Iliacus haematoma syndrome as a complication of anticoagulant therapy.

Medical Memoranda BRrT= 97 She made an uneventful postoperative recovery, and when seen in the outpatient department four months later was well and menstruation had returned to normal. Histology.-By comparison with placentae belonging to embryos of known size the histology corresponds most closely to those of 10 to 15-mm. (37 to 42-day) embryos as regards the characteristics of the cytotrophoblast and syncytiotrophoblast and the disposition of the stromal cells. DISCUSSION Studdiford's (1942) three criteria for a primary peritoneal pregnancy are as follows: (1) both tubes and ovaries must be normal, with no evidence of recent and remote injury, (2) there must be no evidence of uteroperitoneal fistula, and (3) the pregnancy must be related exclusively to the peritoneal surface and young enough to eliminate the possibility of secondary implantation following a primary nidation in the tube. Millar (1961) pointed out that the earlier the pregnancy can be detected the more convincing will be the evidence of primary peritoneal implantation, and recorded the youngest reported case, that of a 23-24-day pregnancy. The present case fulfils the three criteria, and it is significant that the implantation site was well away from the tubes and ovaries. Cavanagh (1958) suggested that the majority of peritoneal pregnancies are secondary, the ovum escaping from the tube and becoming attached to the omentum. It is then transferred to part of the peritoneal surface, where it is finally implanted. If this is so the omentum should be found adherent near the implantation site, which it was not in this case. Iffy (1961), after analysing the timing of a series of accurately dated cases of ectopic pregnancy, concluded that conception occurred just before the last period. He stressed that they were derived from the ovulation before, not after, the last normal period and suggested that the menstrual bleeding itself was responsible for displacement of the ovum by producing blood in the tubes. In the present case, however, the dating is more suggestive of conception from a normal ovulation about two weeks before the last period. Though it is certain that the peritoneal implan-tation was not secondary to tubal rupture, it is possible that a loose initial attachment was formed in the tube and the embryo later extruded from the ostium by retrograde menstrual flow. It is equally possible that the ovum was fertilized outside the tube and descended into the pouch of Douglas. Whichever occurred, the first effective implantation …