In several instances we have found it impossible to differentiate between an
adherent myomatous uterus and a tubal pregnancy that has been ruptured for
several weeks.
The ruptured tube is not only enlarged and surrounded by
partly organizing clots, but is likewise adherent to the adjacent structures.
Where definite multiple myomatous nodules can be felt on the surface of the
uterus,
or where a submucous myoma can be felt or has been passed, the diagnosis
of myoma can be made with a fair degree of certainty, but it must be remembered
that tubal pregnancy occasionally accompanies a myomatous uterus, as noted
on.
The cessation of the period for one or two months, followed by con-
tinuous bleeding and definite pains on one side of the uterus, is, of course,
strong presumptive evidence of tubal pregnancy.
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