Ectopic Pregnancy

Ectopic pregnancy is gestation located outside the uterine cavity. The fertilized ovum implants outside of the uterus, usually in the fallopian tube. Predisposing factors include adhesions of the tube , salpingitis, congenital and developmental anomalies of the fallopian tube, previous ectopic pregnancy, use of an intrauterine device for more than 2 years, multiple induced abortions, menstrual reflux , and decreased tubal motility. Pathophysiology The uterus is the only organ capable of containing and sustaining a pregnancy. When the fertilized ovum implants in other locations, the body is unable to maintain the pregnancy. Common Clinical Manifestations • • • •

Dizziness and syncope (faintness) Sharp abdominal pain and referred shoulder pain Vaginal bleeding Adnexal mass and tenderness

(The client with ectopic pregnancy may report signs and symptoms of a normal pregnancy or may have no symptoms at all) Nursing Management 1. Ensure that appropriate physical needs are addressed and monitor for complications.

Assess vital signs, bleeding, and pain. 2. Provide client and family teaching to relieve anxiety. o Explain the condition and expected outcome.  Material prognosis is good with early diagnosis and prompt treatment, such as laparotomy, to ligate bleeding vessels and repair or remove the damaged fallopian tube.  Pharmacologic agents, such as methotrexate followed by leucovorin, may be given orally when ectopic pregnancy is diagnosed by routine sonogram before the tube has ruptured. A hystesolpingogram usually follows this therapy to confirm tubal patency.  Rh-negative women must receive RhoGAM to provide protection from immunization for future pregnancies. o Describe self-care measures, which depend on the treatment. 3. Address emotional and psychosocial needs.