Treatment For Ectopic Pregnancy

VII. Medical Management TREATMENT FOR ECTOPIC PREGNANCY In most cases, an ectopic pregnancy is treated right away to avoid rupture and severe blood loss. The decision about which treatment to use depends on how early the pregnancy is detected and your overall condition. For an early ectopic pregnancy that is not causing bleeding, you may have a choice between using medicine or surgery to end the pregnancy. Medication Using methotrexate to end an ectopic pregnancy spares you from an incision and general anesthesia. But it does cause side effects and can take several weeks of hormone blood-level testing to make sure that treatment has been successful. Methotrexate is most likely to work: •

When your pregnancy hormone levels (human chorionic gonadotropin, or hCG) are low (less than 5,000).

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During the first 6 weeks of pregnancy.

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When the embryo has no heart activity.

Surgery If you have an ectopic pregnancy that is causing severe symptoms, bleeding, or high hCG levels, surgery is needed. This is because medicine is not likely to work and a rupture becomes more likely as time passes. Whenever possible, laparoscopic surgery that uses a small incision is done. For a ruptured ectopic pregnancy, emergency surgery is needed. Expectant management For an early ectopic pregnancy that appears to be naturally miscarrying (aborting) on its own, you may not need treatment. Your health professional will regularly test your blood to make sure that your pregnancy hormone (hCG, or human chorionic gonadotropin) levels are dropping. This is called expectant management.

Ectopic pregnancies can be resistant to treatment. •

If hCG levels do not drop or bleeding does not stop after taking methotrexate, your next step may be surgery.

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If you have surgery, you may take methotrexate afterward.

If your blood type is Rh-negative, Rh immunoglobulin is used to protect any future pregnancies against Rh sensitization.

II. Patient’s Profile and History NURSING HISTORY A. PERSONAL DATA Name: Modrigo, Marilyn Alvaro Age: 31 Date of Birth: November 21, 1977 Sex: Female

Civil Status: Married

Religion: Roman Catholic Nationality: Filipino Room number: 3034 A Attending physician: Dr. Dizon B. HISTORYOF PRESENT ILLNESS This is a case of Marilyn Modrigo, 31 years old, female, Roman Catholic admitted due to bleeding on May 16, 2009 at East Avenue Medical Center. Three days prior to admission, the patient already complains of pain at her flank. The pain ceased that day, however, was felt again after 2 days, May 15. On the following morning, the patient went to the market when she suddenly sensed pain on her lower abdomen that was intolerable. She described the pain she to be the same as the pain during labor. She noticed that she was bleeding, thus, opted to go to the hospital. The patient underwent pregnancy test which resulted positive. Then, ultrasound was done after and showed that there was a 10- week old fetus found at the right fallopian tube of the patient. It was only then, when the patient knew that she was pregnant, and having an ectopic gestation. C. PAST MEDICAL HISTORY

The patient had no other hospitalizations except when she gave birth to her 3 children. D. FAMILY HISTORY The patient has history of hypertension and diabetes mellitus, both of which her mother has. E. SOCIAL HISTORY The patient does not drink alcohol nor smoke cigarette. F. OBSTETRIC AND GYNECOLOGIC HISTORY 1. Menstrual history The patient had her menstruation when she was 13 years old at a regular interval and usually lasts for 5 to 6 days. The amount was moderate. She experiences dysmenorrheal every time she has menstruation. In addition, the patient had her coitarche at the age of 19. She had two sexual partners. G. OBSTETRIC HISTORY G4P3/T3P0A0L3 Pregnancy and Course of Delivery G1 Normal Spontaneous Delivery

1996

Lying-in

G2 Normal Spontaneous Delivery

1998

Lying-in

G3 Caesarean Section

1999

Jose Reyes Medical Center

G4 Ectopic pregnancy

2009

East Avenue Medical Center

H. GYNE HISTORY The patient uses oral contraceptives since 2004. The patient has no vaginal discharge.

VI. Pathophysiology ECTOPIC PREGNANCY Predisposing factors -

Salpingitis Previous ectopic pregnancy Multiple previous abortion Tumors that distort tubes Smoking Use of intrauterine device

↓ Dysfunction of the cilia which normally propel the fertilized ovum through the tube into the uterine cavity/ stimulation of contractions in the fallopian tubes because of nicotine ↓ damage to the mucosal surface of the fallopian tube/ scarring or disruption of the fallopian tubes ↓ intraluminal adhesions ↓ blocks or slows the movement of a fertilized egg through the fallopian tubes to the uterus ↓ fertilized egg attaches to an area outside the uterus (ampullary area of the fallopian tubes) where it implants ↓

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sudden severe pain abnormal bleeding from the vagina usually scanty amounts or spotting

Abnormal ultrasound findings: -no intrauterine gestational sac identified -hcG level is greater than 6500mlU per mL or 6500 IU/L