The diagnosis as to whether the fetus in the pelvis is dead or alive may be made (1) from the absence or presence of symptoms of tubal rupture during the second and third months, or of mild symptoms indicating only slight bleeding; (2) from the continuation and progress of the evidences of pregnancy, as nausea, mammary changes, fetal movements, or audibility of the fetal heart; (3) from the presence of a loud uterine blood souffle; (4) from the absence of toxemia or suppuration; (5) from a growth of the uterus and a softening of the cervix; (6) from a gradual increase in the size of the suspected ectopic fetal tumor. In making the diagnosis great caution must be observed, as roughness in manipulation may start hemorrhage or rupture a thinned tube.
The diagnosis may be made: (1) that ectopic gestation exists without symptoms of maternal hemorrhage, and the fetus is not viable; (2) that the same maternal condition may be present, but the fetus is viable; (3) that there may be symptoms of slight bleeding, and the fetus is inviable; (4) that there may be symptoms of grave maternal hemorrhage at any stage of the gestation.
The ordinary medical doctrine in the text-books is that as soon as a diagnosis of ectopic gestation is made laparotomy should be done and the sac with the ectopic fetus removed. If the fetus is alive and inviable this procedure will, of course, kill it. Only a few obstetricians of authority advise an expectant treatment. Schauta found 75 recoveries and 166 maternal deaths in 241 cases treated expectantly--a mortality of 69 per cent.
If there are no symptoms of maternal hemorrhage but the fetus is evidently dead, the fetus is to be removed. If it is evidently alive, or doubtfully alive, the treatment must be expectant. The woman is to be removed to a hospital and kept under constant watch, day and night, with everything prepared for immediate operation. Any woman while bearing an ectopic fetus is in constant grave danger of death, but the moralists hold that her danger is not so imminent before actual rupture as to justify the death of the fetus by precautionary removal.
In 1886 the Archbishop of Cambrai proposed the following list of questions to the Holy Office for decision: