Ectopic Pregnancy

Definition

• History of sexually transmitted diseases
• History of pelvic inflammatory disease
• History of previous ectopic pregnancies
• History of previous ectopic pregnancies
• Failed tubal ligation
• Intrauterine device
• Multiple induced abortions
• Maternal age older than 35 years
• Some assisted reproductive techniques such as gamtete intrafallopian transfer
• Use of intrauterine device for contraception
• Anatomic or functional defects in the fallopian tubes
• Cigarette smoking 
• Vaginal douching

Missed menstrual period

Abdominal and pelvic pain

Vaginal spotting or light bleeding

Usual early signs of pregnancy

Intermittent abdominal pain

Small amounts of vaginal bleeding

Sudden, severe pain in one of the lower quadrants of the abdomen

Intraabdominal hemorrhage

Shoulder or neck pain that is worse on inspiration

Hypovolemic shock 

Transvaginal ultrasound- confirm or rule ot an intrauterine pregnancy reliably

Serum tests for B-hCG-screening for a viable or nonviable pregnancy

Progesterone-screening for a viable or nonviable pregnancy

Sensitive pregnancy test-determine pregnancy

High-resolution ultrasound-used to determine pregnancy

Laparoscopy-allows direct visualization of the abdominal cavity to identify the source of the problem

Cytotoxic drug

Folic acid antagonist

Action: Interferes with cell reproduction-inhibits cell division in the embryo

Used for surgical management of tubal pregnancy that is unruptured

-Used to salvage the tube for future pregnancies

Tube is opened with a fine linear incision, products of conception are removed, the incision is left to heal without suturing

Side effects of methotrexate

Importance Of communicating to the health care team bothersome drug effects or worsening symptoms that suggest rupture

Instruct to refrain from drinking alcohol or ingesting vitamins that contain folic acid

Educate patient to refrain from sexual intercourse until B-hCG levels are undetectable with 2-3 weeks

The importance of keeping follow-up appointments should be emphasized 

 Educate the patient to recognize the signs and symptoms of ectopic pregnancy and to notify the doctor immediately if these should occur.

To prevent recurrence, advise the patient to engage in safe sexual practices.

Teach strategies to avoid STDs and pelvic infections that could cause further damage to the fallopian tubes.

Give the patient the following instructions: Limit activity and get plenty of rest.

Increase fluid intake.

Keep the incision clean.  

Delay pregnancy for at least 3 months to allow for tubal healing. 

Monitor maternal vital signs- to determine presence of hypotension and tachycardia caused by rupture or hemorrhage

Monitor for presence and amount of vaginal bleeding-to further assess the present situation indicating hemorrhage

Monitor for increased pain and abdominal distention and rigidity- Increased pain and abdominal distention indicated rupture and possible intraabdominal hemorrhage

Monitor complete blood count-To determine the amount of blood loss

Provide comfort measure like back rubs, deep breathing. Instruct in relaxation or visualization exercises.Provide diversional activities. -Promotes relaxation and may enhance patient's coping abilities by refocusing attention

Provide diversional activities- Diversional activities aids in refocusing attention and enhancing coping with limitations

Administer analgesics as indicated- To maintain acceptable level of pain

The patient and her family will be able to communicate their fears and concerns openly.

 The patient will verbally and nonverbally express reasonable comfort.

The signs and symptoms of hemorrhage will be minimized/managed as measured by

• stable vital signs,
• urinary output of 30 ml/hr or greater,
• absence of signs of shock, and
• hematocrit maintained between 30 % and 45 %.

The patient’s temperature will remain normal, incision will approximate without redness or drainage, vaginal discharge will be without odor, and the white blood cell count will remain less than 16,000/mm3.

The patient and family members will verbalize their feelings of grief appropriately and identify any problems as they work through the grief process.

Postoperative complications will be minimized/ managed as measured by no burning on urination, hematocrit maintained between 30% and 45%, breath sounds clear, bowel sounds active, abdomen soft, and beta-hCG levels drop to zero in 2 weeks postoperatively.

• paralytic ileus,
• urinary tract infection, pneumonia,
• anemia,
• pulmonary edema,
• Rh sensitization,
• persistent ectopic pregnancy, or
• adhesions