Someone you knew discovered that she has an

ectopic pregnancy. What advice would you

give to her? Check all that apply.

A. Most ectopic pregnancies goes to completion, although

the newborn is small.

B. If she have a fallopian tube removed, she will be sterile

afterward.

C. She will have a continuous nagging pain through the

rest of pregnancy

D. Ectopic pregnancy can be either medically or surgically

treated

Ectopic
Pregnancy
-embryo implants outside of
the uterus
-about 2% of all pregnancy
-2nd most frequent cause of
bleeding early in pregnancy

Risk Factors

Smokers

Advance maternal age

Women who douche regularly

Used of IUD (intrauterine device)

Following in vitro fertilization

Repeated induced abortion

History of tubal surgery

History of ectopic pregnancy (10%-20% chance)

Congenital Reproductive system anomalies

Sexually transmitted infection and pelvic inflammatory disease

Assessment:
Signs and Symptoms

Nausea and vomiting

Amenorrhea

(+) pregnancy test

Asymptomatic prior to tubal rupture

Bleeding severe intraperitoneal bleeding (interstitial)

-continuous bleeding (ampullar area)

Dizziness, weakness, or fainting

Sharp stabbing pain (lower abdominal quadrant) followed by scant vaginal

spotting

Acute hemorrhage

Lightheadedness and rapid pulse, signs of shock

Therapeutic
Management

Monitor vital signs and signs of hypovolemic shock

Regular assessment of vaginal bleeding

Before the tube ruptures

Early sonogram

Methotrexate followed by Leucovorin

Mifepristone

When ectopic pregnancy ruptures

CBC

Blood typing and crossmatching

hCG level for immediate pregnancy testing

Intravenous fluid

Laparoscopy to ligate the bleeding vessels

linear salpingostomy or salpingectomy

CASE

Cora is a 42-year-old newlywed. She comes into the Womens Health Clinic
complaining of vaginal bleeding and abdominal pain that is completely unlike her
usual monthly cramping. She describes her pain as very sharp and an 11 on a
scale of 010. Her vital signs are temperature 98.8 F, pulse 102, respiration 24,
and blood pressure 102/64. She indicates that her blood pressure is usually
130/90. She is unable to recall the date of her last menstrual period. Additionally,
she has almost soaked an entire pad in the last hour.
Cora is very anxious and says, Ive never had any real female problems before,
except for the little cramping I get on the first day of my period. I shouldnt be
having this difficulty because I keep my female parts very clean by douching
weekly. She sheepishly admits to having the clap five years ago.
(Case study courtesy of Sharon Walker, RN, MSN.)
Discussion
Cora should be assessed for an ectopic pregnancy. Her risk factors
include: advanced maternal age, regular douching, and a history of an
STI. She is bleeding heavily and showing evidence of hypovolemia. The
priority in this situation is to ensure patient safety by obtaining and
sustaining hemodynamic stability.

Thank you and God

bless

-Gretchen R. Monticalbo,
RN, CRN