Ectopic Pregnancy

What is it?
When the fertilized ovum implants anywhere other than the uterus
Most common: tubal pregnancy (fallopian tube)
Occurs in 1.5 2.0% of pregnancies
Causes 0.5 deaths per 1000 women in the U.S.

Pathology
The fertilized ovum gets interrupted or stopped on its way to the
uterus.

Signs/Symptoms
Signs of hypovolemic shock
Vaginal bleeding, unilateral or bilateral abdominal pain, faintness,
dizziness, possible right shoulder pain
Rigid, tender abdomen and excruciatingly painful vaginal exam
CBC may show hemoglobin and hemocrit and leukocyte
At first, regular signs and symptoms of pregnancy (nausea,
amenorrhea, tender breasts), Chadwicks sign, Hegars sign, hCG
present
-hCG titers slowly

Other sites/types
Abdominal
Ampular
Cervical
Fimbrial
Infundibular
Intraligamentous
Interstitial
Isthmic
Ovarian

Medical Diagnosis
Confirmed with:
Pelvic exam
Lab testing (see CBC, etc.
above)
Ultrasound
Serum hCG
Assessment of menstrual
history and LMP
Laparoscopy

Risk factors
Congenital abnormalities of
the Fallopian tube
Use of ovulation-inducing
drugs
Smoking
Primary infertility
Advanced maternal age
Presence of an IUD
High levels of progesterone
Pelvic inflammatory disease
Endometriosis
Previous ectopic pregnancy
Prior pelvic or tubal surgery

TREATMENT OPTIONS
Methotrexate IM, single-, two-, or multi-dose
Laparoscopic linear salpingostomy or salpingectomy

Nursing Care
Assessment/Diagnosis
Appearance and amount of
vaginal bleeding
VS (BP and pulse)
Emotional status
Coping abilities
Plan/Implementation
Methotrexate
Abdominal pain/lack of
menstrual period for 1 2
months
Teaching about
methotrexate
Report heavy vaginal
bleeding, tachycardia,
dizziness
Return for -hCG testing
Call to follow up
Surgery
Start IV
Preoperative teaching
Prevention of infection
risk of subsequent ectopic
pregnancies
Emotional support