A Case Presentation:

Ectopic Pregnancy
 Introduction

Description of the disease condition/illness

Definition:
“Any pregnancy where the fertilized ovum gets implanted & develops in a site
other than normal uterine cavity”.

It represents a serious hazard to a woman’s health and reproductive potential,

requiring prompt recognition and early aggressive intervention.
 History
• Ectopic Pregnancies were initially described in the 10 th century (Albucasis in 963
A.D.)
• For a long time were universally fatal events for the mother
• Initial treatments (in the old ways) were desperate primitive attempts designed to
destroy the growing pregnancy
• Lawson Tait, THE FATHER OF GYNECOLOGIC SURGERY, reported the first
successful operation for ectopic pregnancy in 1883.

Brief Review of Anatomy

After the egg is fertilize by a sperm and then implanted in the lining of the uterus, it
develops into the placenta and embryo, and later into the fetus.
 Contributing factors to the development of the disease condition/illness.
Major Risk Factors
1. Anatomic Obstruction to the passage of the zygote
• Pelvic Inflammatory Disease
• Congenital Factors
• Salpingitis Isthimica Nodosa of the tube
• Surgical Procedures
2. An Abnormal Conceptus
3. Tubal Motility
4. Transperitoneal migration of the zygote
5. Others
• Contraceptive methods
• Previous Ectopic Pregnancy
• Age
• Assisted Reproductive Technologies - IVF
• Induction of Ovulation
• Smoking
 Signs and symptoms
General Examination
• Weakness, pallor, hypotension, thread pulse with tachycardia, tachypnea, cold extremities-
features of shock.
• Signs of early pregnancy (breast tenderness, nausea and vomiting, change of appetite
Abdominal Examination
• Lower abdominal tenderness a one side may be present.
• No mass felt
• Shifting dullness
• Distended bowels
• Muscle guarding-usually absent
Vaginal Examination
1. Ruptured
• Vaginal spotting with blanched white mucosa
• Bluish vagina and bluish soft cervix
• Uterus is slightly enlarged and soft.
• Extreme tenderness on formix palpation or on movement of cervix
• No mass usually felt
 Cont.

2. Unruptured
• Ill-defined mass with arterial pulsations

Symptoms

1. Pain and discomfort

2. Vaginal Bleeding
3. Amenorrhea
4. Retention of urine
5. Fever
6. Vomiting
7. Fainting attacks
 Nursing and Medical Interventions
Nursing Interventions

• Upon arrival at the emergency room, place the woman flat in bed.
• Assess the vital signs to establish baseline data and determine if the patient is under shock.
• Maintain accurate intake and output to establish the patient’s renal function.

Medical Interventions
The medical management of a woman with an ectopic pregnancy should be initiated the moment she is
brought to the emergency room. Just a few moments of interval for action would cause a big difference in the
safety of the patient.
• Administration of methotrexate. Methotrexate is a chemotherapeutic agent that is a folic acid antagonist.
It destroys rapidly growing cells such as the trophoblast and the zygote. This would be administered until a
negative hCg titer results have been produced.

• Administration of mifepristone. An abortifacient that causes sloughing off of the tubal implantation site.
Both of these therapies would leave the tube intact and no surgical scarring.
 Cont.
• Intravenous therapy. This would be performed when the ectopic pregnancy has
already ruptured to restore intravascular volume due to bleeding.

• Withdrawing of blood sample. A large amount of blood would be lost, so blood

typing and crossmatching must be done in anticipation of a blood transfusion.
The blood sample would also be used to determine the hemoglobin levels of the
pregnant woman.

Surgical Interventions
Surgical interventions would be performed after the rupture of the ectopic pregnancy to ensure that the
reproductive system would still be functional and no complications would arise.

• Laparoscopy. This will be performed to ligate the bleeding blood vessels and repair or remove the
damaged fallopian tube.

• Salpingectomy. This intervention would be performed if the fallopian tube is completely damaged. The
affected tube would be removed and what would be left would be sutured appropriately.
 Salpingectomy

Laparoscopy
 Preventive Measures
There's no way to prevent an ectopic pregnancy, but here are some ways to decrease
your risk:

• Limiting the number of sexual partners and using a condom during sex helps to
prevent sexually transmitted infections and reduce the risk of pelvic inflammatory
disease.

• Don't smoke. If you do, quit before you try to get pregnant.