Ectopic Pregnancy

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50 Terms

1

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.

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2

80% of ectopic pregnancies occur in____

Ampullar portion

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3

12% of ectopic pregnancies occur in ____

Isthmus

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4

8% of ectopic pregnancies occur in ____

Interstitial or fimbrial

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5

Less frequent sites include

Ovary, abdominal cavity, or cervix

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6

Risk/Predisposing Factors

  • Pelvic Inflammatory Disease

  • Previous Ectopic Pregnancy

  • Tubal surgery or damage

  • Intrauterine Device

  • Infertility Treatments

  • Maternal Age

  • Smoking

  • Endometriosis

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7

Pelvic Inflammatory Disease

Infections such as chlamydia or gonorrhea that cause scarring in the fallopian tubes

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8

Previous Ectopic Pregnancy

History or ectopic pregnancies increases the likelihood of recurrence

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9

Tubal surgery or damage

Any surgery or trauma to the fallopian tubes can interfere with the egg’s travel to the uterus

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10

Intrauterine Device

While rare, pregnancies occuring with an IUD in place have a higher chance of being ectopic

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11

Infertility Treatments

Assisted reproductive technologies like in vitro fertilization

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12

Maternal Age

Women over 35 y/o are at increased risk

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13

Smoking

Alters tubal motility and reduces ciliary function in the fallopian tubes

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14

Endometriosis

Can lead to scarring and adhesions that hinder proper egg implantation

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15

Clinical manifestations/Signs & Symptoms

  • Pain (Abdominal pain / Shoulder pain)

  • Vaginal spotting or bleeding

  • Hemoperitoneum (Internal bleeding)

  • Dizziness, headache, weakness, fainting or syncope

  • Tender Mass

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16

Abdominal pain (localized or generalized)

May be confused with strong stomach pain, it may also feel like a strong cramp

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17

Shoulder Pain

This is caused by free blood tracking up the abdominal cavity and irritating the diaphragm, and is an ominous sign

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18

Pain

Pain while urinating or having a bowel movement

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19

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.

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20

Hemoperitoneum (internal bleeding)

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

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21

Dizziness, headache, weakness, fainting or syncope

Resulting from internal bleeding and hypovolemia

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22

Tender Mass

On pelvic examination, an adnexal mass may be felt

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23

Prevention

  • Prevent and Treat STIs

  • Stop smoking

  • Careful Monitoring Post-Tubal Surgery

  • Family Planning

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24

Prevent and Treat STIs

Early diagnosis and management of sexually transmitted infections reduce the risk of PID

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25

Stop Smoking

Smoking cessation can improve reproductive health

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26

Careful Monitoring Post-Tubal Surgery

Women with previous tubal surgeries should have close monitoring during early pregnancy.

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27

Family Planning

Proper use of contraceptives and avoidance of unintended pregnancies in high-risk individuals

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28

Diagnostic Tests

  • Transvaginal Ultrasound

  • Serum Beta-hCG

  • Complete Blood Count

  • Culdocentesis

  • Laparoscopy

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29

Transvaginal Ultrasound

The gold standard for confirming the location of the pregnancy

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30

Serum Beta-hCG

Abnormally low or plateauing hCG levels suggest an abnormal pregnancy

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31

Complete Blood Count

To assess for anemia or signs of internal bleeding

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32

Culdocentesis

Rarely used; checks for blood in the peritoneal cavity

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33

Laparoscopy

Diagnostic and therapeutic; allows visualization and management of ectopic pregnancy

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34

Medication Manage

  • Methotrexate

  • Antineoplastic, Antimetabolite

  • Leucovorin

  • Vasopressors

  • Vasopressin (Pitressin)

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35

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.

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36

Antineoplastic, Antimetabolite

Used to terminate pregnancy

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37

Leucovorin

Used with folic acid antagonists, such as methotrexate

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38

Vasopressors

Used for their alpha and properties and for stimulating vasoconstriction in peripheral circulation

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39

Vasopressin (Pitressin)

Has vasopressor and antidiuretic (ADH) activity. In linear salpingostomy, the involved tube is identified and freed surrounding structures.

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40

Surgical Management

  • Salpingostomy

  • Salpingectomy

  • Laparoscopy

  • Laparotomy

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41

Salpingostomy

Removal of the ectopic pregnancy while preserving the fallopian tube

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42

Salpingectomy

Removal of the entire fallopian, usually in cases of rupture of severe damage

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43

Laparoscopy

Minimally invasive approach for diagnosis and treatment

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44

Laparotomy

Open surgery, reserved for unstable patients or extensive damage

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45

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

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46

Interventios

  • Preoperative Care

  • Postoperative Care

  • Psychological Support

  • Patient Education

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47

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

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48

Postoperative

Monitor for complications such as infection, bleeding, or thromboembolism. Provide pain management. Educate about wound care and signs of infection

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49

Psychological Support

Offer counseling to address emotional distress and grief. Provide resources for support groups or therapy.

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50

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.

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