Le diagnostic et la pathologie gynécologique . Fig. 141.-villosités choriales de cas de grossesse de marée (H.P.). Pathologie gynécologique 142 Changements dans le tube et l'utérus.-Dans les muqueuses andmuscular paroi du tube il y a un certain nombre de réaction comme theresult de la présence de l'ovule. Les vaisseaux sanguins se dilatent, l'endo-thelium leur doublure s'étend, et certaines de ces cellules endothéliales mayfind leur chemin vers l'extérieur dans les tissus de l'article. La prolifération des cellules des tissus conjonctifs et de l'agrandir et peut prendre l'apparence d'un verylike que de véritables cellules déciduales. La relation de la cho

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Gynecological diagnosis and pathology . Fig. 141.—Chorionic Villi from Case of Tidal Pregnancy (H.P.). 142 GYNECOLOGICAL PATHOLOGY Changes in the Tube and Uterus.—In the mucous membrane andmuscular wall of the tube there is a certain amount of reaction as theresult of the presence of the ovum. The blood-vessels dilate, the endo-thelium lining them proliferates, and some of these endothelial cells mayfind their way outwards into the tissues of the part. The connective-tissue cells proliferate and enlarge and may take on an appearance verylike that of true decidual cells. The relation of the chorionic villi tothese cells is seen in figs. 140-141. These changes occur both in themucosa and in the muscular wall. As a rule there is no true deciduaformed in the tube; there is merely this attempt at its formation on thepart of the endothelial and connective-tissue cells. In rare cases, such asthe one described by Haultain, the mucous membrane becomes converted. Fig. 142.—Uterus from a Case of Tubal Pregnancy.Note the thickness of the decidua. into a true decidua. In his case there was also a decidua in the oppositetube. In the uterus a true decidua always forms. The mucous membranethere undergoes exactly the same changes as it would have undergonehad the pregnancy been intra-uterine. The mucosa increases greatly inthickness (fig. 142) and the two layers, compact and spongy, can berecognised. The muscular wall also hypertrophies and the whole uterusbecomes softened and enlarged. Progress and Results.—The course of a tubal pregnancy dependspartly upon the part of the tube in which the ovum has become imbedded.There are four possible sites—the fimbriated end, the ampulla, theisthmus, or the interstitial portion. Owing to the absence of decidualreaction on the part of the tube, the trophoblast of the ovum penetratesmore rapidly and more deeply than in the case of an intra-uterine TUBA I- GESTATION 143 pregnancy, and blood extravasation is

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