Marino M. Abogado Jr.

BSN II - Pure

Objectives of the discussion
To know the definition of ectopic pregnancy
and its manifestation.
To have an idea with its clinical symptoms.
To know the illness etiology and
pathophysiology.
To determine what is the appropriate medical
and nursing management

Definition
Pregnancy in which the fertilized
egg or embryo implants on any
tissue other than the endometrial
lining of the uterus.
Etiology
Pelvic inflammatory disease
History of prior ectopic pregnancy
History of tubal surgery and
conception after tubal ligation
Use of fertility drugs or assisted
reproductive technology
Use of an intrauterine device


Increasing age
Smoking
Salpingitis isthmica nodosum
T-shaped uterus
Prior abdominal surgery, failure with
progestin-only contraception
ruptured appendix.
Common Ectopic Sites

1. Ampullary (mid) portion of the fallopian tube (80-90%),
2. Isthmic (area closer to the uterus) portion of the fallopian
tube (5-10%),
3. Fimbrial (distal end away from the uterus) portion of the
fallopian tube (about 5%),
4. Cornual (within the uterine muscle) portion of the fallopian
tube (1-2%),
5. Abdomen (1-2%),
6. Ovary (less than 1%), or
7. Cervix (less than 1%).


Incidence and Impact
Occurs in 1 in 50 pregnancies
Is becoming increasingly more common
Is the second leading cause of maternal
mortality overall, and primary mortality
factor in first trimester pregnancies
May lead to impairment or loss of fertility


Clinical Signs and
Symptoms
Amenorrhea
Vaginal bleeding(40-50%)
Nausea
Breast fullness
Fatigue
Pain

Low abdominal pain
Heavy cramping
Pelvic tenderness (75%)
Enlarged uterus
Adnexal mass(50%)
Shoulder pain
Recent dyspareunia
Diagnosis
History and physical
any woman presenting with pain and vaginal
bleeding should be considered to have an
ectopic pregnancy until otherwise ruled out

Laboratory markers
Beta-HCG(measured in mIU/mL) --lack of
doubling signals only impending failure, not
indicative of location;absolute value only
helpful in correlation with ultrasound
Progesterone--also only indicates impending
loss, not location

Ultrasound--transvaginal is most
sensitive at this stage of pregnancy.
Correlation with the quantitative serum
hormone levels is suggested to increase
your sensitivity
if intrauterine gestational sac is seen and b-
HCG is 1,000-2,000, normal pregnancy is
virtually certain.
If b-HCG is <1,000 and there is an empty
uterus, ectopic pregnancy is very likely

Culdocentesis
In this test, a needle is inserted into the
space at the very top of the vagina,
behind the uterus and in front of the
rectum. Any blood or fluid found there
likely comes from a ruptured ectopic
pregnancy.

Cullen's sign can indicate a ruptured
ectopic pregnancy.

Medication
Methotrexate 1 mg/kg body weight is
an antimetabolite which inhibits the
reduction of folic acid to tetrahydrofolate.
This interferes with DNA synthesis and
cell multiplication. Ideal for disrupting
trophoblastic tissue proliferation.
Surgery
Tube sparing salpingotomy--used when
gestational sac is <2cm and in distal tube;
lateral incision made and gestational sac
removed.
Tube sacrificing salpingectomy

Effects of Ectopic
Pregnancy
The muscle wall of the tube has not the capacity
of uterine muscles for hypertrophy and
distention and tubal pregnancy nearly always
end in rupture and the death of the ovum.
Tubal abortion usually in ampullary about 8
weeks forming pelvic haematocele
Rupture into the peritoneal cavity
Occur mainly from the narrow isthmus before 8
weeks or later from the interstitial portion of the
tube. Haemorrhage is likely to be severe.
Sometimes rupture is extraperitoneal between the
leaves of the broad ligament Broad ligament
haematoma. Haemorrhage is likely to be controlled

Tubal pregnancy effect on
uterus

The uterus enlarge in first 3 months as if
the implantation were normal, reach the
size of a gravid uterus of the same
maturity.

Uterine decidua grows abundantly and
when the embryo dies bleeding occurs as
the decidua degenerates due to effect of
oestrogen withdrawal.

Nursing Diagnosis: Powerlessness
related to early loss of pregnancy
secondary to ectopic pregnancy
Outcome Evaluation: Client states she
feels sad at pregnancy loss but is able
to deal with situation; has returned to
previous level of activities and has
forward-thinking plans.


Uterus outlined in red, uterine lining in green, tubal ectopic pregnancy
yellow. Fluid in uterus at blue circle - sometimes called a "pseudosac" -
looks like an early pregnancy sac, but is not (usually a small blood
collection).
Citations
Chambers, H. M., & Chan, F. Y. (2009). Support for women/families after
perinatal death. Cochrane Database of Systematic Reviews, 2009(1),
(CD000452).
Chhabra, S., Dargan, R., & Nasare, M. (2007). Antepartum transabdominal
amnioinfusion. International Journal of Gynaecology and Obstetrics,97(2), 9599.
Chauhan, S. P., et al. (2007). Intrauterine growth restriction and
oligohydramnios among high-risk patients. American Journal of
Perinatology, 24(4), 215221.
Clark, E. A. S., Silver, R. M., & Branch, D. W. (2007). Do antiphospholipid
antibodies cause preeclampsia and HELLP syndrome? Current Rheumatology
Reports, 9(3), 219225.
Crombleholme, W. R. (2009). Obstetrics. In S. J. McPhee & M. A.
Papadakis (Eds.). Current medical diagnosis and treatment. Columbus, OH:
McGraw-Hill.
Yeah!! Natapos din pag
REPORT. HEHE!! relax