Delayed Diagnosis in Tubal Abortion

The first operation for early rupture of tubal pregnancy was performed 'by Lawson Tait in 1883. Since that time, advances in surgical technic and in methods of supportive therapy have saved countless lives from the sudden collapse following the classical acute rupture of such implantation. Of great consequence, too, has been increasing alertness in early diagnosis and the removal of this potentially dangerous lesion as soon as possible. A statement by Novak is not unlike that to be found today in any of our standard texts. "Even in patients who are ambulatory and whose symptoms are relatively mild there should be no delay in recommending operation because of the ever-present possibility of life-endangering hemorrhage from tubal rupture or abortion." The problem should be certainly a clear one in both the intact and the acutely ruptured tube. It is the intention of this communication to emphasize by two case reports that the problem should be similarly dealt with in those cases of tubal abortion where surgical intervention does not appear urgent, and where a question of expectant treatment may arise. It is known that certain cases of tubal abortion may become entirely well spontaneously, pass unrecognized, and never reach operation. The occasional finding of old hyalinized villi in tubes removed long after possilble pregnancy is ample evidence for this statement, but the frequency of such a favorable outcome cannot be known. One may ask, therefore, is it not best to wait for such an end result if the imminent danger seems to have passed? Cannot the patient who presents herself with only mild subjective complaints, and with hematocele already developed, be allowed a period of observation, hoping for absorption of the accumulated blood clot? The reports which follow call particular attention to the extensive pelvic inflammatory reaction which may result in such instances. During the period of observation, or where tubal abortion has not been suspected, hemorrhage may be recurrent, yet of such slight