A Text-book of Diseases of Women

by Charles B. Penrose

Rupture of the tube or of the gestation-sac into the peritoneal cavity is a very fatal occurrence. In the majority of cases death from hemorrhage occurs within twenty-four hours.

Unless the ovum plugs the rent in the tube, there is nothing to arrest the hemorrhage.

The woman is seized with sudden pain in the side, often described as the sensation of “something giving away.” She suffers from faintness, acute anemia, nausea, vomiting, and collapse. As in other cases of acute anemia, there may be delirium and convulsions.

Bimanual examination made after intraperitoneal rupture reveals an indefinite fulness or a yielding mass in the pelvis behind the uterus. The blood free in the peritoneal cavity coagulates slowly, and the fluid blood or soft unrestrained clots are often very difficult to palpate. For this reason, at first the examiner can feel only an ill-defined fulness in the pelvis. If the woman survives and the mass of blood becomes more solid, it may then be distinctly palpated as a solid mass behind the uterus, bulging into the vagina, and extending up into the abdomen. Though the hematocele may at first be difficult to define, yet the enlarged tube may usually be palpated, and the ovum may sometimes be felt in the midst of the ill-defined mass of blood.

As has already been said, in rare cases rupture may occur intraperitoneally or into the broad ligament without producing any of the severe symptoms just described. The fetus continues to develop, and the woman will be ignorant that rupture has ever occurred. Between the two extremes there are all degrees of severity.

In tubal abortion the symptoms resemble those of intraperitoneal rupture.

If the fetus dies within the tube, the symptoms become those of hematosalpinx or other form of tubal disease.

Diagnosis.—The diagnosis of tubal pregnancy is not often made before rupture, because there are usually no symptoms that direct the woman’s attention to the abnormality of her condition. Very often she thinks that she is normally pregnant.

If opportunity is given for examination before rupture, the diagnosis may sometimes be made. The woman presents the signs of pregnancy. The uterus may be slightly enlarged, though not of the size or shape normal for the stage of pregnancy. There is a soft tubal tumor.

Immediately after rupture the diagnosis of the condition must be made from a study of the previous history, from the present subjective symptoms, and by bimanual examination.