Ectopic Pregnancy

• An ectopic pregnancy is an abnormal

pregnancy that occurs outside the uterus. The
baby (fetus) cannot survive, and often does
not develop at all in this type of pregnancy.
 Sites of Ectopic pregnancy:

• Fallopian Tube – 95%

• Interstitial (Cornual)
• Ovary
• Cervix
• Peritoneum
 What Causes an Ectopic Pregnancy?
• An infection or inflammation of the tube
might have partially or entirely blocked it.
• Pelvic inflammatory disease (PID), which can
be caused by gonorrhea or chlamydia, is a
common cause of blockage of the fallopian
tube.
• Endometriosis (when cells from the lining of the uterus
implant and grow elsewhere in the body) or scar tissue from
previous abdominal or fallopian surgeries can also cause
blockages.
• Birth defects or abnormal growths can alter the shape of the
tube and disrupt the egg's progress.
• This may be caused by a physical blockage in
the tube by hormonal factors and by other
factors, such as smoking.
• Most cases of scarring are caused by:
– Past ectopic pregnancy
– Past infection in the fallopian tubes
– Surgery of the fallopian tubes
• Up to 50% of women who have ectopic
pregnancies have had swelling (inflammation)
of the fallopian tubes (salpingitis) or pelvic
inflammatory disease (PID).
 Some ectopic pregnancies can be due to:

• Birth defects of the fallopian tubes

• Complications of a ruptured appendix
• Endometriosis
• Scarring caused by previous pelvic surgery
 The following may also increase the risk of
ectopic pregnancy:

• Age over 35
• Having had many sexual partners
• In vitro fertilization
• Ectopic pregnancies occur in 1 in every 40 to 1
in every 100 pregnancies.
 Symptoms
• Sharp, stabbing pain in one of her lower
abdominal quadrants at the time of rupture
• Scant vaginal spotting
If the area of the abnormal pregnancy
ruptures and bleeds, symptoms may get
worse. They may include:
Lightheadedness
Rapid pulse
Signs of shock
• Feeling faint or actually fainting
• Intense pressure in the rectum
• Pain that is felt in the shoulder area
• Severe, sharp, and sudden pain in the lower
abdomen
Diagnostic Procedure:

• Culdocentesis
• Hematocrit
• Pregnancy test
• Quantitative HCG blood test
• Serum progesterone level
• Transvaginal ultrasound or pregnancy ultrasound
• White blood count
 Therapeutic Management:

1. Oral administration if diagnosed before the tube

ruptures
- Methotrexate – a folic acid antagonist chemotherapeutic
agent, attacks & destroy fast growing cells
– followed by Leucoverin- is a reduced folic
acid. Leucovorin is used in combination with
other chemotherapy drugs to either enhance
effectiveness, or as a "chemoprotectant."
2. Blood transfusion for ruptured tube
3. Laparoscopy- to ligate the bleeding blood
vessels & to remove & repair damage fallopian
tube.
Nursing Diagnosis:

• Powerlessness related to early loss of

pregnancy secondary to EP

• Nursing Intervention:
• Encourage her to verbalize her concern about
this & future childbearing
Prognosis

• One-third of women who have had one

ectopic pregnancy are later able to have a
baby.
• A repeated ectopic pregnancy may occur in
one-third of women.
• Some women do not become pregnant again.
Possible Complications

– The most common complication is rupture with

internal bleeding that leads to shock. Death from
rupture is rare.