Ectopic Pregnancy Study Guide

Angeles University Foundation Angeles City

“Ectopic Pregnancy”

Submitted By: Ano, Carl Elexer C. BSN IV-11, Group 41 Submitted To: Lheiza V. Dimalanta R.N., M.N.

November 7, 2009

DEFINITION:

Ectopic pregnancy is an abnormal form

Fig.1

of pregnancy which is characterized by the implantation of products of conception in a site other than the uterine cavity. 95% of ectopic

pregnancy

cases

accounts

to

implantation in the fallopian tube (fig.1) wherein 80% of which occurs in the ampullar portion, 12% occurs in the isthmus, and 8% of which are interstitial or fimbrial. Ectopic pregnancy can also occur in the ovary, cervix and rarely in the peritoneal cavity.

CAUSES: With ectopic pregnancy, fertilization occurs as usual in the distal third of the fallopian tube or the

Fig. 2

ampulla. Immediately after the union of ovum and spermatozoon, the zygote begins to divide and grow normally. Unfortunately, because of an obstruction, the zygote cannot travel the length of the tube and lodges at the strictured site along the tube and implant there instead of in the uterus. Obstruction in the fallopian tube is usually because of adhesion brought about by previous infection particularly salphingitis, scars from tubal surgery, tumors pressing on the proximal end of the tube, and improper use of IUD. On the other hand, peritoneal pregnancy is brought about by ruptured ectopic pregnancy wherein it was not detected and the zygote continuously to grow.

SIGNS AND SYMPTOMS: An ectopic pregnancy may seem like a normal pregnancy at first there would be a positive hCG pregnancy test. Early signs and symptoms may be the same as those of any pregnancy a missed period, breast tenderness, nausea and fatigue. But later on, the mother may experience the following: •

Light vaginal bleeding/spotting

•

Lower abdominal pain

•

Cramping on one side of the pelvis

If the fallopian tube ruptures, symptoms may include: •

Adnexal mass

•

Dizziness and syncope

•

Lightheadedness

•

Symptoms of Hypovolemic shock

•

Vaginal bleeding

•

Board – like rigid abdomen

•

Cullen’s sign

•

Sharp stabbing abdominal pain which is also referred as shoulder pain.

EXAMS AND TESTS: Ectopic pregnancy still shows normal results from laboratory exams. The only way to diagnose the condition is through imaging exams such as ultrasound and MRI.

TREATMENT: If the ectopic pregnancy is detected early, an injection of the drug Methotrexate (Trexall) a folic acid antagonist chemotherapeutic agent may be used to stop cell growth and dissolve existing cells. Leucovorin is also given to patient during the therapy to prevent excessive damages that may occur with methotrexate therapy. Patient is treated until a negative hCG test is achieved. After which a sonogram is performed to check if the tube is fully patent. Mifepristone (Mifeprex) an abortifacient, is also effective in sloughing off the tubal implantation site. If ruptured tubal pregnancy occurred, a laparoscopic ligation of the bleeding vessel is performed together with either removal of the affected tube or suturing the tube using a microsurgical technique (9-0 or 10-0 nylon). NURSING RESPONSIBILITIES: •

Ensure that appropriate physical needs are addressed and monitor for

complications. Assess vital signs, bleeding and pain. •

Provide client and family teaching to relieve anxiety o Explain the condition and expected outcome o Describe self care measures depending on the treatment

•

Address emotional and psychosocial needs.