Ectopic Pregnancy

implantation occurs ______ the uterine cavity approximately __ in every ___ pregnancies

outside, 1, 200

pain from ______ _______ quadrant reaching to _______

lower abdominal, shoulders

the majority or ____ of ectopic pregnancies occur in _______ portion of fallopian tube

80%, ampullar

12% of ectopic pregnancies occur in the _____

isthmus

Other Sites for Ectopic Pregnancies

• Cervix/Cervical

• Intestine/Abdominal

Predisposing Factors of Ectopic Pregnancies

• PID (pelvic inflammatory disease)

• Tubal surgery (scarring, adhesions)

• Endometriosis

• Salpingitis

• Congenital tube defects

• Prolonged use of IUD

• Previous hist. of ectopic pregnancy

• Uterine or tubal tumor

Woman may experience _______ and ________ of early pregnancy (early sign of ectopic pregnancy)

nausea, vomiting

Pregnancy test for ____ will be positive (early sign of ectopic pregnancy)

hCG

Many ectopic pregnancies are diagnosed by ________ _________

pregnancy ultrasound

_________ ___________ _________ (MRI) can also be used to detect ectopic pregnancy

magnetic resonance imaging

Tubal rupture: ___ to ___ weeks or 4 to ___ weeks after missed period

6, 12, 10

Sudden, sharp, severe _____ _______ pain radiating to ________

low quadrant, shoulders

_________ __________ or spotting signs of _____ (early sign of ectopic pregnancy)

vaginal bleeding, shock

______ sign: bluish discoloration of the ________ area (early sign of ectopic pregnancy)

Cullen’s, periumbilical

excruciating pain in the _____ upon _______ examination (early sign of ectopic pregnancy)

cervix, pelvic

Tender mass palpable in the ___-__-___ of the uterus (early sign of ectopic pregnancy)

cul-de-sac

Douglas Laboratory findings: decreased HgB (_____), HcT (______), increased WBC due to trauma

hemoglobin, hematocrit

Diagnostic Exams for Ectopic Pregnancy

• HCG Titer

• Culdocentesis

• Laparoscopy

• Culdoscopy

• Ultrasound

• Laparotomy

• Oral Administration of Methotrexate

Culdocentesis

procedure in which peritoneal fluid is obtained from the cul-de-sac of a female patient

Laparoscopy

type of surgical procedure that allows a surgeon to access the inside of the abdomen and pelvis without making large incisions in the skin

Culdoscopy

an endoscopic procedure performed to examine the rectouterine pouch and pelvic viscera by the introduction of a culdoscope through the posterior vaginal wall

Laparotomy

surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity

Oral Administration of Methotrexate

medicine that stops cells from dividing

Can be used as a way, other than surgery, to treat a pregnancy that’s implanted outside the uterus

Oral Administration of Methotrexate

Will stop the pregnancy and decrease the level of pregnancy hormone in your blood over 2-4 days

Oral Administration of Methotrexate

An ectopic pregnancy will rupture in ___ to ___ weeks

6, 8

Place patient in _______ position

Trendelenburg

Observe for increasing pain, especially at the ______

shoulder

Assessment of ______ bleeding

vaginal

Observe for signs of _______ shock

hypovolemic

___ administration

O2

Carry out and follow up ______ request

laboratory

Start ___ fluid and _______ ________ as ordered

IV, blood transfusion

Monitor ___

VS

Prepare for pelvic ________

laparotomy

Nsg. Dx: Potential for _____ _______ deficit rift blood loss or restricted _____ ______

fluid volume, fluid intake

Nsg. Dx: Anxiety or uncertainty about her condition/threat of _____; possible loss of ability to ______

death, conceive

Abdominal Pregnancy

implantation in an abdominal organ such as the intestine

Very rarely happens after ectopic pregnancy rupture

Abdominal Pregnancy

The product of conception is expelled into the ______ ______ with a minimum of bleeding

pelvic cavity

Placenta continues to grow in the ________ _____, spreading into the uterus for a better ______ supply, or it may escape into the ______ cavity

fallopian tube, blood, pelvic