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Ectopic Pregnancy
occurs when a fertilized egg implants outside the uterine cavity, most commonly in the fallopian tube. It is a life-threatening condition requiring immediate medical attention.
80% of ectopic pregnancies occur in____
Ampullar portion
12% of ectopic pregnancies occur in ____
Isthmus
8% of ectopic pregnancies occur in ____
Interstitial or fimbrial
Less frequent sites include
Ovary, abdominal cavity, or cervix
Risk/Predisposing Factors
Pelvic Inflammatory Disease
Previous Ectopic Pregnancy
Tubal surgery or damage
Intrauterine Device
Infertility Treatments
Maternal Age
Smoking
Endometriosis
Pelvic Inflammatory Disease
Infections such as chlamydia or gonorrhea that cause scarring in the fallopian tubes
Previous Ectopic Pregnancy
History or 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
While rare, pregnancies occuring with an IUD in place have a higher chance of being ectopic
Infertility Treatments
Assisted reproductive technologies like in vitro fertilization
Maternal Age
Women over 35 y/o 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 (Abdominal pain / Shoulder pain)
Vaginal spotting or bleeding
Hemoperitoneum (Internal bleeding)
Dizziness, headache, weakness, fainting or syncope
Tender Mass
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
Pain while urinating or having a bowel movement
Vaginal spotting or bleeding
Usually mild. EP 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 to 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
Prevent and Treat STIs
Stop smoking
Careful Monitoring Post-Tubal Surgery
Family Planning
Prevent and Treat STIs
Early diagnosis and management of sexually transmitted infections reduce the risk of PID
Stop Smoking
Smoking cessation can improve reproductive health
Careful Monitoring Post-Tubal Surgery
Women with previous tubal surgeries should have close monitoring during early pregnancy.
Family Planning
Proper use of contraceptives and avoidance of unintended pregnancies in high-risk individuals
Diagnostic Tests
Transvaginal Ultrasound
Serum Beta-hCG
Complete Blood Count
Culdocentesis
Laparoscopy
Transvaginal Ultrasound
The gold standard for confirming the location of the pregnancy
Serum Beta-hCG
Abnormally low or plateauing hCG levels suggest an abnormal pregnancy
Complete Blood Count
To assess for anemia or signs of internal bleeding
Culdocentesis
Rarely used; checks for blood in the peritoneal cavity
Laparoscopy
Diagnostic and therapeutic; allows visualization and management of ectopic pregnancy
Medication Manage
Methotrexate
Antineoplastic, Antimetabolite
Leucovorin
Vasopressors
Vasopressin (Pitressin)
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.
Antineoplastic, Antimetabolite
Used to terminate pregnancy
Leucovorin
Used with folic acid antagonists, such as methotrexate
Vasopressors
Used for their alpha and 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 surrounding structures.
Surgical Management
Salpingostomy
Salpingectomy
Laparoscopy
Laparotomy
Salpingostomy
Removal of the ectopic pregnancy while preserving the fallopian tube
Salpingectomy
Removal of the entire fallopian, usually in cases of rupture of 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
Interventios
Preoperative Care
Postoperative Care
Psychological Support
Patient Education
Preoperative Care
Explain the procedure to the patient and obtain informed consent. Administer fluids and blood products as needed. Monitor vital signs and signs of shock
Postoperative
Monitor for complications such as infection, bleeding, or thromboembolism. Provide pain management. Educate about wound care and signs of infection
Psychological Support
Offer counseling to address emotional distress and grief. Provide resources for support groups or therapy.
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 modifications.