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 ECTOPIC
PREGNANC
Y
 ECTOPIC
PREGNANC
Y
 ECTOPIC
PREGNANC
Y
 Who’s reporting?

EDELYN JOYCE M. TEMPLADO KARL CHRISTIAN ONG

Ectopic Pregnancy
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.
 Ectopic Pregnancy
An ectopic pregnancy is often caused by damage to the
fallopian tubes. A fertilized egg may have trouble passing
through a damaged tube, causing the egg to implant and grow in
the tube.
 Signs and Symptoms of
Ectopic Pregnancy
Most of the time, an ectopic pregnancy happens
within the first few weeks of pregnancy. You
might not even know that you're pregnant and
may not notice any problems.

Early signs of an ectopic pregnancy include:

>Light vaginal bleeding and pelvic pain
>Upset stomach and vomiting
>Sharp abdominal cramps
>Pain on one side of your body
>Dizziness or weakness
>Pain in your shoulder, neck, or rectum
What are the risk factors of an ectopic pregnancy?
Previous ectopic pregnancy
Prior fallopian tube surgery
Previous pelvic or abdominal
surgery
Certain sexually transmitted
infections (STIs)
Pelvic inflammatory disease
Endometriosis
What are the risk factors of an ectopic pregnancy?

Cigarette smoking
Age older than 35 years
History of infertility
Use of assisted reproductive
technology, such as in vitro
fertilization (IVF)
 Types of Ectopic Pregnancy
Tubal pregnancy
A tubal pregnancy occurs when the egg has implanted in the fallopian
tube. This is the most common type of ectopic pregnancy and the
majority of ectopic pregnancies are tubal pregnancies. The type of
tubal pregnancy can be further classified according to where inside
the fallopian tube the pregnancy becomes established.

>A pregnancy grows in the fimbrial end in around five percent of all
cases.
>A pregnancy grows in the ampullary section in around 80% of all
cases.
>A pregnancy in the isthmus of the fallopian tube is seen in around
12% of all cases. Increased vasculature in this area means hemorrhage
is more likely to occur and mortality of the pregnancy is therefore
more likely.
>A pregnancy in the cornual and interstitial part of the fallopian
tube is seen in around two percent of cases and again is more likely
to lead to mortality of the pregnancy due to increased vasculature in
this area.
 Types of Ectopic Pregnancy
Non-tubal ectopic pregnancy
Nearly two percent of all ectopic pregnancies become
established in other areas including the ovary, the cervix
or the intra-abdominal region.

Heterotopic pregnancy
In some rare cases, one fertilized egg implants inside the
uterus and another implants outside of the structure. The
ectopic pregnancy is often discovered before the
intrauterine pregnancy, mainly due to the painful nature
of ectopic pregnancy. If human chorionic gonadotropin
levels continue to rise after the ectopic pregnancy has
been removed, the pregnancy inside the womb may still be
viable.
 Diagnostic Tests
Tests to determine the possibility of ectopic pregnancy must be
performed first before the diagnosis.

>Pelvic Ultrasound. An early pregnancy ultrasound is the most common

determinant of an ectopic pregnancy.

>Magnetic Resonance Imaging. This is also another way to detect the

presence of ectopic pregnancy and it is safer than undergoing a CT
scan for pregnant women.
 Medical Interventions
The medical management of a woman with an ectopic pregnancy should be initiated
the moment she is brought to the emergency room. Just a few moments of interval
for action would cause a big difference in the safety of the patient.

>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.

>Intravenous therapy. This would be performed when the ectopic pregnancy has
already ruptured to restore intravascular volume due to bleeding.

>Withdrawing of blood sample. A large amount of blood would be lost, so blood

typing and crossmatching must be done in anticipation of a blood transfusion.
The blood sample would also be used to determine the hemoglobin levels of the
pregnant woman.
 Surgical Interventions
Surgical interventions would be performed after the
rupture of the ectopic pregnancy to ensure that the
reproductive system would still be functional and no
complications would arise.

>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.
 Nursing Management
Nurses must also have their own function when it comes to ectopic
pregnancy, even without a direct order from the physician.

Nursing Assessment
>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.
>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 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.
 Nursing Management
Nursing Diagnosis
>Risk for Deficient Fluid Volume related to bleeding from a ruptured ectopic
pregnancy.
>Powerlessness related to early loss of pregnancy secondary to ectopic pregnancy.

Nursing Interventions
Upon arrival at the emergency room, place the woman flat in bed.
Assess the vital signs to establish baseline data and determine if the patient is
under shock.
Maintain accurate intake and output to establish the patient’s renal function.

Evaluation
The goal of the evaluation is to ensure that maternal blood loss is replaced and
the bleeding would stop.

>The patient must maintain adequate fluid volume at a functional level as

evidenced by normal urine output at 30-60mL/hr and a normal specific gravity
between the ranges of 1.010 to 1.021.
>Vital signs, especially the blood pressure and pulse rate, should be stable and
within the normal range.
>Patient must exhibit moist mucous membranes, good skin turgor, and adequate
capillary refill.
Ectopic pregnancy is a menace for both the mother and the
zygote. However much we want to save the zygote, it would be
impossible because it has grown outside the usual site of
implantation. The only thing that we could provide to the woman
and their families is proper education about ectopic
pregnancy and ways on how to prevent it from recurring.
1.What is
the most
common
ectopic
pregnancy?
 2. Give
three risk
factors of
an ectopic
pregnancy.
3. Give one
medical
intervention
that can be
given to a
patient with
an ectopic
pregnancy.
4. Give one
possible
nursing
diagnosis
for a
patient with
an ectopic
pregnancy.
 5. It’s an
ectopic
pregnancy
wherein one
fertilized egg
implants inside
the uterus and
another implants
outside of the
structure
Incompetent cervix
Incompetent Cervix
It is an inability of the cervix to remain closed. As the baby
grows the pressure of the
baby on the cervix cause the cervix to start to
open before the baby is ready to be born
It lead to miscarriage or premature delivery
It happens in only about 1 out of 100 pregnancies
Treatment
Surgical treatment for incompetent cervix is the procedure known as CERCLAGE
(suturing the cervix). It is performed to prevent dilation of the cervix. Some other
modifeid techniques such as Shirodkar or the McDonald are most commonly used
An alternative treatment for an incompetent cervix is the bedrest, sometimes for
several months.
Nursing Care
>Determine any factors that further contribute to the anxiety of the woman so
it could be avoided.

>Monitor vital signs to determine any physical responses of the patient that
could affect her condition.

>Convey empathy and establish a therapeutic relationship to encourage client

to express her feelings.

>Provide accurate information about the situation to help client back into
reality.
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