CLINICAL CASE ANALYSIS – ECTOPIC PREGNANCY

INTRODUCTION:

Ectopic pregnancy in simpler terms means “an out-of-place pregnancy”. It is a common,

occasionally life-threatening condition when an ovum is implanted on an area outside of the
uterus. Normally, the ovum should be attached to the lining of the uterus, or the endometrium,
that will later on grow into a baby in a span of 9 months. In ectopic pregnancy, the fertilized egg
gets caught or delayed while travelling from the fallopian tube to the uterus and attaches itself in
other areas of the body. The fertilized egg will not be able to survive, hence, ectopic pregnancy
cannot proceed normally because of the growing tissue that can cause life-threatening bleeding
if not treated.

Tubal ectopic pregnancy is the most common type of ectopic pregnancy experienced by women.
It happens when a fertilized egg implants itself in one of the fallopian tubes because it didn’t
quickly move down the uterus or the fallopian tube is damaged or misshapen.

Other types of ectopic pregnancy are:

 Interstitial pregnancy
 Caesarean scar pregnancy
 Cervical pregnancy
 Cornual or Rudimentary horn pregnancy
 Ovarian pregnancy
 Intramural pregnancy
 Abdominal pregnancy
 Heterotopic pregnancy

Symptoms of ectopic pregnancy include:

 Vaginal bleeding
 Pain in the lower abdomen, pelvis, and lower back
 Dizziness or weakness

And when the fallopian tube ruptures, it can cause additional symptoms like:
 Fainting
 Hypotension
 Shoulder pain
 Rectal pressure or bowel movements

Risk factors of ectopic pregnancy include:

 Previous ectopic pregnancy
 History of pelvic inflammatory disease (PID)
 Surgery on the fallopian tubes
 History of infertility
 Treatment for infertility with in vitro fertilization (IVF)
 Endometriosis
 Sexually transmitted infections (STIs)
 IUD in place at the time of conception
 History of smoking tobacco
PATHOPHYSIOLOGY:

DIAGNOSTIC PROCEDURES:

Individuals clinically suspected of having ectopic pregnancy fall into two primary categories:
those who have an acute abdomen and in whom emergent surgery is necessary, and those who
are clinically stable and in whom adjunctive diagnostic procedures can be conducted.

Vaginal ultrasound
This is accomplished by inserting a small, easily insertible probe into the vagina without the use
of local anesthetic. In order to produce a close-up image of the reproductive system on a
monitor, the probe sends out sound waves that are reflected back. If an egg has been fertilized,
this will frequently indicate whether it has implanted itself in one of the fallopian tubes, though
occasionally this may be very challenging to determine.

Blood tests
Human chorionic gonadotropin (hCG), a pregnancy hormone, is measured in blood tests. It may
also be done twice, 48 hours apart, to track changes in the level over time. Since the level of
hCG tends to be lower and rise more slowly over time than in a typical pregnancy, this can be a
useful way to detect ectopic pregnancies that are missed during an ultrasound scan. Finding the
most effective course of treatment for an ectopic pregnancy may benefit from the test's findings.

Laparoscopy
A laparoscopy can be performed if the diagnosis and location are not clear after vaginal
ultrasound and blood tests. In order to perform this kind of keyhole surgery under general
anesthesia, a small incision in the abdomen is made, and a laparoscope viewing tube is
inserted. Direct examination of the fallopian tubes and womb is done with it. Small surgical tools
may be used to remove an ectopic pregnancy if it is discovered during the procedure in order to
prevent the potential need for a subsequent operation.

MEDICAL MANAGEMENT:

Linear Salpingostomy
The implicated tube is located and released from supporting structures during a linear
salpingostomy. To reduce bleeding, the mesosalpinx immediately below the ectopic pregnancy
may be injected with a diluted solution containing 20 U of vasopressin in 20 mL of isotonic
sodium chloride solution. Thereafter, a 1- to 2-cm linear incision is made along the
antimesenteric side of the tube along the thinnest part of the membrane using a microelectrode,
scissors, harmonic scalpel, or laser. Usually at this point, the pregnancy pokes its head through
the incision and may even escape the tube. On rare occasions, it needs to be teased out with
forceps or an aqua-dissection, which helps to loosen the pregnancy with pressurized irrigation.

Segmental Tubal Resection

In isthmic pregnancies, where the endosalpinx is frequently harmed, resection of the tubal
segment containing gestation or total salpingectomy is preferred over salpingostomy. With a
linear salpingostomy, these individuals have poor outcomes and frequently experience recurrent
ectopic pregnancies.

When performing a segmented tubal resection, the tube is grasped at the proximal and distal
edges of the segment that contains the gestation, and the antimesenteric border is thoroughly
coagulated to the mesosalpinx. This part of the tube is then removed. Moreover, the underlying
mesosalpinx is coagulated and removed, paying particular attention to minimizing harm to the
nearby vascular system.

Total Salpingectomy
The mesosalpinx can be gradually coagulated and cut, beginning at the fimbriated end and
moving toward the proximal isthmic section of the tube, to achieve total salpingectomy. The tube
is now cut apart from the uterus using either a laser or scissors after being coagulated.
NURSING MANAGEMENT:

Methotrexate Therapy
This medical management refers to the use of Methotrexate, an antimetabolite
chemotherapeutic agent that binds to the enzyme dihydrofolate reductase, which is involved in
the synthesis of purine nucleotides. It is simply a medicine that stops cells from dividing.
Methotrexate has a well-established track record for treating trophoblastic tissue, as seen by the
success with which it has been used to treat choriocarcinomas and hydatiform moles.
Methotrexate is injected intramuscularly (IM) once or several times as part of the treatment for
ectopic pregnancy.
Name of Students: GANOTICE, Marron Jane A., GONZALES, Xyrence P.
Date Submitted: February 28, 2023 CI’s Signature: Ma’am Flora Tel-equen