If the woman is not destroyed by the first effects of the rupture, the fetus, surrounded by its membranes, may escape into the peritoneal cavity, while the placenta may remain attached to the tube and gestation may continue. It is very doubtful whether the fetus will continue to live if it escapes into the peritoneum free of the membranes. There is no evidence that an early ovum may escape into the cavity of the abdomen and develop on the peritoneum.
If the fetus does not survive, it may be absorbed by the peritoneum or mummification may occur.
Tubal abortion means the separation of the ovum from the tube-wall, and its partial or complete discharge through the ostium abdominale into the peritoneal cavity. The accident is accompanied by hemorrhage into the tube and thence into the peritoneal cavity.
Tubal abortion is most likely to occur during the early weeks of pregnancy (the first and the second months), before the abdominal ostium has become closed.
It is probable that tubal abortion is much more frequent than is generally supposed. According to Sutton, tubal abortion was probably the cause of the peritoneal hematocele in many cases in which the bleeding was attributed to other origin, as reflux of menstrual blood from the uterus and simple hemorrhage from the tube.
In tubal abortion the loss of blood into the peritoneum may be so great that the woman is destroyed. In other cases death results from peritonitis and suppuration of the hematocele. And, finally, in a good many cases the blood and ovum may be absorbed, and recovery takes place. Sometimes, at operation, the ovum is found in the peritoneal cavity without any blood. The blood had either been small in amount and quickly absorbed, or there had been no escape of blood into the peritoneum. Blood-clot is usually found in the Fallopian tube after tubal abortion. The ostium may become closed and a hematosalpinx may result.
Fig. 156.—Extra-uterine pregnancy; tubal abortion. The bleeding is checked by a large coagulum distending and thinning out the tube; the fimbriated opening is greatly distended, but the greater diameter of the clot in the ampulla prevents its escape. Wall of tube averaging 1 millimeter in thickness. Operation. Recovery, July 7, 1896. Natural size. (Kelly. Copyright, 1898, by D. Appleton & Co.)
Fig. 157.—Coagulum turned out, showing a cast of the tube extending up into the isthmus. On its surface lies the fetus. Natural size. (Kelly. Copyright. 1808, by D. Appleton & Co.)