Ectopic Pregnancy Notes

Ectopic Pregnancy Overview

  • Definition: Ectopic pregnancy occurs when a fertilized egg implants outside the uterus.
  • Life-threatening emergency: Considered a life-threatening condition for both mother and fetus, with no chance of fetus survival.

Incidence and Demographics

  • Accounts for 6-9% of pregnancy-related deaths in women.
  • Most common in women aged 25-34.
  • Important to consider in any woman of childbearing age (typically ages 12-60) presenting with abdominal pain.

Pathophysiology of Ectopic Pregnancy

  • Normal pathway of the egg: Released from the ovary, travels through the fallopian tube, fertilized by sperm, and implants in the uterine wall.
  • In ectopic pregnancy, the fertilized egg may implant in:
    • Fallopian tube (most common site)
    • Ovary
    • Pelvic cavity
    • Cervix

Risks and Complications

  • Risk of rupture: Can lead to potential life-threatening intra-abdominal hemorrhage and hypovolemic shock.
  • May lead to sepsis post-rupture if bleeding is controlled but infection persists.

Risk Factors for Ectopic Pregnancy

  • History of ectopic pregnancy increases future risk.
  • Pelvic Inflammatory Disease (PID): Often due to STDs (e.g., gonorrhea, chlamydia) leading to scar tissue, obstructing the path of the egg.
  • Adhesions from previous abdominal surgeries can obstruct normal movement of the egg and lead to ectopic pregnancy.
  • Previous tubal ligation may leave the uterine tubes partially open, allowing for possible fertilization.

Signs and Symptoms

  • Initially, dull, diffuse abdominal pain as the fallopian tube distends; may progress to sharp, localized pain as ischemic tissue becomes necrotic.
  • Referred pain to shoulder (left or right) depending on the side affected.
  • Vaginal bleeding may occur, especially if rupture and intra-abdominal bleeding happen.
  • Amenorrhea: Patients may report missed menstrual cycles due to hormonal changes from pregnancy.

Management and Treatment

  • BLS Level Treatment:
    • Supportive care focusing on airway, breathing, and circulation.
    • If signs of shock are present, administer oxygen regardless of hypoxia status.
    • Rapid transport to emergency care is critical.
  • Further medical intervention typically required for diagnosis and management of ectopic pregnancy (e.g., ultrasound confirmation, surgical intervention).