ectopic-pregnancy

Ectopic Pregnancy Overview

  • Definition: Ectopic pregnancy is when a gestation implants outside the uterine cavity, most commonly in the fallopian tube (96%).

  • Common locations:

    • Fallopian tube (most common, occurring in the ampullary section)

    • Ovary

    • Cervix

    • Abdominal cavity

Ectopic Pregnancy Locations

  • Intramural: <1%

  • Cesarean scar: <1%

  • Tubal: >95%

    • Isthmic: 12%

    • Interstitial: 2-4%

    • Ampullary: 70%

  • Cervical: <1%

  • Ovarian: 3%

  • Fimbrial: 11%

  • Abdominal: 1%

Incidence

  • Philippines: 1 in 125.81 pregnancies.

  • Most affected: Women aged 25-29 with a history of previous ectopic pregnancies, pelvic inflammatory disease (PID), or intrauterine device (IUD) usage.

Risk Factors

  • Previous infections (e.g., salpingitis or PID can cause adhesions in the fallopian tubes).

  • Scars from tubal surgery affecting the transport of the fertilized egg.

  • Congenital malformations in the reproductive system such as strictures.

  • Uterine tumors preventing the fertilized egg from entering the uterus.

  • Intrauterine devices (IUDs) can impede travel post-conception.

  • Smoking has been linked to increased risk.

  • Recent in vitro fertilization can slow transportation of the zygote.

Signs and Symptoms

  • Typical Progression: Most ectopic pregnancies may not show early symptoms.

  • Symptoms:

    • Sharp abdominal pain: Often sudden, may indicate movement triggering pain.

    • Vaginal spotting: May accompany pain, signaling possible rupture.

    • Sharp, stabbing pain in the lower quadrant: Indicates rupture.

    • Vaginal bleeding: Occurs post-rupture due to vessel tearing.

    • Physical shock: Severe rupture may lead to shock symptoms (e.g., rapid pulse, low blood pressure).

Diagnostic Tests

  • Pelvic Ultrasound: Commonly used to diagnose ectopic pregnancy.

  • Magnetic Resonance Imaging (MRI): A safer alternative to CT scans for pregnant women.

Medical Interventions

  • Conservative therapy: Desired for future childbearing, initiated in stable conditions.

  • Methotrexate: Chemotherapeutic that destroys rapidly growing cells like the trophoblast.

  • Mifepristone: Leads to the sloughing of the implantation site.

  • Intravenous Therapy: Applied when rupture occurs to restore volume due to bleeding.

  • Blood sample withdrawal: To assess for transfusion needs and hemoglobin levels.

Surgical Interventions

  • Laparoscopy: Performed to ligate bleeding vessels or repair/remove damaged tubes.

  • Salpingectomy: Removal of a completely damaged tube with appropriate suturing.

Nursing Management

1. Nursing Assessment

  • Usually, no symptoms present at initial implantation.

  • Signs like positive pregnancy test and nausea should be noted.

  • At 6-12 weeks, potential for rupture increases, leading to possible hemorrhaging and sharp pain in lower quadrant.

2. Nursing Diagnosis

  • Deficient Fluid Volume: Relative to blood loss from ruptured tube.

  • Acute Pain: Related to ectopic pregnancy or rupture.

  • Anticipatory Grieving: Relating to loss and potential childbearing capacity.

3. Nursing Interventions

3.1 Maintaining Fluid Volume

  • Establish IV line for fluid and blood component therapy.

  • Perform CBC and type/screen blood samples.

  • Monitor vital signs and urine output closely.

3.2 Promoting Comfort

  • Administer analgesics as prescribed.

  • Encourage relaxation techniques.

3.3 Providing Support through Grieving Process

  • Offer emotional support and listen to patient concerns.

  • Recognize possible grief stages; offer counseling as needed.