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ECTOPIC GESTATION (PREGNANCY)
The ovum is usually fertilised within the Fallopian tube, along which it passes to reach the cavity of the womb and there become implanted. It may happen that the ovum becomes arrested within the tube and undergoes growth and development in this abnormal situation; such a condition constitutes an ectopic gestation.
The cause of the arrest of the downward progress of the fertilised ovum is usually some obstruction in the Fallopian tube. The obstruction may be congenital in origin, but by far the commonest cause is the formation of kinks and adhesions, the result of previous inflammation, sometimes of venereal origin. The arrest and growth of a gestation in the Fallopian tube is a very serious matter, as the tube is thin-walled and only slightly dilatable ; furthermore, no protective decidua (q.v.) is formed to limit the activity of the chorionic villi of the gestation sac, which, eating their way into the walls of the blood vessels of the Fallopian tube, cause profuse and serious internal haernorrhage. This occurs as a rule some time between the sixth and twelfth week of the pregnancy.
 
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Most frequently a menstrual period has been missed and the patient think she may be pregnant. Very soon acute attacks of abdominal pain come on which vary in intensity, but may be so severe as to cause complete collapse and fainting. The commonest time for this pain to appear first is about ten days to a fortnight after the expected but missed menstrual period was due, but it may occur much sooner. About this time a slight but continuous loss of blood from the vagina commences. In about a quarter of all eases there is no history of a missed period, owing to the bleeding from the vagina just mentioned commencing earlier and at the time the missed period was expected.
The condition is a very serious one, and practically always requires surgical treatment to save the woman's life. The child never survives, or only in very rare instances. See Conception.
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