 Implantation of a fertilized ovum outside the

uterine cavity, most commonly in the fallopian

tube.
 Good maternal prognosis with prompt
diagnosis, appropriate surgical intervention,
and control of bleeding.
 Poor fetal diagnosis (rare incidence of survival
to term with abdominal implantation).
 About 33 % chance of giving birth to a live
neonate in a subsequent pregnancy.
 Incidence: about 1 to 200 pregnancies in
whites; about 1 of 120 pregnancies on nonwhites.
 Complications: rupture of fallopian tube, hemorrhage, shock, peritonitis,
infertility, disseminated intravascular coagulation, and death.

Pathophysiology

 Transport of a blastocyst to the uterus is delayed.

 The blastocyst implants at another available vascularized site, usually the
fallopian tube lining.
 Normal signs of pregnancy are initially present.
 Uterine enlargement occurs in about 25% cases.
 Human chorionic gonadotropin (hCG) hormonal levels are lower than in
uterine pregnancies.
 If not interrupted, internal hemorrhage occurs with rupture of the fallopian
tube.

Causes

 Congenital defects in the reproductive tract

 Diverticula
 Ectopic endometrial implants in the tubal mucosa
 Endosalpingitis
 Intrauterine device
 Previous surgery, such as tubal ligation or resection
 Sexually transmitted tubal infection
 Transmigration of the ovum
 Tumors pressing against the tube

Assessment findings

 Amenorrhea
 Abnormal menses (after fallopian tube implantation)
 Slight vaginal bleeding
 Unilateral pelvic pain over the mass
 If fallopian tube ruptures, sharp lower abdominal pain, possibly radiating to
the shoulders and neck.
  Possible extreme pain when cervix is moved and
adnexa palpated.
 Boggy and tender urine
 Possible enlargement of adnexa

Test Results

Serum hCG is abnormally low; when repeated in 49

hours, the level remains lower than the levels found in
a normal intrauterine pregnancy.
 Ultrasonography may show an intrauterine pregnancy
or ovarian cyst.
 Culdocentesis shows free blood in the peritoneum
 Laparoscopy may reveal a pregnancy outside the uterus.

Treatment

 Initially, in the event of pelvic-organ rupture, management of shock

 Diet determined by clinical status
 Activity determined by clinical status
 Transfusion with whole blood or packed red blood cells
 Broadspectrum I.V. antibiotics
 Methotrexate (Rheumatrex)
 Laparotomy and salpingectomy if culdocentesis shows blood in the
peritoneum; possibly after laparoscopy to remove affected fallopian tube
and control bleeding.
 Micro-surgical repair of the fallopian tube for patients who wish to have
children.
 Oophorectomy for ovarian pregnancy
 Hysterectomy for interstitial pregnancy
 Laparotomy to remove the fetus for abdominal pregnancy.

Nursing Interventions

 Determine the date and description of the patient’s last menstrual period.
 Monitor vital signs for changes.
 Assess vaginal bleeding, including amount and characteristics
 Assess pain level
 Monitor intake and output
 Assess for signs of hypovolemia and impending shock
 Prepare the patient with excessive blood loss for emergency surgery.
 Administer prescribed blood transfusions and analgesics.
 Provide emotional support.
 Administer Rh (D) immune globulin (RhoGAM), as ordered, if the patient is
Rh negative.
 Provide a quiet, relaxing environment
 Encourage the patient to express feelings of fear, loss, and grief.
 Help the patient develop effective coping strategies.
 Refer the patient to a mental health professional, if necessary, prior to
discharge.