ectopic pregnancy

Ectopic Pregnancy

  • Good maternal prognosis with prompt diagnosis, appropriate surgical intervention, and control of bleeding.
  • Poor fetal diagnosis (rare incidence of survival to term with abdominal implantation).
  • About 33 % chance of giving birth to a live neonate in a subsequent pregnancy.
  • Incidence: about 1 to 200 pregnancies in whites; about 1 of 120 pregnancies on nonwhites.
  • Complications: rupture of fallopian tube, hemorrhage, shock, peritonitis, infertility, disseminated intravascular coagulation, and death.

Pathophysiology

  • Transport of a blastocyst to the uterus is delayed.
  • The blastocyst implants at another available vascularized site, usually the fallopian tube lining.
  • Normal signs of pregnancy are initially present.
  • Uterine enlargement occurs in about 25% cases.
  • Human chorionic gonadotropin (hCG) hormonal levels are lower than in uterine pregnancies.
  • If not interrupted, internal hemorrhage occurs with rupture of the fallopian tube.

Causes

  • Congenital defects in the reproductive tract
  • Diverticula
  • Ectopic endometrial implants in the tubal mucosa
  • Endosalpingitis
  • Intrauterine device
  • Previous surgery, such as tubal ligation or resection
  • Sexually transmitted tubal infection
  • Transmigration of the ovum
  • Tumors pressing against the tube

Assessment findings

  • Amenorrhea
  • Abnormal menses (after fallopian tube implantation)
  • Slight vaginal bleeding
  • Unilateral pelvic pain over the mass
  • If fallopian tube ruptures, sharp lower abdominal pain, possibly radiating to the shoulders and neck.
  • Possible extreme pain when cervix is moved and adnexa palpated.
  • Boggy and tender urine
  • Possible enlargement of adnexa

Test Results

  • Ultrasonography may show an intrauterine pregnancy or ovarian cyst.
  • Culdocentesis shows free blood in the peritoneum
  • Laparoscopy may reveal a pregnancy outside the uterus.

Treatment

  • Initially, in the event of pelvic-organ rupture, management of shock
  • Diet determined by clinical status
  • Activity determined by clinical status
  • Transfusion with whole blood or packed red blood cells
  • Broadspectrum I.V. antibiotics
  • Methotrexate (Rheumatrex)
  • Laparotomy and salpingectomy if culdocentesis shows blood in the peritoneum; possibly after laparoscopy to remove affected fallopian tube and control bleeding.
  • Micro-surgical repair of the fallopian tube for patients who wish to have children.
  • Oophorectomy for ovarian pregnancy
  • Hysterectomy for interstitial pregnancy
  • Laparotomy to remove the fetus for abdominal pregnancy.

Nursing Interventions

  • Determine the date and description of the patient’s last menstrual period.
  • Monitor vital signs for changes.
  • Assess vaginal bleeding, including amount and characteristics
  • Assess pain level
  • Monitor intake and output
  • Assess for signs of hypovolemia and impending shock
  • Prepare the patient with excessive blood loss for emergency surgery.
  • Administer prescribed blood transfusions and analgesics.
  • Provide emotional support.
  • Administer Rh (D) immune globulin (RhoGAM), as ordered, if the patient is Rh negative.
  • Provide a quiet, relaxing environment
  • Encourage the patient to express feelings of fear, loss, and grief.
  • Help the patient develop effective coping strategies.
  • Refer the patient to a mental health professional, if necessary, prior to discharge.

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