Ectopic Pregnancy

Ectopic Pregnancy

• An ectopic pregnancy is an abnormal pregnancy that occurs outside the uterus. The baby (fetus) cannot survive, and often does not develop at all in this type of pregnancy.

Sites of Ectopic pregnancy:

• • • • •

Fallopian Tube – 95% Interstitial (Cornual) Ovary Cervix Peritoneum

What Causes an Ectopic Pregnancy? • An infection or inflammation of the tube might have partially or entirely blocked it. • Pelvic inflammatory disease (PID), which can be caused by gonorrhea or chlamydia, is a common cause of blockage of the fallopian tube.

• Endometriosis (when cells from the lining of the uterus implant and grow elsewhere in the body) or scar tissue from previous abdominal or fallopian surgeries can also cause blockages. • Birth defects or abnormal growths can alter the shape of the tube and disrupt the egg's progress.

• This may be caused by a physical blockage in the tube by hormonal factors and by other factors, such as smoking.

• Most cases of scarring are caused by: – Past ectopic pregnancy – Past infection in the fallopian tubes – Surgery of the fallopian tubes

• Up to 50% of women who have ectopic pregnancies have had swelling (inflammation) of the fallopian tubes (salpingitis) or pelvic inflammatory disease (PID).

Some ectopic pregnancies can be due to:

• • • •

Birth defects of the fallopian tubes Complications of a ruptured appendix Endometriosis Scarring caused by previous pelvic surgery

The following may also increase the risk of ectopic pregnancy: • Age over 35 • Having had many sexual partners • In vitro fertilization

• Ectopic pregnancies occur in 1 in every 40 to 1 in every 100 pregnancies.

Symptoms • Sharp, stabbing pain in one of her lower abdominal quadrants at the time of rupture • Scant vaginal spotting

If the area of the abnormal pregnancy ruptures and bleeds, symptoms may get worse. They may include: Lightheadedness Rapid pulse Signs of shock

• • • •

Feeling faint or actually fainting Intense pressure in the rectum Pain that is felt in the shoulder area Severe, sharp, and sudden pain in the lower abdomen

Diagnostic Procedure: • • • • • • •

Culdocentesis Hematocrit Pregnancy test Quantitative HCG blood test Serum progesterone level Transvaginal ultrasound or pregnancy ultrasound White blood count

Therapeutic Management: 1. Oral administration if diagnosed before the tube ruptures

- Methotrexate – a folic acid antagonist chemotherapeutic agent, attacks & destroy fast growing cells

– followed by Leucoverin- is a reduced folic acid. Leucovorin is used in combination with other chemotherapy drugs to either enhance effectiveness, or as a "chemoprotectant."

2. Blood transfusion for ruptured tube 3. Laparoscopy- to ligate the bleeding blood vessels & to remove & repair damage fallopian tube.

Nursing Diagnosis:

• Powerlessness related to early loss of pregnancy secondary to EP • Nursing Intervention: • Encourage her to verbalize her concern about this & future childbearing

Prognosis

• One-third of women who have had one ectopic pregnancy are later able to have a baby. • A repeated ectopic pregnancy may occur in one-third of women. • Some women do not become pregnant again.

Possible Complications

– The most common complication is rupture with internal bleeding that leads to shock. Death from rupture is rare.