Ectopic Pregnancy Implantation of a fertilized ovum outside the uterine cavity, most commonly in the fallopian tube.

tube. 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 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 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.

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 culdocentesis thumb Ectopic PregnancySerum hCG is abnormally low; when repeated in 49 hours, the level remains lower than the levels found in a normal intrauterine pregnancy. 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 patients 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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