Angeles University Foundation

Angeles City

“Ectopic Pregnancy”

Submitted By:

Ano, Carl Elexer C.

BSN IV-11, Group 41

Submitted To:

Lheiza V. Dimalanta R.N., M.N.

November 7, 2009
DEFINITION:

Ectopic pregnancy is an abnormal form Fig.1

of pregnancy which is characterized by the
implantation of products of conception in a
site other than the uterine cavity. 95% of
ectopic pregnancy cases accounts to
implantation in the fallopian tube (fig.1)
wherein 80% of which occurs in the ampullar
portion, 12% occurs in the isthmus, and 8% of
which are interstitial or fimbrial. Ectopic pregnancy can also occur in the ovary, cervix
and rarely in the peritoneal cavity.

CAUSES:

With ectopic pregnancy, fertilization occurs as

Fig.
usual in the distal third of the fallopian tube or the 2
ampulla. Immediately after the union of ovum and
spermatozoon, the zygote begins to divide and grow
normally. Unfortunately, because of an obstruction, the
zygote cannot travel the length of the tube and lodges at
the strictured site along the tube and implant there
instead of in the uterus. Obstruction in the fallopian tube
is usually because of adhesion brought about by previous
infection particularly salphingitis, scars from tubal surgery,
tumors pressing on the proximal end of the tube, and improper use of IUD. On the other
hand, peritoneal pregnancy is brought about by ruptured ectopic pregnancy wherein it
was not detected and the zygote continuously to grow.
SIGNS AND SYMPTOMS:

An ectopic pregnancy may seem like a normal pregnancy at first there would be
a positive hCG pregnancy test. Early signs and symptoms may be the same as those of
any pregnancy a missed period, breast tenderness, nausea and fatigue. But later on,
the mother may experience the following:

• Light vaginal bleeding/spotting

• Lower abdominal pain
• Cramping on one side of the pelvis

If the fallopian tube ruptures, symptoms may include:

• Adnexal mass
• Dizziness and syncope
• Lightheadedness
• Symptoms of Hypovolemic shock
• Vaginal bleeding
• Board – like rigid abdomen
• Cullen’s sign
• Sharp stabbing abdominal pain which is also referred as shoulder pain.

EXAMS AND TESTS:

Ectopic pregnancy still shows normal results from laboratory exams. The only way to
diagnose the condition is through imaging exams such as ultrasound and MRI.
TREATMENT:

If the ectopic pregnancy is detected early, an injection of the drug Methotrexate

(Trexall) a folic acid antagonist chemotherapeutic agent may be used to stop cell growth
and dissolve existing cells. Leucovorin is also given to patient during the therapy to
prevent excessive damages that may occur with methotrexate therapy. Patient is
treated until a negative hCG test is achieved. After which a sonogram is performed to
check if the tube is fully patent. Mifepristone (Mifeprex) an abortifacient, is also effective
in sloughing off the tubal implantation site.

If ruptured tubal pregnancy occurred, a laparoscopic ligation of the bleeding

vessel is performed together with either removal of the affected tube or suturing the
tube using a microsurgical technique (9-0 or 10-0 nylon).

NURSING RESPONSIBILITIES:

• Ensure that appropriate physical needs are addressed and monitor for
complications. Assess vital signs, bleeding and pain.
• Provide client and family teaching to relieve anxiety
o Explain the condition and expected outcome
o Describe self care measures depending on the treatment
• Address emotional and psychosocial needs.