Unruptured interstitial pregnancy

Abstract

Mrs. R. H., white, aged twenty-nine years, had been married ten years, and had three chiIdren Iiving and weII, the fourth, born in I 919, having died after five months of pneumonia. She had had one earIy abortion without complications. AI1 the Iabors and puerperia were normal. Menstruation began at the age of 14. It is of the twenty-eight day type, Iasts three days, and the flow is moderate, and without pain. The patient’s Iast menstrua1 period ended February 3, 1925. In ApriI she used “sIippery elm sticks” to induce an abortion. The next day she had some uterine bIeeding, foIIowed in two days by chills and fever and general malaise. On ApriI 22 she was admitted to the hospital. There was generahzed tenderness throughout the Iower abdomen. The fundus was large and very tender with marked induration and tenderness in the region of both adnesae. A diagnosis was made of peIvic peritonitis, metritis and perimetritis. Her hemogIobin was 32 per cent, WAC. 11,500, P.M.N., 79 per cent. Her temperature was 100’ F., pulse I IO, respirations normaI. She remained in the hospita1 for eight days, at the end of which time her temperature returned to normal, and she was feeIing quite weI1. She was seen again in the Out-Patient Department June 14, because of a severe pain through the lower abdomen, more marked on the right side, At that time the vagina1 mucosa was bIue, the cervix was enIarged and soft, there was a mass which rose within a finger breadth of the umbilicus. This mass was irregularIy softened and felt Iike a normaIIy progressing pregnancy. Because of the temperature of 99.4’ F. and the severe pain, the patient was again admitted to the hospital. Her temperature soon feI1 to normal, and she was discharged at the end of the second day. On JuIy 2 she was examined again. The uterus seemed about the size of a five months’ pregnancy. There was great tenderness in the region of both tubes and ovaries, more marked apparentIy on the left side. Her temperature was 99.8” F., and she compIained of some frequency and dysuria and pains in the Ieft Iower quadrant. On July 21 the patient began having a few cramps, which were foIlowed by a bloody vagina1 discharge. July 23 she had a sudden gush of fluid. The next day the uterus was a IittIe smalIer than formerly, and there was Iess tenderness in the abdomen. We thought at that time that the patient would abort. On August 20 she was examined again, and the uterus seemed definiteIy smaIIer than previously. The patient said she had been having a fouI-smelIing brownish discharge, with some bright blood at times. When seen in September she had been feeIing quite weI1; there had been a IittIe bright red discharge; the uterus was definiteIy smaIIer, but stiI1 considerabIy Iarger than normal. She was examined the first of October. At that time the uterus was about the size of a three months’ pregnancy and rather hard and freeIy movable, and the cervix was closed. She returned to the hospitat October IS, stating that for the previous twenty-four hours she had been having considerable bleeding. The uterus was about the same size as that at the Iast examination, at which time it was felt that the patient should be curretted, and this was done in August. The left waI1 of the uterus seemed about norma thickness. The right cornu was about 2 inches thick, feeling Iike an intramural fibroid in this region. The uterine cavity itself did not contain any product of pregnancy. It was curretted, but nothing abnormal was obtained. Pathologica examination showed no suggestion of feta1 tissue. The patient made an uneventfu1 recovery from this, and left the hospital three days later. On November 19 she returned. The emargement in the right cornu of the uterus was about the size of a basebaI1. It was discrete, firm and not tender. The uterus was quite movabIe. We made a diagnosis then of fibromyoma of the uterus. In December she was examined again, and at that time we advised operation for fibromyoma. * From the Gynecological Division of the Henry Ford HospitaI.