Ectopic Pregnancy

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 cause 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 Management

• 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

Interventions

• 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.