ECTOPIC PREGNANCY

ectopic pregnancy

pregnancy occurs when a fertilized

egg implants outside the uterine cavity, most

commonly in the fallopian tube (in approximately 95% of such pregnancies). 80% occur in the ampullar portion, 12% occur in the isthmus, and 8% are interstitial or fimbrial. Less frequent sit include the ovary, abdominal cavity, or cervix. It is a life-threatening condition requiring immediate medical attention.

Risk/Predisposing Factors

- Pelvic Inflammatory Disease (PI

Infections such as chlamydia or gonorrhea

that cause scarring in the fallopian tubes.

- Previous Ectopic Pregnancy History of

ectopic pregnancies increases the likelihood

of recurrence.

- Tubal Surgery or Damage Any surgery or

trauma to the fallopian tubes can interfere

with the egg’s travel to the uterus.

- Intrauterine Device (IUD) While rare,

pregnancies occurring with an IUD in place

have a higher chance of being ectopic.

- Infertility Treatments Assisted reproductive

technologies like in vitro fertilization (IVF)

- Maternal Age Women over 35 years old are

at increased risk.

- Smoking Alters tubal motility and reduces

ciliary function in the fallopian tubes.

- Endometriosis Can lead to scarring and

adhesions that hinder proper egg

implantation.

Clinical Manifestations/ Signs &

Symptoms

• Pain

• Vaginal spotting or bleeding

• Hemoperitoneum (Internal bleeding)

• Dizziness, headache, weakness, fainting or syncope

• Tender Mass

Pain

● Abdominal pain (localized or generalized)

May be confused with strong stomach pain,

it may also feel like a strong cramp.

● Shoulder Pain This is caused by free blood

tracking up the abdominal cavity and

irritating the diaphragm, and is an ominous

sign.

● Pain while urinating or having a bowel

movement.

Vaginal spotting or bleeding

Usually mild. An ectopic pregnancy is usually a failing pregnancy and falling levels of progesterone from the corpus luteum on the ovary case withdrawal bleeding.

Hemoperitoneum (Internal bleeding)

Severe internal bleeding from the affected tube can lead hemodynamic instability.

Dizziness, headache, weakness, fainting or

syncope

Resulting from internal bleeding and

hypovolemia

Tender Mass

On pelvic examination, an adnexal

mass may be felt.

Prevention

1. Prevent and Treat STIs Early diagnosis and

management of sexually transmitted

infections reduce the risk of PID

2. Stop Smoking Smoking cessation can

improve reproductive health

3. Careful Monitoring Post-Tubal Surgery

Women with previous tubal surgeries should

have close monitoring during early

pregnancy.

4. Family Planning Proper use of

contraceptives and avoidance of unintended

pregnancies in high-risk individuals

Diagnostic Tests

1. Transvaginal Ultrasound (TVS) The gold

standard for confirming the location of t

pregnancy

2. Serum Beta-hCG Abnormally low or

plateauing hCG levels suggest an abnormal

pregnancy

3. Complete Blood Count (CBC) To assess

for anemia or signs of internal bleeding

4. Culdocentesis Rarely used; checks for

blood in the peritoneal cavity

5. Laparoscopy Diagnostic and therapeutic;

allows visualization and management of

ectopic pregnancy.

Medication Management

Methotrexate

- Used for the treatment of

unruptured tubal pregnancy and for

persistent disease after

salpingostomy.

- A chemotherapeutic agent that

inhibits cell division in the

developing pregnancy. Best for

early, unruptured ectopic

pregnancies.

- Antineoplastic, Antimetabolite - used to

terminate pregnancy.

- Leucovorin - used with folic acid

antagonists, such as methotrexate.

- Vasopressors - used for their alpha and

betal properties and for stimulating

vasoconstriction in peripheral circulation.

- Vasopressin (Pitressin)- has vasopressor

and antidiuretic (ADH) activity. In linear

salpingostomy, the involved tube is

identified and freed from surroundi

structures.

Surgical Management

- Salpingostomy: Removal of the ectopic

pregnancy while preserving the fallopian

tube.

- Salpingectomy: Removal of the entire

fallopian tube, usually in cases of rupture or

severe damage.

- Laparoscopy: Minimally invasive approach

for diagnosis and treatment.

- Laparotomy: Open surgery, reserved for

unstable patients or extensive damage.

assessment

- Monitor for signs of rupture (severe pain,

hypotension, tachycardia, shoulder pain).

- Assess for vaginal bleeding and

hemodynamic stability.

- Check serum beta-hCG levels and

ultrasound reports.

interventions

1. Preoperative Care:

- Explain the procedure to the patient and

obtain informed consent.

- Administer fluids and blood products

needed.

- Monitor vital signs and signs of shock.

2. Postoperative Care

- Monitor for complications such as infection,

bleeding, or thromboembolism.

- Provide pain management.

- Educate about wound care and signs of

infection.

3. Psychological Support

- Offer counseling to address emotion

distress and grief.

- Provide resources for support groups or

therapy.

4. Patient Education

- Teach about the importance of follow-up

care, including beta-hCG monitoring.

- Discuss future pregnancy planning and risk

reduction strategies.

- Emphasize adherence to prescribed

medications and lifestyle modification