In incomplete tubal abortion the maternal blood may slowly trickle from the fimbriated extremity of the tube into the abdominal cavity, become encapsulated, and thus form an haematocele. If the fimbriated extremity of the tube is blocked, the blood accumulates in the tube and makes an haematosalpynx.
In complete tubal abortion the foetus dies; in incomplete tubal abortion the viability might depend on the injury done the placenta, but in almost every case of even incomplete tubal abortion the foetus dies as a result of its separation from the tubal wall, or from compression after the bleeding.
In cases of rupture of the tube in extrauterine pregnancy, if the foetus with its attachments is expelled from the tube into the peritoneal cavity or into the broad ligament, the embryo dies.
If the foetus or embryo itself alone is expelled into the abdominal cavity and the placenta remains attached to the wall of the tube and communicates with the foetus by the umbilical cord which runs through the tear in the tube, the foetus may [{7}] possibly live, provided the mother does not die from hemorrhage. If the foetus goes on growing in this case, we have an abdominal pregnancy. One such case is reported by Both where a fully developed foetus was found in the abdominal cavity even lacking all its membranes, which had been left in the tube, but a foetus will not live apart from its membranes within the maternal body.
When an embryo or foetus ruptures the tube and goes into the broad ligament, it may live or die according to the injury done its attachments to the tubal wall, but it ordinarily dies. Sometimes such a broad-ligament pregnancy ruptures again into the abdominal cavity. Because the bleeding is more likely to be confined within the folds of the broad ligament, the immediate danger of maternal death from hemorrhage is less in this than in other forms of rupture.
Concerning tubo-abdominal pregnancy the only remark to be made is that, owing to adhesions, it is often surgically difficult to remove such a growth.
If the foetus is expelled after rupture into the peritoneal cavity it dies, and if the hemorrhage does not kill the mother the dead foetus if small is absorbed; if large it becomes mummified, or it hardens into a lithopoedion, or it turns into a yellowish greasy mass called adipocere, or it putrefies. A lithopoedion may be carried for years. There are more than thirty cases reported which were carried from twenty to thirty years in the abdomen, and one case where a lithopoedion was carried for fifty years.
If the foetus putrefies it causes fatal septicaemia in the mother, or a perforating abscess, unless it is successfully removed.
There are various abnormalities of the uterus, and in these pregnancy resembles in effect extrauterine pregnancy. An abnormal uterus may be unicornis, didelphys, pseudodidelphys, bicornis duplex, bicornis septus, bicornis subseptus, bicornis unicollis, or bicornis unicollis with a rudimentary horn. The impregnated ovum may fasten in the rudimentary horn and be blocked there; then the usual result is rupture within the first four months, with fatal hemorrhage unless the bleeding is immediately checked by coeliotomy and ligation.