When the ovum is destroyed in the tube before rupture takes place, the fetus and the blood may be absorbed; or mummification, adipoceration, or lithopedion-formation may result; or suppuration may occur, with the formation of a pyosalpinx; or, if death of the fetus happens in the early weeks, the tube may be found closed at the ostium abdominale, and filled with blood in which no fetus may be detected. Such cases have been repeatedly described as hematosalpinx, the real origin of the condition in pregnancy not being known. The fetus had been absorbed or broken up and scattered through the blood-mass. Careful microscopic examination of the tube reveals the true condition—a destroyed tubal pregnancy with hemorrhage into the tube. As has already been said, hematosalpinx not caused by tubal pregnancy is very rare.
Coincidently with the development of the tubal pregnancy there occur enlargement of the body of the uterus and decidual transformation of the endometrium. The decidual membrane separates, entire or in fragments, and is discharged from the uterus, after the death of the embryo or during its development, from the eighth to the tenth week. The decidua again forms only when gestation continues undisturbed.
The enlargement of the uterus varies a great deal according to the position of the tubal pregnancy and the course of its development. The interstitial variety is accompanied by the greatest uterine enlargement. When the tubal gestation has reached full time the uterus may measure from 4 to 7½ inches in length.
The increased size of the uterus is most marked in the long diameter. The change of shape does not resemble that which occurs in normal pregnancy.
The uterus also becomes softer in tubal pregnancy, and the cervix softens somewhat, though not so much as in a uterine pregnancy.
If the woman and the fetus survive the many dangers that accompany the progress of tubal gestation, the development of the fetus will go on to full term, and then the phenomenon of spurious labor will come on.
In spurious labor there are a series of periodical pains that resemble those of normal labor. The pains may last from a few hours to several days. They may cease, and reappear after varying intervals.
Hemorrhage usually takes place from the uterus. After the spurious labor the uterine discharge may be of the same character as that seen after normal labor.
It is probable that the fetus always dies after spurious labor. The liquor amnii is absorbed, the gestation-sac shrinks, and changes take place in the fetus similar to those already referred to. It may become mummified or converted into adipocere or a lithopedion. In this condition it may remain in the abdomen for many years. A mummified fetus that had been carried for fifty years has been removed post-mortem from a woman aged eighty-two.
Rarely, after spurious labor the gestation-sac ruptures and the fetus is discharged into the peritoneum, the vagina, or the large intestine, whence it is born through the anus.