Abdominal pregnancy—Fifth month

Abstract

From a review of the above descriptions and diagnoses, it is apparent that this represents an abdominal ectopic pregnancy, apparently originating within the tube. The development of the placenta had taken place principally within the wall of the tube and along the surface of the tube, ovary and broad ligament. The tube and ovary were the seat of an old, healed inflammatory reaction in which the lumen of the tube had become partially obliterated. There was still a mild chronic inflammatory reaction in portions of the broad ligament. The cord and the amnion and the chorionic membrane and chorionic villi adjacent to the attachment of the cord were healthy, mature and free of disease. The chorionic villi in this portion of the placenta were loosely attached to the broad ligament in the region of the tube and ovary. In this area, there were well developed intervillous spaces, bordered by chorion on the one hand, and by fibrin, decidua, and smooth muscle fibers of the broad ligament, on the other. There was a hypertrophy and a hyperplasia of the smooth muscle fibers of the broad ligament, and of the vessels of the broad ligament, especially those in the immediate vicinity of the attachment of the placenta. The vessels here were large, dilated, and gave rise to broad, thin, endothelial lined sinuses, bordered by edema fluid, fibroblasts and decidua. Chorionic villi and nests of trophoblasts were found within the lumma of some of these thin-walled sinuses. The decidua, connective tissue stroma, smooth muscle fibers of the broad ligament, and the dilated and hypertrophied vessels represented the functioning portion of the maternal placenta. The remainder of the placenta was thin, and for the most part, non-functioning, and was composed of a compact layer of chorionic villi that showed degeneration and necrosis, fibrin, and bloodclot. This portion of fetal placenta was attached to portions of the broad ligament and pelvic peritoneum and to the surface of the ovary by dense fibrin, which showed very little attempt at organization. There was no evidence of malignancy.