Licence: Public Domain Mark
Credit: Practical manual of obstetrics. Source: Wellcome Collection.
Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.
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![layers of peritoneum, rather than perform the posterior operation ; when we hear of seventy consecutive and successful ovariotomies, why should not an operation such as gastrotomy, in extra-uterine gestation, be per- formed as certainly the only means by which the peritoneal cavity can be emptied of, or prevented from containing, the most irritating material which can find its way there. Experience has shown that the danger of alarming hemorrhage—which has often occurred after separation of the placenta—can be greatly lessened by allowing a number of days or even weeks to elapse before attempting to remove the placenta. The principal, and, to many minds, the only argument standing in the way of laparotomy and removal of the Fallopian tube in suspected extra- uterine pregnancy at an early period, is the difficulty of making a positive diagnosis of the condition.—Ed.] Art. V.—Molar Pregnancy. This is due to an altered product of conception. The cause which de- termines this species of pregnancy seems to be either traumatic or moral, without our being able to explain in what way the alteration is effected. Three varieties are distinguished. A. The embryonal mole or false germ, when the ovum is arrested in its development. It generally terminates by an abortion about the third or fourth month. The embryonal remains are found floating in the waters contained in a sac formed by the decidua, the chorion, and the amnion. B. The carneous mole, which results when the false germ grows through its sojourn in the uterus, and its envelopes assume very great consistence and thickness, in consequence of exaggerated nutrition. ItsToIume varies from the size of an egg to that of a foetus at term. Its texture is filamen- tous and resembles that of the placenta. Its expulsion rarely occurs later than the fifth or the sixth month. Sometimes we meet with the remains of a foetus encysted in its interior. C. Finally the hydaUdiform, better called vesicular mole, which consists of a series of vesicles united into clusters, the individual particles of which are of different size and filled with a clear serous lluid which contains no echinococcus deoris, and to which the name ossicular has been applied l>y ral authors. In this kind of mole the foetus lias been absorbed and the chorionic villi have hvpertrophied (as has recently been demonstrated by Professor Charles Robin), and thus the vesicles are formed. The vesicular mole is generally expelled from the fourth to tin sixth month, in several instalments and piecemeal, thus exposing the patient to septic absorption and death. 5](https://iiif.wellcomecollection.org/image/b2100013x_0095.jp2/full/800%2C/0/default.jpg)
