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Ectopic Pregnancy

The document discusses ectopic pregnancy which occurs when a fertilized egg implants outside the womb, usually in a fallopian tube, causing life-threatening bleeding if left untreated. It provides information on the symptoms, risk factors, diagnosis, and medical or surgical management of ectopic pregnancy including administering methotrexate or performing laparoscopy to repair the fallopian tube or salpingectomy to remove the damaged tube.

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Regine Aldamar
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67 views10 pages

Ectopic Pregnancy

The document discusses ectopic pregnancy which occurs when a fertilized egg implants outside the womb, usually in a fallopian tube, causing life-threatening bleeding if left untreated. It provides information on the symptoms, risk factors, diagnosis, and medical or surgical management of ectopic pregnancy including administering methotrexate or performing laparoscopy to repair the fallopian tube or salpingectomy to remove the damaged tube.

Uploaded by

Regine Aldamar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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ECTOPIC

PREGNANCY
An ectopic pregnancy is when a fertilized egg implants
itself outside of the womb, usually in one of the
fallopian tubes.
An ectopic pregnancy most often occurs in a fallopian
tube, which carries eggs from the ovaries to the uterus.
This type of ectopic pregnancy is called a tubal
pregnancy. Sometimes, an ectopic pregnancy occurs in
other areas of the body, such as the ovary, abdominal
cavity or the lower part of the uterus (cervix), which
connects to the vagina.
An ectopic pregnancy can't proceed normally. The
fertilized egg can't survive, and the growing tissue may
cause life-threatening bleeding, if left untreated.

OVERVIEW
FOCUS ASSESSMENT
IMPLANTATION

No unusual symptoms are usually present at the


time of implantation of an ectopic pregnancy.
The usual signs of pregnancy would occur, such
as a positive pregnancy test, nausea and vomiting,
and amenorrhea.

6 – 12 WEEKS

At 6-12 weeks of pregnancy, the trophoblast would be large


enough to rupture the fallopian tube.
Bleeding would follow, and it would depend on the number
and size of the affected blood vessels the amount of
bleeding that would occur.
Sharp, stabbing pain in the lower quadrant is likely to be felt
by the woman once a rupture has occurred, followed by
scant vaginal bleeding.

UPON ARRIVAL

Upon arrival at the hospital, a woman who has a


ruptured ectopic pregnancy might present signs of
shock such as rapid, thread pulse, rapid
respirations, and decreased blood pressure.
There would be a decreased hCg levels or
progesterone levels that would indicate that the
pregnancy has ended.
DIAGNOSTIC AND LABORATORY
PELVIC ULTRASOUND
Positive findings include an empty
uterine cavity, decidual cast, a thick
echogenic endometrium, or a
pseudo-gestational sac in the
presence of beta hCG levels above
the discriminatory zone.

Magnetic Resonance
Imaging
MRI can confirm abnormal
implantation sites, and
distinguish rupture from non
rupture cases before
management. .
RISK FACTORS
Smoking Use of intrauterine devices.
Women who frequently smoke have a IUDs are contraceptive devices shaped
higher incidence of ectopic pregnancy like an inverted T and inserted into the
than non-smoking women. . uterus of a woman. It may impede the
travelling fertilized egg to reach the ideal
place of implantation if it is inserted after
conception.

Uterine tumors Congenital malformations.


. A tumor might be pressing at the Physical defects of the reproductive
proximal end of the tubes, which would system such as strictures in the fallopian
not allow access of the fertilized egg tube could cause ectopic pregnancy.
into
the uterus. .

Previous infection such as salpingitis


Scars from a tubal surgery or pelvic inflammatory disease.
These scars cause an adhesion that Women who experience infection of the
would not let the fertilized egg travel reproductive system increase the
towards the uterus. . incidences of having ectopic pregnancy
because the scar from these infections
could cause adhesion in the fallopian
tube.
Pathophysiology as Blastocyst
Implanting into Fallopian Tissue
Sufficient (Zygote
Growth)
Release of Remodeling of
Trophoblast Maternal Vessels
Insufficient
(Zygote Death)
Fallopian
Ampulla Tube (Wall)

Blastocyst Stretch of Nerve Fallopian Tube


Bleeding
Implantation Fibers Wall Destruction
Nursing Diagnoses by Priority / Nursing
Management / Intervention
Acute Pain related to ectopic pregnancy as evidenced by
abdominal pain.
Intervention:
● Administer prescribed pain medications.
● Assess the patient’s vital signs and characteristics of pain at least 30 mins after
administration of medications.
Rationale:
● To alleviate the symptoms of acute abdominal pain.
● To monitor effectiveness of medical treatment for the relief of abdominal pain.
The time of monitoring of vital signs may depend on the peak time of the drug
administered.

Risk for Deficient Fluid Volume related to bleeding from a


ruptured ectopic pregnancy. .
Intervention:
● Assess vital signs, conduct physical examination, and commence daily weight
monitoring.
● Start input and output monitoring.
Rationale:
● Edema, headaches, low blood pressure, and pain are associated with the
patient’s blood loss. Fluid retention may be evident if the patient has unexplained
weight gain.
● To monitor circulatory blood volume. To ensure that the patient has adequate oral
hydration or if there is a need to commence IV hydration therapy. .
Nursing Diagnoses by Priority / Nursing
Management / Intervention
Risk for Maternal Injury
Intervention:
● Assess the patient’s mental status.
● Prepare the patient for immediate surgical intervention for the removal of the
ectopic pregnancy.
Rationale:
● Ectopic pregnancy may cause the patient to have low mood, depression, or
negative emotional state, which puts her at risk for maternal injury.
● Ectopic pregnancy is the leading cause of maternal death during the first
trimester due to internal bleeding, therefore an urgent surgery to remove it is
needed.
Medical / Surgical Management
Medical Interventions
Administration of methotrexate
Methotrexate is a chemotherapeutic agent that is a folic acid antagonist. It destroys
rapidly growing cells such as the trophoblast and the zygote. This would be
administered until a negative hCg titer results have been produced.

Administration of mifepristone
An abortifacient that causes sloughing off of the tubal implantation site. Both of
these therapies would leave the tube intact and no surgical scarring.

Surgical Interventions
Laparoscopy
This will be performed to ligate the bleeding blood vessels and repair or remove
the damaged fallopian tube.

Salpingectomy
This intervention would be performed if the fallopian tube is completely damaged.
The affected tube would be removed and what would be left would be sutured
appropriately.
Reporter: Acierto,
Gwyneth Jem
2BSN6

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