and McCurrich, H. .T. 25. MacGregor, I. G.

12 months 13 months Full term

Full term Full term

1934 1934

1934

1934 1934

1935 1935 1935

1935 1935

28. Remzy 29. Ro:xas Villarama

30. Serimgeom, H.

31. Steel, W. A. 32. Umnova

33. Arndt, E. 34. Arndt, E. 35. Arndt, E.

36. Arndt, E. 37. Boogart, H. S.

7 months intraligamentary Full term; vaginal delivery; in· traligamentary pregnancy Full term 9 years

Full term

1394

1 months

8 months

1934

26. Margetson, N . .T. L., and Ogilvie, D. C. 27. Powell

Full term

8 months Full term

1934

20. Dueuing

tuhal rup· ture Over term

Full term,

1934

19. Cruickshank, M. M., and Achar, S. T.

Lived 12 hours Dead; 6 months' development Dead, macerated Dead, macerated Well developed, lived 1 day Living Lived 1 day

Macerated

Macerated Lived

Living

Macerated, deformed 'fwins; 1 small, macerated; other lived 12 hours Dead

Dead for 1 month

Died 2 weeks before deliYery; well developed Lived 9 hours Macerated

Living

3,000 4,300

1,400 2,550 2,600

3,033

2,778

3,855

3,061

2,608 4,139

3,150

2,267

Died Died

Lived Lived Died

Lived Lived

Died in 1 day

Died in 10 hours Lived Lived

Lived

Died

Lived

Lived

Lived Lived

Lived

Lived

Lived Died

Stillborn Stillborn Died

Died Stillboru

Stillborn

Stillborn Lived

Stillborn

Stillborn

1 died 1 stillborn

Stillbol'n

Stillborn

Di!'d Stillborn

Stillborn

Lived

19~4.

5223-~~3.1,.1935:

Gynecologic 84: 481-488, 1935. Nederl. tijdschr. v. geneesk. 79:

Gynecologic 84: 481-488, 1935. Gynecologic 84: 481-488, 1935. Gynecologic 34: 481-488, 1935.

Brit. M .•T. 2: 62-63, 1934. Cited by Bland, et al., 1934.

Malayan M . .T. 9: 174, 1934.

Gynec. & Obst. 9: 440, 1924. J. Philippine Islands M. A. 4: 50, 1924.

J. Kansas M. Soc. 35: 99-102,

Brit. M . .T. 2: 115, 1934.

West African M. J. 8: 12, 1934.

Brit. M • .T. 2: 111-113, 1934. AM. .T. 0BST. & GYNEC. 28: 452454, 1934. Am. Fac. fran~. de med. et de pharm. de Beyrouth 3: 119-121, 1934. Brit. M . .T. 1: 557-558, 1934

Bull. Soc. d 'obst. et de gynec. 23: 106-112, 1934.

1934.

Z<

t:ll

0') <::¢

~

z > z 0

0

ttj

!;1:1

'"0

ttj

z

.....

!;1:1

ttj

>-:1

0

>

>-:1 !;1:1

ttj ~

ttj

t"'

> >-:1

:;rs ...... .f>.vo "'

<:2.. S<::

-----~-~

AUTHOR

1,730

Wdl-den•lop1·,1 twins, dead Living. norma 1

Dear! D~ead ~m-<>ral l~<>nrc<

J2 months

Full term

7 months

.Full tP!'Ill

Full term

81h munth:-; l''ull-term

Full tc
] 93.i

l!B.'i

1!l3i:i

19ii;)

1935

1935 19:;;,

183.)

1935 1935

19:li)

1935

50. Sarkar, A.

51. Stapleton, (' 52. Swanson, 0, '·N.

53. Swanson, ('. ::\.

54. Swanson, G. N.

55. Swanson. C. N.

56. Swanson, C. N.

OV<'l

;i,:!S'"'

LiVf'
Liviug

Full term

FuU term

19Bii

1935 l.,i \"ittg:

LivPd

Lin•d

Dead

b'ull term

DPtHl

Liw•d

},ull t\'r!ll

Dead

Livp
l,/ive1l Di,.,J

Liw•l Livtc
M!li'PI':ttt••l

Li,·in~:

Li\'e•l

Liwd

!lend

Lin•d

Liver]

~tillbom

1-'ti\lhot'll

Stillbom Stillhon•

Ktillhoru

KtilllH It'll Lh·ed

Died

llit-'d

.1,

Or;;:;T.

,J'

0BST

,\:

,\:

r;y

~EC.

f+YXF:C .

+o:l-41:~.

(.;y~r:t.

.

29: 711

29:

''

]:i!l]\l;_l.1,

30:

.. ][;;~.-

()],~t, & CiyHat••·. 11~~-l)~;'i, 1935.

Brit. 1-:m]>. 42:

l\1,

~01' •

34:

.)S.J-;)~!'.

Ul3.). .1. 2'\fi<'higan .\I. 1n:~;i.

~01',

34:

.}~.).;){'i~t.

.Miehigmt ':\1. :-;,,., 34: .),~.1· :1~H,. 193:5. ,J. Mi<'hig·an :\1, ~I.J{', 34: .i/i.i-i}.':\[1,

..r.

19:!5. •1. Mi<·hignn lll:15.

.).

Brit. l\f.•T. 1: 879. 19:1;), Mil'hi;.;an M. Rtw. 34: ,J>-:,}-.l?'lt,

.I

ill. l !\:3.). .-\1\L .1. OHO>T. GY:\1\C, 29: 711 714, Hl:1fi. Am . .T. Sur g. 27: :{-1-}t.;i;,:;, w::~,5. A~r. . i. Onwr. c\ {i'{XEC . :30: :?0~~' :!!J,'J, Hl8.:>.

A~!.

71-1. 1n:~;;.

\.\!.

I .in·d

Liw•d l>ied

.'DL ,J. On:-n. c\:" Hl. Hlil?i. .\111 •• J. Nul';;. 29:

:-:t illlmn<

19:l!i, A. :\1. ,\, 10-i: :! 17,}-:21/tl .

ZPtltralhl. f.
Liwd

Lin•d

:·:,.)..t,;)

:l}!;);)

\', ~·PtJet":-<:k. 79: J :J;J.i. ::-.T ederl. tijd:-whr. \, g't'llf>t'""k, 79: :)~~;{-,):,!;:{ 1. 1 ~~:~;). Brntisl. lC'Knr. li:.;ty 15: llti. Hi;l;;,

---~-------~"-----------

;):;;!;J.:;;!:l].

::-Teder I. tijfhv·h !'.

. 1.

Rtillhom

Ktillhom

Ktillhon1

Rtillbom

Liv•'fl

rl.av~

Dit•d i11 1H

De!ld

ll<'ad

Maeen
Full term

~8 WPek~

cervix

prolap~Pd

teni-1

1,400

Livt'.l

:~~~:):!

Li,·inA

Pull term

1935

·i::!. Eisaman, .J. IL :mtl Ziegler, E. 43. f'erguson, ;r. A., ~nd Otis, I. S. H. Hellman, A. M .. anrl Simon, H .•T. 45. James, ,T. E., .Jr. and Lafferty, H. P. 4G . .James, ,J, E., .Jr., and Lafferty, H. D. 47 ..James, J. E., ,Jr., and Lafferty, H. ll. 48. Longley, E. G. 49. PoRnPr. A.('

:3.700

17 daY:'

Lin•• I

Hl33

DPa<1

,u. Daners, H.

term

~'ull

LivNl

Liw•d

1935

Dt>ad

Denrl

--------------------------------

40. Cernoevie. M. I

INlli

term

Full

l~u\1

"----·--

1fl:'\.)

] 93.)

~---------·-·

I---CO::\T "I•

Boogart, H. R.

:w.

:18. Boogart, H. R.

T.\BfF:

>

...

trl

~

:;;:;

....

(:,,:t ·::T•

76.

H,

1936

1936

75. Wilson, A. S.

\Vla~sow,

:B'ull term; Dead; driven vaginal dethrough sac of livery Douglas, ripping uterus from attachments 8lh months Living

1936

74. Wilson, 0. S.

~T 1~.

Full term

J9:lG

--

Full term

Dead Full tern1, tqbal pregnancy

Dead, well formed

::}faeerated, intraligamentous Living

1936

defornH?d

72. Pruys, W. M., and Wiersema, J. S. 1:l. Schumann, E. A.

Living Mummified

~:facerateJ,

1936

1~

71. Mascaretti, M.

.L.

1936 1936

uo.

69. Krishman, R. G. 70. Lemaire, M.

UlCt::a.tu.t.ll'

Dead

Dead

Deal!

ruonths Full term 81h months interstitial pregnancy 8 months

~o

1936

1936 1936 1936 1936

Cathey, A. D. da Silva, A. Dunham, L. H. Fiith, F.

n

1936

63. Anderson, M. W.

T t.J,

Living; deformed before tern' Died at birth; Full term believed to be primary abdominal 7 months Dead Living Past term Dead, deformed 8 months Lived 12 rlays Full term

1935

62. Zar:ii., M.

n_.......... ..-.1~.:11

Premature

1935

61. Swanson, C. N.

64. 65. 66. 67.

Premature

1935

60. Sw.anson, C. N.

2 to 3 weeks

Premature

1935

59. Swanson, C. N.

Dead

Pre;nature

1935

Dead

58. Swanson, C. N.

Full term

1935

57. Swamon, C. N.

Lived ,;;.,oov

Lived •1 OOf\

Liwd

Lived

Lived

LiYed

Lived Lived Lived Died in 5 days Lived Lived Lived

Liwd

Died

M. Soc. 34: 585-589,

654-661, 1936.

Stillborn

Lived

Liven

1651· 1651-

Med. 29: ~"fed.

Proc. Roy. Soc. 1654, 1936. Proc. Roy. Soc. 1654, 1936.

29:

1651Med. 29: Proc. Roy. Soc. 1654, 1936. Stillborn

38~

Stillborn

C'lin. ostet.

Tri-State M. J. 8: 1664-1665, 1936. Indian M. Gaz. 71: 590-591, 1936. Nebraska M. J. 21: 338-340, 1936. Miinchen. med. Wchnschr. 83: 9293, 1936. J. },._. ~L _..A:.... 106: 606-608, 1936. Brit. M. J. 1: 795, 1936. Bull. Soc. d'obst. et de gynec. 25: 204-205, 1936.

J. Michigan M. Soc. 34: 585-589, 1935. Ztsehr. f. Kinderh. 5i: 505-515, 1935. Brit. ~f. J. 2: 589-590, 1936.

1!135.

J. Michigan M. Soc. 34: 585-589, 1935 . .J. Michigan M. Soc. 34: 585-589, 1935. ,T. Michigan M. Soc. 34: 585-589,

.J.9u ......

.r., ~i;hi:;an

Geneesk. tijdschr. v. Nederl. Indie 76: 3427-3436, 1936. Am. J. Surg. 33: 570-573, 1936.

Stillborn

Lived Stillborn

S.tillborn

Died Stillborn Lived

Died

Lived

Stillborn

Stillborn

Lin-'d Lived

Stillborn

Lived

Stillborn

Lived

2,381

2,835

2,440

1,701 1,38(1 3,400

2,721

~.0;10

1,105

Stillborn

Died

Z<

~ (i.,"l

o•

>1

z > z 0

0

t.:rj

i;d

"0

H

zt.:rj

i;d

t.:rj

~>-3

i;d

>-3

P1

t.:rj

t.:rj

> >-3

r

...~

3

= g-3 ~ ~

:g.

.

RE·

('

('

Crir.hton, E.

83. Crichton, E.

BABY

tltillborn

Lived Lived

Lived 12 hour" Dead for som
="ear term

14¥2 months

1937

1937

1937

88. Hoffman, 'IV. E.

89. Karki-Pahwa,

90. Kreis, .J.

1D37

1937

91. Kyriakis, L.

92. Lailey, W. 'IV.

Lived, Cesarean deliven· Lived 40.hour;.

time

4 to 5 weeks Ovennature, living, over term dubfooted broad liga· ment preg· nancy

8 months

Full term

Died

Live<1

:Yiaceratrd

7 months

1937

R. R. D.

Stillbort<

Lived

Lived (i honnc

}'ull term

:5,01 7

3,443

~,OH7

Lived

Lived

Lived

Lived

llicrl

LiVC'
Died

Lived

1937

3,345

Died

Full term

193/

Lived

Lived

85. Eno, E., and Towers. A. E. 86. Eno, E., and '!'owen;, A. E. 87. Priedman, t-1. L.

:1,500

"'ormal ex<·elJT f'lubfoot<:>d Living, defonne<1

Die
Livf'cl

Pull term

defonnit~·

1937

Died

Dieil

Stillborn

Atill horn

Liverl

Livec1

Lived

Live<1

Lived

Dierl

Lived

Died

84. Elsholz

·~.OS~

2,2(i7

2,49-t

2,lii-t

2,324

RE8l'LT ~I OTHER

Pull term

Pull term

Dead, slightly Jp. formed Lived for a few minutes l\iacerate
~_._._

Pc.ninnvorarllQ '-''"1 ..... ..... ....., .. """'-'

i

WEIGHT 1 (GM.)

l- -·

UUIJ \'

1..~

that lived 5 days Macerated, no de· formities Macerated, talipes

!-4.-~

.. ._ __ : _ lUt,J ctUlJt:"J Jlitj

Normal, living; twin to 3¥2 lb.

Li-dng

STATUS 0]' FE'l'US

--·--·--~·-·-···-

[ --f'0:\'1' 'J•

19R7

R~.

c.

81. Crichton, E.

1937

il4 weeb

1937

Burke, I<'. ,T.

~0.

Pull terlll

7 months

Hl3i

79. Burke, P. J.

19il7

Slf! months

77. \Voods, E. B.

Hl37

DURATION OF PREGNANCY

78. Bondurant, F.

.

I

Full term

I PORTED

1936

AU'l'HOR ---------

TABU:

REFEREN
-------

. ·--------

---~-----

------

~\L

J. 1: 7/:i. 1937.

.T. 1: 775, 1937.

:\1. .J. 51: :l:J-40, 1!)3/.

32: 8D·llG, 1n:n. Gatrika chronica (Greek, 1037; abst. Zentralhl. f. Gynak. 64: \191, 1\14-0. ('ana d. l\f. A .•T. 36: (ii-68, ]937.

Re,·. fran.;. de gynCt·. et d 'ohst.

AM. .r. OBST. & (iYNEC. 33: ti83· (i8(i, 1037. WeRt Virginia ~L .T. 33: 4!.164!)7, 1!)37. Lancet 1: 1228, l 03 7.

t ~hiue~e

htBchr. f. Geburtsh. u. Gynak. 115: ·HHl-4Dii. IU:H. Chi ne~e :\1. .T. 51: 33-40, 1937.

1P:~7.

South African M. J. 11: 229-230, 1937. South African Jl.f. .T. 11: 220-230, Hl:37. ~nuth Afriran M. .I 11: 229-230,

Brit.

Brit.~\!.

.T. OBST. & GYNEC. 32: 15:i· l:ii, l!J3
. --- - - - - - - - - ------·--·-

,,.0

rxr·

~~

. c;·

2.;~·

~~

.,.

,_

l:t:!

::6

~ ~

'="· a

1937

1937

1937

1938

102. Stoel, G.

103. Varner, H. H., and Green, L., Jr.

104. Waters, E. P.

105. Bray, P. N.

2,400

3,300

3,000

Lived 7 hours, sac ruptured 1 week before birth Macerated Macerated

7 months

Full term

Full term

8 months

109. Gaines, C. D., CollinB, 1938 C., and Brown, H. 110. Gerrard, E. A. 1938

111. Hardy

Calcified, dead 10 years

Living

Full term 1,871

2,664

3,855

Full term, Dead tubal preg· nancy Full term Lived, clubfooted; only partly outside uterus; previous section scar torn S months Newly dead 1,353

Lived 24 hours

Living

Living, normal

Macerated

1938

3,457

1,947

2,6e:l

Shriveled, faint heart • beat at lOth month Dead

Dead Normal, living Lived 4 hours

Living, slight de· formity corrected Living

10 months

106. Champion, P. K., and 1938 Tessitore, N. J. 107. Crecca, W. D., and 1938 Cacciarelli, R. A. 108. Gaines, C. D., Collins, 1938 C., and Brown, H.

1937

101. Stavenhagen, K.

Full term

Full term, ovarian pregnancy Full term

Full term

1937

1937

98. Parker, P. E.

Full term 7 months Near term

49 weeks

1937 1937 1937

95. Marchisio, V. 96. McNeile, L. G. 97. Opocher, E.

Full term

1937

1937

94. Marchisio, V.

Near term

99. Roques, F., and Winterton, W. R. 100. Schorsch, IV.

1937

93. MacGregor, A . .S.

Ginecologia 3: 35-46, 1937. West. J. Surg. 45: 119-1331 1937.. Rassegna di ostet. e. ginec. 46: 59-73, 1937. .J. Tennessee M. A. 30: 163·165, 1937. J. Obst. & Gynaec. Brit. Emp. 44: 687 ·695, 1937. Arch. f. Gynak. 162: 371-378, 1937. Med. Klin. 33: 1609-1610, 1937. NederL tijdschr. v. geneesk. 81: 1021-1024, 1937. Southwestern Med. 21: 191·196, 1937.

Stillboru Lived Died Stillborn S.tillborn Lived Lived Died

Died in 5 days Lived Lived Lived Lived Lived Died in 1 day Lived -Lived

South. M. J. 31: 1278-1280, 1938.

Stillborn Stillborn

Lived Lived

Stillborn

Died Lived

Died

Lived Lived

Reported

by Champion-Tessitore.

Clin. J. 67: 116·118, 1938.

AM.

J. 0BST. & GYNEC. 36: 281293, 1938. AM, J, 0BST. & GYNEC. 36: 312313, 1938. South. M. J. 31: 1278-1280, l!l38.

Minnesota Med. 21: 498·500, 1938.

Stillborn Stillborn

Brit. M. J. 1: ll58, 1937.

Lived

Stillborn

Lived

Lived

Lived

Died

Lived

J. OB!:lT. & GYNEC. 34; 1030· 1032, 1937. Ginecologia 3: 35-46, 1937.

AM.

Lived

Livetl

<:.n ~ ~

1-
§ :;... z 0

~ t.%j

zt.%j'""

~

>-3

~

§

> ~

!:"'

... ~

.

Z< §~ :fS .,

.T., ancl

-------- --·-·- · - - - - - - -

Term?

14 months 10 months

103k

Hl:J,,

lH:OS

19.38

1938

1938 1938

1!-l:JS

liS. Xowy. ::\1. •.\..

M. A.

119.

120. :t\uwy, M. A.

12.1. Xowy. M. A.

J 22. Novey. 1\L A.

1:?4. Posner, A. C.

1:.'5. PosnPr. A. C.

week~

1~138

l!t:lb

1:.'S. Stabler, F.

l ~!l. Tarleton. L.

ill

11\lllltl
Full term

Pull term

1938

C. R.

r'ull term

1938

7 months

Xenr tpnu

40

::-
Full tPrm

l2tl. Hamirex Olivella, ,l, Barroso, L., and Machado, 0. 127. Ritsema Yan Eek.

123. Payne, R. H.

Xow~··

1fJ.1S

117. Lelling, K

I months

Liw
LiYing, t(•mpo nuih- deformed 1>· "'·I. : .... ,, .. ,.,. t". ,.

LiYing

Livin.£!'

lJpa.J

Dear! :'rlarem t t•rl

Lil'ing". deformerl feN Lil'i11g. JHll'IWd

Large. tun"erated

JlPHd

!JiPd at birth. defornwrl
I

711 ~.:l.~

;~.1

:1.1:--.j

1.2/.)

3,288 2.3R1

:?,6!1.1

2,494

:3.7D~

:18 ~lll. lnng

'i'ill

f.iYed 1:2 months

7 month"

1938

hone,,

~t

J)if'rl

l>i>'HH'HJb<•n•rl fet:ll

LiH·d

l.in·d

Liw
l.iwd

Lin•d

Lived Lived

Lin•d

J,iwrl

Died

J)ierl

Liwd

Died

~ti!!Lot!l

l. i "''"

l.in·d

J.iw
StillbOI'll

Still hum i::itillborn

Li1e•l

LiYeol

:'-:till linn

Srillbont

,.;tillhnru

JJiPrl

/)it··l

jIll >(II' ll

REFERENCE

.1. 0BST.

"'

···---

r.

c;_,·nak. 62:

2:3:2~·2326.

(;.1·1"'''·

ric 0\,q. 66: ilil-1176.

I J),~t.

66: H/1 (\/ti.

42:

60:)-1)1 I.

19il·"·

Hrit ..\1 .. 1. 2: :,tJf;.

l!_)_q(~,

ij,heln·. v. ;-..;,,d<'rL lnoliP. 78: 1 I II- 111:\, lfi38. Bri I. :\I. .I. 1: 77!1-7k0, 1\13.~. I

11<'11\':t

! ienf't>~k.

\'ida

IP.i.~.

.I. 0B>'T. & UV I>El'. 36: 60i~691. 1938. A~f. ,). 0Bc;'l'. S: (;Y~E<'. 36: 6fl:~-lifli. .\~!.

:-:urg·, (!,~·IJ<.•r·. 0: 19:11-.

Hl3S.

<3.\ ut~(·. & 0hf'1. 66: t:ill-6/n. l9:'lfl. Smg., ~t. 66: 1)71-fi/(),

~nrg ..

1D3S.

"urg.,

Hn.~.

Zentralbl. f. nynak. 62: 2:!0!1-2214, 1838. :'-:mg., U.l'll(•e, 8: Ohst. 66: f]/1 fi76.

Hl:lk.

l':t•Jitralld.

()!tin :'-\tat<• :'If. .1. 34: :):.':)-:)27. HIC\11.

1\1:lS.

:)85-.).~~l.

UYKEC.

:.'84, 1H38. "outh. ~1. & S . .J. 100:

_\:IL

--

35: :.'8()

- --------------------·--·-

Hrit. 'I. .1. 2: ]044, 1938.

- L_____ .___

. - - -------·----------

-----

~tilll>Onl

l~nk11o\\·n

LiY<:<1

1H3.~

p;,.a

·--------

f.i\Pd

lli<•
Ljyprl

:~.401

~--·

BABY

Li1·ing·

u~ad, q>rtpx pre~-

M
7 months

··--

1

-------------JmSJ-r.T

-----

1938

Full tenn

( (a.r.

i

Full term

1938

FETUS

\\-EH~11T

1 ~!38

--

!

I

·------- --------

ll :1. Hellman, A. M., and Simon, H. J. 1 H ..Jennings, D., anrJ Hunsucker, ,V. C. 1 L'i. Kauffman, L. G., Finley, R. K., :tn
Bell, F.

Harkne,~,

POn.TEV

c;TA1TS OF

1---('11:\'[' 'I•

entation through ,·a gina :'11 arera tP
l l ~-

AUTHOR

ll LTRATIO!\ OF PREGNA!\('Y

T.\BU:

~~

0"

~~

:-c _...,

:::;.~

'0'

;;....~

0

3

>

:a> !;d t:rj

:y:

Full term Full term

26

14 months

Near term

1939 1939 1939

1939 1939

1939

1939

1939

133. Cunningham, J. F. 134-. Cunningham, J. F. 135. Gepfert, J. R.

136. Hains, I. C. 137. Lemgruber, S., and Paizao, W. 138. Mathieu, A.

7 mouths

Pull term

1940

]!140

1 !7. Carc:JartJ, V. M.

F'ull term

Hl40

146. Becker. C.

Full term

1940

Pull term

}'ull term

1940

1940

8%

1939 month~

year~

143. Bcal, A. M., anu Cassel, N. S.

141. Vaste,aeger, M., and de Tocuf, G. 142. Acosta-Sison, H., and Espinola, N. A. 1-13. Ayres, Netto P., et a!. 11!. Ayres, Netto P.

139. Smyth, G. S., and Mackinto~h, R. H. 140. Snow, W.

Full term, tubal rup· ture at 7 months .S months Full term 4 weeks over term

1939

132. Corbet, :C. M.

:Full term

1939

131. Bishop, B. W. F.

Full term

1939

130. Bcrgenfeldt, E.

Dead

hours Died at deli very; left foot harl pierred broaci Jigament. foot de· formed DiPd ~~t birth

De~d ~ev<:'ral

Lived

Lived

Rtillhorn

Died

fltillhorn

Livd

Lived Lived

1.200

Stillbom

Stillborn

Lived

Died

Lived

Live•l

Stillborn

Lived

3,115

3,800

Living Dead several hours

2,030

hour~

Living

Lived ;)

Slightly macerated

Stillborn

B7 g

Lived

Stillborn Lived Died

Still horn

LHhopPdion

Lived Lived Lived

Lived

Lived

DiPd

Lived Stillborn

2,381

Lived

LivPd

Lived Lived

. 2,494

2,R50

1,105 Dead Living 1,927 Died just before operation, ruptured into abdomen throu~~:h cesarean section scar 3,515 Living Dead

Dead

Died after 4 hours Living

G~·niik.

64: :!06i-J06R. :1121. 1940.

Hcv. nwd. veracruzRna 20: 3119-

Zeutralbl. f. 1910.

A eta mod. Phillipina 2: 31·36, 1940. Bol. Soe. de me d. e cir de sao Paulo 23: 8-23, 1939. Hoi. Soc. de med. e eir de sao Prmlo 23: 8·23, 1939. .T. Iowa M. Soe. 30: 445-H7. 1910.

M. J. Australia 1: 268-269, 1939. An. brasil. de gynec. 8: 302-312, 1iJ39. AM. ,J. 0BST. & GYNEC. 37: 297· 302, 1939. South African M. J. 13: 320-321, 1939. Am. J. Roentgenol. 41: 537-540, HJ:J9. Bruxelles-med. 19: 333-338, 1939.

Iri~h

J. M. Sc. pp. 846-847, 1939. Iri:,h J. M. Sc. pp. 846-84-7, 1939.. AM. J. 0BST. & GYNEC. 37: 4-66472, 1939.

Acta ohst. et gynec. scandinav. 19: 27-±-289, 1939. :-;outh Afriean 1\I. J. 13: 167-168, 1930 .

s~£: ~

cr.>

<.0

Ul

~

§ z> a

t:cJ

'ti i:d

zt:cJ

i:d ......

t:cJ

0...,

>

i:d

...,~

trJ

t:l

t"'

> ...,

~" •r. .,.,n

g-s

-

-

I

7Jh month>

Full term

1940

1940

1940

1940

159. Lull, C. B.

160. Lull, C. B.

161. Nieodemus, R. E., and Carigg, L. G. 162. Oghi, A.

1940

1940

1940

1940 1940

165. Richter, W,

166. Rkhter, 'W.

167. Ridtter, W.

168. Satta Flores, G. 169. Sigwart. Vv.

'3 months

14 months

1940

K month~

Full term

1940

163. von Pallas, K. . 164. von Pallas, K.

81;2 monthH

Lived 2± houro D<:>ad

No details

No details

No detailH

Dead

~lacerated

:\Taceratecl

Died at birth

Living

::IIa~l'rate.]

7 months

1940

158. Lull, C. B.

7% month,-

Living Living· Living Living Living Lived 3 hours Macerated, deformed Died at birth

• 3,070

2.069

8,211

2,324 3,000

:l,94S

1,980

Lived Lived

Lived

Lived

Lived

Lived

L1ved

hour~

Died in 36

Lived

Died in 8 hours Died in 4 months of T.B. Lived

Died Stillboru

Stillborn

Sltillbom

Lived

Sltillborn

Sltillboru

Sltillbom

Died

Li\•eJ

~tillborn

Dierl

Lived Livecl Dierl Died Di<:>d Diell Stillborn

Dieu

Live
Stillhor11

Stillborn

Lived

Livell

!__~GM. ) _______ ~10T_J_f]';_lt --~~

T~~~;;~~~~~-~--------

}'ull term Full term Full term Jo~ull term Full term Full term Full term

-

Full term

FETUS

--~-;;ATUS~;;-·

149. Elkins. H. B., and 1940 Bowdle, R. A. 150. Gavaldon Salamanca. 1940 A. 151. Gomez Azearate, G. 1940 152. Gomez Azearate, G. 1940 153. Gomez Azearate, G. 1940 154. Gomez Azearate, G. 1940 155. Gomez Azearate, G. 1940 156. Hamblen, N. 1940 157. Leinzinger, :K 1940

PREGNANCY

DURATION O>'

Dead, well developed, dehydrated :\lacerated

I

14 months

PORTED

1940

148. Chung, C. T.

I

TARLE 1--CONT 'Jl

------~~----·-----·---·------------------···--------

--- --------;~:----~

_____ AUTHOR______

-----

--

i REFERENCE

116-.117, Hl40.

1~.

Zentralbl. f. 1940. Zentralbl. f. 1940. Zentralbl. f. 1940. Zentralbl. f. 1940. Zentralhl. f. 1940. (;]in. ostet. Zentralhl. f.

I;ll1-1:1J:l. l\!40.

\53-

Hl4-

HH-

Hl4

1940. 1940. 1940. 1940. 1940. 1940. 1506,

42: 306-313. 1940. Gyniik. 64: ·1906-HllJ.

Gvnak. 64: 1505-1506,

Gyniik. 64: 1505-1506,

Gyniik. 64: 1505-1506.

Gvntik. 64: l052-10G1. . Gyniik. 64: lOG:l-1061,

] 54. J 040. Sp,mnna med. 2:

AM. ,]. 0BST. ,\" lhNF:c. 40: 202, Hl40. AM . •T. 0BST. & GYNEC. 39:

:l/2, 1940. Cir. y. cirujanos 8: 179-190, Cir. y. cirujanos 8: 179-190, <'ir. ~-. cirujanos 8: 179-190, Cir. y. cirujanos 8: 179-190, Cir. ~-. cirujanos 8: 179-190, West. J. Surg. 48: 310-312, Zentralbl. f. Gynii.k. 64: 1940. AM . •J. 0BST. & GYNEC. 40: 202, 1940. .\~i.; J, OBST. & OYNr:C', 40: 202, 1940.

.T. Rurg. 49:

.1. lnternat. Coli. Flurgeons 3: 271-

.\m.

r'hine'
•.:,)!

~;!

~

?~ _2.:~

cr

';

~

~

t:'J

~

:;:;

>

:::::!

3,061

Living Living

Dead

Full term

7 months

3 weeks over Living, normal term Living Full term

7 months

Full term

7 months

1941

1941

1941

1941

1941

1941

1941

180. Renner, M. J.

181. Schwarz, M.

182. Speiser

183. Tornqvist, G. W.

184. Vierira Mareondes,

185. Weintraub, M., and Weintraub, D. I. 186. White, R. A.

187. Hamilton, W. S., and 1942 Steingrube, C. R. 1942 188. Lucas, C. F.

189.

A.

D., and

I •. J.

1942

Lived

Lived

Stillborn

Died Stillborn Lived Stillborn

Lived

Lived Lived Lived Lived Died

2,800

Macerated Made a few :feeble 2,267 movements Dead, poorly de· 13 inches long veloped 2,381 Lived

8 months tubal, early rupture Dead Full term

Lived

Died

4,100

Lived

Lived

2,340

Stillborn

Lived

Lived

Lived

Lived

4,620

Living

10 month ovarian Full term

1941

179. Nicholls, R. B.

Lived

Lived

2,270

Living

Full term

1941

178. Ney de Almeida

Lived

Lived

Full term

1941

177. Matusovsky, A.

Died

Lived 1h hour, sae 2,721 ruptured 22 days earlier after de· livery of 5lh pound intrauterine living twin Living 3,400

Full termi

1941

176. Leech, R. B.

I~adiology

38: 35·38, 1942.

North Carolina M. J. 2: 87·92, 1941. Cincinnati J. Med. 23: 477-488, 1942. Brit. M . .J. 1: 722, 1942.

Geburtsh. u. Frauenh. 3: 242-246, 1941 An. brasil. de ginec. 12: 299-307, 1941. AM. J. 0BST. & GYNEC. 42: 341· 342, 1941. J. Kansas M. &c. 42: 245-247, 1941. Zentralbl. f. Gynak. 65: 204-209, 1941. Zentralbl. f. Gynak. 65: 1056-1062, 1941. Acta obst. e. gynec. scandinav. 21: 100·102, 1941. Revista de dined. e d 'obst. 35: pt. 1, 4-15, 1941. Am. J. Surg. 54: 747-752, 1941.

Zentralbl. £. Gynak. 65: 819-822, 1941. Brit. M. J. 2: 805, 1941.

Lived

3,500

Died in 1 hr. Lived

Full term

1941

175. Langes, E.

Stillborn

Lived

8 to 9 months' dead fetus Living

12 months

1941

Bol. Soc. de obst. ginec. 19: 657· 669, 1940. Calcutta M . .J. 38: 301·304, 1941.

Lived

Lived

2,400

Living

Full term

Died

1940

Brit. M. J. 1: 91, 1940. Duodecim. 56: 159·163, 1940. Ohio State M . .J. 36: 520·521, 1940.

Stillborn Sitill born

Lived Lived Lived

3,175 1,790 3,231

Dead Macerated Lived 48 houri!

Full term l!'ull term Full term

1940 1940 1940

170. Slinger, L. A. P. 171. Soikkonen·Bardy, A. 172. Sprague, J. R., and Chappel, M. R. 173. Tejerina Fothering· ham, W. 174. Ghosh, S. K

~e:

.....

~

Cl

"<.

z Cl

~·

[':j

;g

[':j

~

z

~

;5

[':j

~

;5

~::.

......

lf8

8"

tll!'lll

1\!4:1

1!14:l

:!09. Poddar

·'to.

and H. P.

1!14:.\

l[J-1:{

207. Poddar

:.'08. Poddur

194il

206. Pizano, .T . .J.

194:1

Term

Full t1~nn

Term~

I months

l;'nll term

Full term

S llJOUtlJH

1943

G.

ll month:<

1943

205.

13 mouthN

1943

202. LovelesH, P. H., and Austin, C. P. :!Oil. Lubin, S., and \Valtman, R. 21}!. Martin, P. J., and 1\L E.

1943

1943

7 months montl!, month:;

14 days be fore term, tubal pregnmH: ~· F'ull term

r'ull

l''ull term

J 0 month"

200. Hudgins, A.. P. 201. Kobak, A. J.

1943

1942

UJ8. \Vide, E. R. 199. Hart, R. D.

1942

1942

1942 1942

lllO!l\h~

1942

-

8 monthR

Full term

· -F'ulltenn

!ICRA'J'l
1942

1942

1942

P<>WJ:E;IJ

19l1. 8lotover, M. L. lfli". Wallau, F'

192. Mattingly, D., and Menville, L .•r. J 9:3. Mattingly, D., and Menville, L . .J. 194. Netto, P. J 95. Schulze, H.

191. Mattingly, D., and Menville, L. J.

MeJlvillle, L.

Al"'J'JlO[(.

llE-

r'ETn<

.'-'!'il'

li(Jpt:diuJJ, dit>d ,'j 11w. aft.•r ruptun·

I >Pad. tncHI:-<.H•r

Vead

Pend

~1nr•erntet1

:\lummified

:\Iaeerated

Macerated

Macerated

Dead Maeeratt:d

Dead

Dead

Normal, living·

llpad

.':>'L'\'JTS Ur

:l,l 'j;)

l,/.)7

1, Hlll

~,5:.?a

HI ent.

:!.B kg.

:! . tHil

T.\BLL 1--l·nxT

·v

Lin·d

Li1·et!

Lin•d

,i\t>
Lin•
Liw·d

Lin~J

Lin•d

Llwu

Liyed LiYed

Liw•d Lh·er1

Tlietl LiYPf1

Ljypf!

Li n•d

Ljypt)

St illl)f)l'IJ

~tillht>l'll

Stillborn

:-\till born

::>till hom

Ktillhorn

~tillbmn

~tillboi'H

Rtillborll

~tillbom

:->till horn

Jjycd

Lived Stillborll

~till born

~till hom

Lived

BABY

:),)-:J,f;,

1942.

,r.

Omn. ~!\fed.

Hll:l.

:.\L .T.

.1. 1:

12:1.~

1:'1L".

27: 301-:lO:l_. H!-HL

Ul42. 66:

66: 4i'i">--His.

-+D3-46ti. l LJ.f:!.

Oklahon1a .:\f. 194:i.

A. 36:

1!12 ]!)~,.

l\.1. 194:5. Indian :\1. 194:). itJdiun .\1 Hi4:{ .

I ndiuu

194~1.

(iHzPtt<'

<+azPttt·

!fnzette

78:

78:

78:

-t:{:J ..n-~c.

4:H-4X(i,

4i:H--±ilu.

Hospital (Hi"de.fnlldro, 24: :2.)::. 272. ] £14:1. Indian .:\1 lhtzPtt" 78: .n-~c -~c:l!i.

.l.

\'Pi:>n,,-;ka ~\J. .1. 28: l4S 1-!n, w~::.

.i.ut. J. :-lmg·. 60: 2fl?l-:Wo. 1940.

.\:»r.

~outh.

~\f.

Wl'~t .•T.

Brit.

:\fetl. l'ir. phtn·m. Zentr11lhl. f 1\lJ2. Brit. :.\I. J. 1: Z;•atwlhl. 1H.+:!.

Radiology 38: :J;J-38, 1H42.

Radiology 38:

Radiolog:· 38: 3:i-3S, 1942.

::..;, -1

$.1

M

l;)j

>

t~

Retained 8 yean

12 months Pull term

8 months

1944

1944 1944

Aro~kar,

B. Y.

Large, macerated Macerated Died at birth Lived 1 hour

12 months

Full term

1944

1944

1945

22:1. Pearson, J. \V., ,Tr.,

22-1. Pump, K. K.

1945

1945

Morgan, R. G., and Keevil, N. L. 229. Rose, M. J. 230. Selliah, L. G., and Hill, W. C. 0.

Snoke, P. 0.

z:n.

1945

1945

Greene, G. G. Greene, G. G. Greene, G. G.

225. 226. 227. 228.

Died 1 week before operation, macerated

Living, normal Dead, well developed

Dead

7 months

1944

7 months Full term About 8 months Full term Full term, tubal, secondary opening into birth canal Near term

Lived 2 hours, deformed Lived 12 hours

Pull term

194-±

1945 1945

Maeerated

l<'ull term

1944

and Parks, J.

Lithopedion Living

1944

Full term Full term

w. c.

Denoon, H. L., ,Jr., and Henderson,

219. Dibbins, S. A. 220. Gardner, A. R., and Middlebrook, G. 2:!1. Grufetz, M. W., and Polayes, fl. H. 222. Lin, A. Y.

~18.

216. Bereovitz, N. 217. Cravioto, R.

215.

1944

\Vel! developed, lived 4 days Dead Normal, living

Full term

1943

214. Thomas, R. C.

Macerated

34

194:{

213. Strumpf, I ••T. WCtJkS

I months' tubal pregnancy; livered at autopsy of m who died of generalized 'l'.B. Living, normal Pull term

1943

Living

:.?12. Shannon, D., and Heller, E. L.

K. L.

t·'ull term

~dtaupp,

1943

:.!11. All!. J. OBST. & GYNEC. 45: 345:350, 1943.

AM .•T. 0BST. & GYNEC. 45: 350353, 1943. .r. Obst. & Gynaec. Brit. Bmp. 50: 189-195, 1943. l\I. Bull. Bombay 12: 1-5, 1944.

1-'tillborn Lived Htillborn

Died Lh·oo

Lived

2,721

Lived

Stillborn

Lived Stillborn

LivcJ Lived Lived Lived Lived Died

Stillborn Stillborn Died Die(l

LivcJ

2,267

2,324 1,389

Stillborn

Livoo

Died

Died

Lived Lived

Stillbom

Lived Stillborn Lived 4¥2 months f:t ill born

Stillborn Lived

Dioo Livoo

Livoo Livoo

Died

Died

l-rol. &. ('utan. Re\·, 49: 338-3-W, 1945.

.T. Ol11c. Brit. Emp. 52: 11·7±, l!H-5.

J. Flol'ida M. A. 31: 475-476, 1945.

AM. J. 0BST. & GYNEC. 47; 127· 129, 1944. Bull. Vancouver M. A. 20: 110111, 1944. South. M. J. 38: 747-752, 1945. South. ~r. J. 38: 747-752, 1945. South. M. .J. 38: 747-752, 1945. Brit. M. ,T, 2: 6,10, Hl±5.

AM. J. 0BST. & GYNEC. 48: 379· 386, Hl44. Chinese M. J. 62: 383-387, 194-1.

Am. J. Surg. 63: 402-404, 1944. Am . .J. Surg. 66: 161-167, 1944.

Chinese M. J. 62: 197-198, 1944. OIJ~t. y giner. latino-am. 2; 213· :!16, 1944. Am .•J. Surg. 63: 257-258, HJ44.

West. J. Surg. 51: 49I~493; 1943.

Lived

LivcJ

1,333

2,239

4,195

2,900

2,778

~.83:~

Z<

~:,;

-1

<::.;1

"'(

z0

~

0

~ t:j

1-ti

i:'j

z

~

0

> ~

~

>-3

H

i:'j

t"

> ~

+--~

~~ g-s ... "

AUTHOR

Armand, M. !<'., and Sam, F. G. 233. Beacham, ·w. D., and Beacham, D. W. :234. Beacham, W. D. and Beacham, D. W. 235. Beacham, ·w. D., and Beacham, D. \Y.

246. Beacham, W. D., and Beacham, D. \V. 247. Kushner, D. H., and Dobrzynski, F. A. 248. Lee, A. F. 249. Waters, H. S.

240. Beacham, W. D., and Beacham, D. W. 241. Beacham, W. D., and Beacham, D. W. 242. Beacham, W. D., and Beacham, D. W. 243. Beacham, \V. D., and Beacham, D. W. 244. Beacham, W. D., and Beacham, D. W. 245. Beacham, ·w. D., and Beacham, D. W.

236. Beacham, W. D., and Beacham, D. W. 237. Beacham, W. D., and Beacham, D. W. 238. Beacham, \V. D., and Beacham, D. W. 239. Beacham, \V. D., and Beacham, D. W.

~32.

TABLE

Dead, macerated Dead, macerated

Dead, macNated Dead, macerated

7 months

=""ear term tubal 10 months. tubal, rupture '' months

l•'ull term

months

-~

~·uu

7 months

Pull term tubal rupture l•'ull term

.-; months

l94ti

1946

1946

1946

1946

1946

]94(1

1946

1946

1946

1946

1946

1946

1946

=""ear term not deliv ered r~ull term

194(1

month~

~'nll term l•'nll term, tubal rupture, 4

term

Macerated, Lieformed Living Living

Calcified

Dead

Living, abnormal

Dead

Living

Dead, macerated

Dead, macerated

Dead, deformed jaw, clubfootefl

·well formed

[·'nll term

1946

month~

1%

194()

FETUS

Normal, well formed Dead, macerate
2,778 3,175

~.976

:1,543

3,401

I

( 'tl:\'1' "p

i ( GM.)

1

~~;~;;~-~;---F~:~~-GH1'

-~------~----

Full term

P1 :RA'riON OF PREGKANCY

---

1946

PORTF;l>

Jn:-

------~--------·-

Lived Lived

Lived

Lived

Liven

Lived

Lived

LivPd

Live•l

Lived

Lived

Lived

Lived

Lived

Died

Live
Lived

Lived

MO'l'HER

Lived Lived

Stillborn

Htillborn

StillbOl'l'

Died

Stillborn

Lived

Stillborn

Htillhorn

:'\t.illborn

Stillborn

Stillborn

Htillborn

:-4tillborn

Dif'd

Stillborn

Lived

BABY

---------~;!:~--=--=~~=: ~~EI•'EH.K~('!'

.

.

.

.

1P4f3. J. 0BST. & (}y~EC. 52: 160· 161, 1946. Nmthwest Med. 45: -10-4-1, 1946. .r. Ohst. & Gynac.>•·. Brit. Bltlp. 53: :285-288, 1946. AM.

I >bst. & Gynec.·. Surl'e,\' 1: 777-806,

] 9-±6. Ohst. & C+Yne('. Run·e1· 1: 177-806, 1946. . .

Obst. & G_vnPc. StHYP_I" 1: 777-806, 1946. Obst. & Gynec•. 1'\un·e,- 1: 777-806, 1946. . . Obst. & Gynec. Sun-e.1· 1: 777-806,

19-±6.

Obst. & O;·nec·. SUlT<'_I" 1: 777-806, 19-!6. I)Jwt. & G.1·m•r. Sttnl'.'- 1: 777-806,

1946.

1946. Obst. & GnH'<'. Rttl'l'<'l" 1: 777-806. 1946. . . Ohst. & G_l-nt'C. Run·c•y 1: 777-806,

8\111"('\' 1: 177-806. . ' . Obst. & Gynee. Rnn·p;· 1: 777-806,

1946.

.

Obst. & Gyne•·.

1046.

.

Ohst. & G.-nee·. HurYcl- 1: 777-806.

10-!~

Ubst. & G;;npc·. RnnPI- 1: 777-806.

19-!6.

Ob~t.

;; ginec. latino-arn. 4: 20-2tl. ] 9-±6. Ol>st. & G;·nec. Snn-<'y 1: 777-806,

--

"'" ~~

-"'

:-(;)

'0' :::!.~

>~

0'

':0

?

;>

t
Ed

:;]

::~

+--

575

LATE EXTRAUTERINE PREGNANCY

Volume 55

Number 4

baby weighing 10 pounds, 3 ounces lived; another that was four to five weeks overdue weighing 11 pounds, 1 ounce, also lived. Most of the babies that lived were delivered at term; none were under seven months. Bland reported a maternal mortality rate of 34.7 per cent for 240 eases of late extrauterine pregnancy collected from the literature from 1813 to 1907, and a mortality rate of 16.7 per cent· for sixty-one cases collected from 1907 to 1923. Cornell and Lash reported a maternal mortality of 14.3 per cent in 236 collected cases of abdominal pregnancy (Table I). All thirteen of our personally observed cases• occurred in Negro patients, although only about one-half of the obstetric patients in the Medical College of Virginia Hospitals are of this race. Early ectopic pregnancies in these hospitals occur in about the same percentage of white and Negro patients. The fact that late extrauterine cases occurred only among the Negro patients may indicate that these women sought medical care after their symptoms had persisted for a long period of time. Most of our patients were between the ages of 25 and 35 years. Four were between 20 and 25 years, five between 26 and 30 years, three between 31 and 35 years, and one was 40 years old. Previous operations could not be a factor in this series because not one of the patients had ever been subjected to a laparotomy. TABLE

II.

THIRTEEN PERSONALLY OBSERVED CASES OF LATE EXTRAUTERINE PREGNANCY, DURATION OF PREGNANCY, CONDIT;ON 01!' FETUS, MORTAMTY

PREGNANCY

2

1932

25

3

1932

34

4

1932

20

5

1934

25

6

1935

36

7

1935

23

8

1936

9

gravi~~ iii parn n gravida i para 0 gravida i para 0 gravida ii para i gravi~~ iv para u gravida H para i

2,680

32

gravida iii para ii

3,487

1937

30

gravida iii para ii

1,474

10

1937

26

iii

3,033

11

1944

32

iv

2,891

12

1945

22

ii

3,005

13

1946

30

gravida para 0 gravida para ii gravida para 0 gravida

ii

2,664

2,438 2,069

4,422

42 weeks macerated 48 weeks macerated 36 weeks living and normal 15 months macerated 28 weeks macerated 44 weeks macerated hydrocephalic 42 weeks macerated

24 months macerated, unruptured tubal pregnancy 36 weeks living and normal 40 weeks living and normal 44 weeks not delivered 38 weeks normal

*For lack of space, the detailed case reports are not Included.

stillborn lived

stillborn

lived

lived

lived

stillborn

lived

stillborn

died 18 hours after oper· ation died 3 months after oper· ation of other eonditions lived

stillborn

lived

lived

lived

lived

died before operation lived

stillborn

stillborn

stillborn

lived

WARE

\tu. !. tY,:-1 . .X lJ~ t1•.'l .\rril, i').f~

:\inc patients g·ave a history of one or more spontaneows deliveries prior

to

the extrauterine pregnancy and thrt
spontaneous abortions. Two patients had abortions previously but no full-tct·nt pregnancies. Two patients had no earlier pregnane~-. an<1 OlH' of these has siw·· lwd H normal term intrauterine pregnancy. 'rlw matc•rnal mortalit~- in late extrauteriw· pregnancy n~mains too high E:qwriener ·with our eases and a review of the literature convinces us that leaY ing: the placenta with no attempt to separate it whenever its removal might r·an;;p hemorrhage or other diffienlties rrdnces thr mortalit:v in patiC'nts with PXtl'auterine pl'egnaney. Operation for a late extrauterine pt·egnaney, as in any ''etopic pregnant·,\. should he performed as rapid]~, as possible after the tliagnosis is made, heeatts<· .. r tlw high matrmal mortality rate in c·ases of 28 wet•ks' or more duration. As sltmn1 in an l'arliPl' eonnnunication hv the author, tlw matemal mortalitY rai• in llil l'ases of early l'etopic pregnancy was 1.7 plH' l'ent, whereas in the th.irteen (·asl·s of late t'Xtranterinr pregnanc~-. thf' maternal mor-tality rate was 30.76 P<'l' t·t•!Jt. This opiuion is in agreemeut with that of Bland and Montgomen· ( Hl:3~1 \\·ho stated that recognition of ectopie gestation prior to rupture {~alls for imlltediHte removal, for the welfare of the mother eomes first, and operativr meth weeks in order to savP the infant, unless there is a false labor with dt>ntlt of the t•hild. Champion and Tt-ssitore (193R) believe that if tlw infan1 i~ \·iahlt', operation with conservativn handling of the plarenta is inflica ted ; i I tlw t't>tus is dead, operation should hP ddrrred six to eight weeks until the; pl;:l'l'llilll eirenlat.ion hm; atrophied. l)pLel' suggested deferment from SI'VI'll f,._ tm·nty days for th0 :same reason, but Reek believed, as J\'LcNeile (1937) point~ 11111. that in tilt' interest of the ehild it Jlta.\· he dt•sirable to postpone operatiot: ttntil after the thirty-eighth week. Tonneau disagreed, stating that then; is t·i~k of a st-eoudan· infeetion of the fetal ~al·, m; ~hown in his ease in whieh tlw fPtlt~ was within n'ouglas' pou(•h. I-h· hellewd the infe>Ption was from the i.nh•stim In om· mYn series of thirteen cast-s, seven fetuses were macerated, on<' or tht>lll having hytlroeephalus. \Vinckel 's statement in 1904 that half of tlw t'etns('S in eeiopie pregnancy are deformed has bern frequentl:v challenged. lmt Bland in 19~i9 stated that healthv infmtts at·e rar<'ly found. that usuallv thPI die within a few hours or daYs ~fter dPliven·, and inore than one-half ~re d~·­ rormed. ::llahfouz. howE·ver. 'in 1938 report~d that in his series of 120 r·as<·~ !he t'duses whieh advancNl to term, whetht·r· in~ide or ontside the tu}w, showPd littl<' or· no ddormitv, and the habiPN would t·ertain]y haw• been saved if 1lw pat.if'nts had he<'tt adinitt.ed in time. Some of tlw fetu~es whieh died at an t>ilt'l\ :tge ;;bowed marken malformations, and ahout B per (•ent were ealcifirrw ,f his patients had earried the fetus for fifteen years and had four living hahi<·s in tlw meantinw. )Iundell in 193:~ reportPd :1 deformity in eig·ht. of fort.\'-nine livP babirs; in thirty-four dead babies then• was drformity in one, and twenty<'ight were maceratPd. In Champion and Tessitorr 's series, thirty-seven fetus''' di(;
Volume 55

577

LATE EXTRAUTERINE PREGNANCY

Number 4

In five of our thirteen cases the fetuses were alive when the mothers were admitted to St. Philip Hospital.• These five babies were delivered alive, appeared to be normal, and were living when last heard from. This gives a fetal survival rate of 38.46 per cent for the entire group, and a fetal survival rate of 100 per cent for those alive when the mother was admitted to the hospital. !<'our of the five mothers having living babies survived. The fifth mother (Case 1) died of bronchopneumonia and peritonitis seven days after operation, probably because of manipulation before operation and removal of the placenta and uterus. There were four maternal deaths (30 per cent), all occurring in patients with· abdominal pregnancies. However, one died of other causes than the pregnancy, so that the true mortality rate was only 25 per cent (Table III). 'rABLE

III.

LATE EXTRAUTERINE PREGNANCY AFTER THE TWENTY-EIGHTH WEEK CONDITION OF BABY

LOC ATIONOF PRJWNANCY

Broad ligament Fallopian tube Abdominal Abdominal (post· mortem operation) Total

NUMBER OF CASES

4

1 7 1 13

J\J,JVE

0

0

5 0 5

I

STILL· BORN

IMORTAJ,ITY RA~'E

(PER CENT)

CONVITION (W MO'rJIER RECOVERED

1

28.57 100

4 1 .! 0

8

61.53

9

4 1 3

100

100

I

MORTAJ,l'rv

I

D!ED

RA~'E

(PER CENT I

0

0

()

()

3 1

100

1

42.85

30.76

----------------------------------------------------------------

Three patients died in eighteen hours, five days, and three months, respectively, after operation. The fourth patient was too ill to operate upon, and died undelivered (Table II). The possibility of an extrauterine pregnancy is suggested by the presence of the fetus in an abnormal position and a long, thick, uneffaced cervix which is still fairly firm and closed. If the cervix is in an abnormal position the evidence of extrauterine pregnancy is increased. Uterine contractions which occurred at regular intervals and were both strong and painful were observed in one instance (Case 2). The histories of other patients suggest that rhythmical uterine contractions associated with pain and simulating labor may occur about the thirty-sixth week in most patients with extrauterine pregnancies. Several of our patients who gave such a history unfortunately were not admitted to the hospital until after that period. If the fetus is viable and near term the fetal heart sounds are usually louder in abdominal pregnancy than in a normal intrauterine pregnancy. A positive diagnosis of extrauterine pregnancy frequently can be made after a careful history and an abdominal and vaginal examination. In some eases roentgen studies or a hysterosalpingogram may be necessary to confirm the diagnosis. Roentgen studies were made in all of our cases to confirm the diagnosis, and hysterosalpingograms were made on a few. We were unable to obtain any hysterosalpingogram which showed the relationship of the uterus and Fallopian tubes to the pregnancy as clearly as the one reported by Greenhill. A history of persistent pelvic or abdominal pain after the second or third month of pregnancy was obtained from ten patients in this series, and the other three patients complained of pelvic and abdominal pain during the latter months of pregnancy. This is the most frequent symptom of extrauterine pregnancy. Therefore, whenever it is obtained from a patient with an advanced gestation, extrauterine pregnancy must be thought of, and ruled out. *The St. Philip Hospital for Negro patients is one of the Medical College of Virginia Hospitals.

578

WARE

\tt ..

J'

Less frequent, but equally suggestive, i!> a history of seven! indigestion. eonst.ipation, and loss of weight. l<'requently tl1ese :;ymptoms are associated with anemia. In more than half of the cases the fetal movements were reported as either very high or very low. The latter symptom was associated most frP· quently with intraligamentous pregnancy. The position of the fetus is usually high iu abdominal pregnancy, and B; most of these cases the baby is extended or at least poorly flexed. In Case 12 the fetus was unusually high in the abdomen, but otherwise its attitude seemed normal. It is possible for an abdominal pregnancy to have such a thick sac that the fetus may be flexed almost as mueh as it is in a normal uterus. On abdom· inal palpation the fetus is usually no1Pd in do;;;<' proximity to the anterior abdominal wall. In broad-ligament pregnanry ilw baby ifl usually below the lew] or the umbilicm;, assumes an abnormal rwsition, nne! frequently seems compressed and overflexed, as demoustrated by roentgen examination of four such patiPnl!-in this series. In late extrauterine pregnaney
LATE EXTRAU'rERINE PREGNANCY

Volumes;

Number 4

!519

Each new case of extrauterine pregnancy presents new problems in diagnosis and treatment. The management of the placenta in late extrauterine pregnancy is unquestionably an important factor in determining maternal mortality. Beck, 1919, advocated that the placenta be left in situ in abdominal pregnancy if its blood supply could not be easily ligated. He also advised closure of the abdominal wound without drainage in these cases. He had proved experimentally in animals that a normal placenta can be absorbed from the peritoneal cavity without harmful results to the animal. Since the publication of Beck's paper, it has become an accepted practice to leave the placenta whenever its removal can cause hemorrhage or other difficulties, and to close the abdomen without drainage. The use of this procedure has reduced the mortality 1ll:!sociated with these cases. Case 4 in our series illustrates the excellent results, without development of further complications one may obtain with this treatment. TABLE

IV.

MORTALITY FOLLOWING DIFFERENT MANAGEMENTS OF PLACENTA

PROCEDURE

Placenta removed nay·tiallv. Placenta left, marsupializ!ttio•n Placenta left, abdomen

:J 1 5

0 l

1

0

100

20

Two of the patients (Cases 8 and 12) in whom the placenta was left and the abdomen closed later developed drainage from the abdominal incision. One patient (Case 8) had an elevation of temperature after operation, but the abdominal incision healed by primary union. Later a sinus developed in the lower portion of her abdominal wound. She then went home against advice, attempted suicide at home by poisoning, and was later con:fined in a mental institution. She was re-admitted to St. Philip Hospital three months after delivery and died four days later. This death should not be charged to the extrauterine pregnancy, since the suicidal drugs she took may have been harmful and her mental condition prevented proper nutrition and management of her case. Case 11 illustrates one of the dangers encountered when the placenta cannot be removed. This patient's placenta was attached to the rectum, the ileum, the uterus, and the broad ligament. The placenta was left and the abdomen closed. Her abdominal incision healed by primary union, but ten days after the operation drainage occurred from the lower portion of the incision; cultures from the exudate were positive for B. coli. Whenever the placenta is attached to the intestine, the danger of infection and suppuration is increased. This should not prevent one from leaving the placenta and closing the abdomen without drainage, but it necessitates a careful follow-up of the patient so that drainage can be established if necessary. A second operation on these patients for t·emoval of the placenta has been suggested by some writers. We doubt the necessity for and the wisdom of such an operation except in very rare cases. Case 11 illustrates the results one may obtain with conservative treatment even if the placenta is not absorbed and there is drainage from the abdominal incision. In two cases in which the babies were alive at the time of operation and the placenta was left in situ, positive Friedman tests were obtained on specimens of urine from the patients for thirty-five days after operation. When an operation is performed for an abdomina] pregnancy careful ineision in the anterior abdominal wall should be made. The operator should avoid any attempt to separate the fetal sac and to remove the placenta until he is reasonably sure the blood vessels supplying the placenta and the sac can he

WARE

\\11.

1 ( li,1-,t i Gyne. r\pri\. ft.Jt:-;

Pasil,v ligated. The llSl' of eoagulants now available may t"nabh• one to eont I'\! I a moderate amount of oozing· lmt this JI1'0!'Pd\11'l' ma.\· 1101 owrr·omP morl' f•x iPnsive hemorrhage. 'l'lw use of penieillin and stlll'a dmgs 1uay [ll't'\l'llt or 1knca:st: int'edioJJ iu the placenta. when it is atiadwd to i !t1• ini<·stin<· and ll'ft in situ and 1ltt> ah domen is closec1 without chainagP. 'l'hl' lJJOl'l' fl'<•qnent usc· or transfusions sine··· tiH: rstablishnwnt of blood banks has ll<'<'l'I'HS<'
Summary and Conclusions L Observations 011 1::) c·asl'~ of 1·xl rauLct·inl' pn·g1rali<',\· oi' tweut.\·-ei~dtl more cluration havl' hc·t·n pt·cs<·ntrll, tog('tlwr with a n·,·iew nt' 24-!1 1·ases reportPd in tlw liil'l'atnn· sill<'<· 19:-\::l. Th<· lllnt<'J'!Htl 1\lortality in the I:! opL~rated upon was 2;) JH'l' •·•·nt iJl(•lnding that of " nliltlwr 11·lw ldt tht> hospi tal and died thr\'t' uwnths nftPJ' opn·ation. Th<· mat\'l'ltal mortalit.1· t'o1· all ];{ •·a~es was 30.76 Jli'l' 1'\'111 inc·.iuding: on<· wonJHII \\'ho <1iP11 llllLlelin·t·<·d. 2. A histm·y of lOWI'I' ahdomin~d p:1in ]H•t·~isting· sin•·e tlw OllSt'f nt' pregnan<:y- or soon 1hPt'eafte1'. n<·<·unqHnli(·d hy indig·pstion. ('onstipation and sonh~-­ times inegula1· 1·aginal hiPPn awl hysit'l'<• salpingogTains \vere YHluah1P aids in f'olrflrrn1ug the diagnosii). a. An extrauterint· fct.us l~an I'Cillain \·iahh· and t•ontimH· to grow ilftt•l' I'P peatt>d cpisocll's ol' utcrinP hlt·Prling. 4. :Regular rh:vihmieal ntt•rin<' t·on1t'a<·1 ions Wt'l't· ohs<'l'n•d in " patien! wit it an f'Xt.l'auterinr· prrg-nam·.v. b. The treatment for t·
"" ,.;j" .Cl \ ~· .. \ •

1

1. \Vhen the plac<•nta is left in situ. JIOsit.i\'1' l·'riedman lt·~ts haY<' ht·\'11 obtained on lll'illP fi'(Hil the pntit•nt thirt:·-tivt' days ;~ftct· opt't·ation. s. 'rran~fusion~ of whole blood <11ld tltl' ns" ol' 11<'\\' <·oag·ulants lllii,l' he· lit'•· sa.ving; lllt
References 1. Beacham, \V. [),,and BPaeharn. lhut \\'.: Ol'"t. & :l,

}', A. Da vi~ l'ompany.

·-:!-. Champion, P. 1(., and Te~~itore .. 1. • t_: A)1. ,J. l)HS'!'. & (~Y~JE<'. 36: :2~!-:!~t3, J9:i9. G. Cornell, Jo;. L., and Lash, A. F.: Hurg., liynt><· .. & Ol"t.. Tnternat. Ah~i. :4urg. 57: !I~

104, 1933.

(), Ureenhill, ,f. 1'.:

.l ..\. M. A. 106: (i06·1lil.'i, 1 ~1;;n.

Volume S:i Number 4

7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18.

LATE EX'rRAU'fERINE PREGNANCY

581

Hellman, A. M., and Simon, J. J.: Am. J. Surg. 29: 403-413, 1935. Mahfouz, N. P.: J. Obst. & Gynaec. Brit. Emp. 45: 209-230, 1938. McNeile, I. G.: West. J. Surg. 45: 119-133, 1937. Mundell, J. J. M. Ann. District of Columbia 2: 80-90, 1933. Schu~ann, Edward A.: Gynec. & Obst. Monograph, New York, 1922, D. Appleton & Co., p. 393. Titus, Paul: The Management of Obstetric Difficulties, ed. 2, St. Louis, 1940, '!'he C. V. Mosby Co., pp. 301 and 323. Ware, H. H., Jr.: AM. J. OBST. & GYNEC. 27: 756-759, 1934. Wa1·e, H. H., Jr.: AM .•J. OBST. & GYNEC. 42: 33-38, 1941. Ware, H. H., Jr.:. Virginia M. l\fonthly 71: 428-430, 1944. Ware, H. H., Jr.: South. M. J. 39: 44-49, 1946. Ware, H. H., Jr.: New York State J. Med. 36: 24, 1936. von Winckel: Handbuch der Geburtshilfe. Part 1,'Wiesbaden, 1904.

Discussion Dl~. SAMUEL A. CosGROVE, Jersey City, N. J.-Dr. \Vare would appear to have had the good fortune of an uniquely extensive personal experience in the subject of his pre~entation. I have seen and operated on only three such cases in thirty-four years of direction of a large service, he four times that number in one-half that time. 'l'he relatively large number of these cases coming to his clinic would appear to connote in the locality served by him either or both of the following conditions: firet, that the clientele that they derive from do not seek medical advice early in abnormal pregnancy, or, second, that the type of medical service they do seek fails to recognize and properly treat those early abnormalities which lead to late extrauterine pregnancy. There is apparently much room indicated here for a double-harrelrd program of pf1uration designed to reach both laity and doctors. Especially is this need for physician education exhibited in tho~e cases improperly manipulated before admission to Dr. "Ware's service. Any least appreciation of the conditions suitable for such manipulation would have demon~trated that they were not present in these cases, and the attendants would have been at onee on their guard. Dr. 'IVare's discussion of the symptoms and signs of late ectopic gestation is logical. Careful study of it may be helpful to each of us in relation to re<'ognition of this relatively infrequent condition. He is to be congratulated on the surgical ingenuity and resource with which he has met extremely varying conditions. He properly insists on the prime necessity for individualization of these cases. His maternal results are good, in consideration of the handicap against him represented by mismanagement of some of the cases before coming to his hands. I believe his fetal resultH are unusually good in comparison with other Pxperience. His present larger series bears out his previous showing that where an entire ectopic mass cannot be definitely isolated, and its pedicle readily d~?alt with, best results attend leaYing the placenta in situ, and closing the abdomen. DR. LoUIS H. DOUGLASS, BALTIMORE, Mo.-Recently in Baltimore we had occasion to look up all the abdominal pregnancies over a twenty-five-year period in all of the hospitals in Baltimore. There were twenty-six such cases, and, fortunately, we were able to get from the Health Department information about a!l of the viable births during that time. Our total was twenty-six cases in 425,620 live births, or an incidence of 1:16,370. It was sixteen times as high in the Negro race a~ in the white. I thought thi~ might be interesting, in view of the paper this morning. Our total maternal mortality in this whole series was eight and, peculiarly enough, the rate was the same aR Dr. \Yare's, 30.77 per cent. In the first twenty years the maternal rnm·tality waR 41.7 per cent, whereas in the second twelve years, with the improvement in treatment and ·enre, leaving the plrwentn in, it fell to 21.4 per cent. Our fetal mortality was 77 per cent. I would like to stress one thing that Dr. \Vade mentioned, and this is s:o self-evident that littl
WARE

:\m.

J

Ob~l. & li~'JrC·

April. i0!S

Then• was one rather interesting· ca'e in our group. The patient was iu a hospital ir Baltimore in 1n:n with a diagnosis of cirrhoRiR of thP livPr and ascites. Hhe was a Phroni .. :di·oholic. Largr ~unounts. of fluid \Yere \Vithdra\vn and it promptly filled up again. H!H· signeo a rel!'asP, went hom!', apparently rerowred, and P.ame in to see us in 1934, pregnant. !'\he was deliv<:'red ~pont.aneously at full term. The day Ph<:' wa~ to le:we the hospital we had " Hat. plate of tht- aht1on1eu made, \vhieh shu\ved a rnnss of fetal hone~ in t1H:o pelvi~, so t1w1 lwr '' rirrhosis .. of the livpr in 1031 har1 b<:>en an abdominal rn·egnanry. f4he refused opem I ion ancl sai<1 she would keep the fetal skeleton sine•• slw had harsity of Maryland Ho~pital.

This was a Negr<> girl: and we r~ouhl not lwn.r a fetal heart bPat. One man on the servi<'
<"at-'PS

and they all rr.C'O\~ered.

One factor eoneerning the diag·no,is of tltes<' cases will h•· found very true by wakhingall I have seen haw bP<'n after eight months' gE-station. If an x-ray is taken on admissiot; nrHl another ju a Wt-'t?k or ten day:-~, it will he fou1u1 that the bahy ha~ not c.hanged position at all. In intraut\'rinp pregnancy a change in position of these babiPs may bt' foun<1. DR. ltliAKJ<: 1, l~losin~;') .-(hw of the patient" operated upon 11eeausl· of an abdominal pregnancy was delivered of a 110rmal living baby. '!'he plaeenta was left in situ and th<· abrlomen close.l withou1 drainage. '!'his patiC'nt. 'H temperature remaine1l normal, hut n mas'

,,·hich we thought

wa~

the plnr•.pnt:t

wat-~

palpable in the lnwer HbdnnH?n nnrl pelvis f'nr

~i:\

months. Two ~·f'Hr' Inter ;;lu• was sarean sPetion of a nornml intrauterine prer:· naney. Carefnl f'Xamina\ion of lwr p