Ectopic Pregnancy

ECTOPIC PREGNANCY
Definition
 Extra uterine pregnancy. An ectopic pregnancy is one in which implantation
occurs outside the uterinecavity.
 The implantation may occur on the surface of the ovary or in the cervix. The most
common site is in a fallopian tube.
 Rupture of Fallopian tube is between 10th-12th week of pregnancy.
Risk factors:
There are several risk factors that could increase your chance of developing an ectopic
pregnancy. You may be at a higher risk of developing an ectopic pregnancy if you’ve had:
 A previous ectopic pregnancy.
 A history of pelvic inflammatory disease (PID), an infection that can cause scar
tissue to form in your Fallopian tubes, uterus, ovaries and cervix.
 Surgery on your Fallopian tubes (including tubal ligation) or on the other organs of your
pelvic area.
 A history of infertility.
 Treatment for infertility with in vitro fertilization (IVF).
 Endometriosis.
 Sexually transmitted infections (STIs).
 An IUD in place at the time of conception.
 A history of smoking tobacco.
Sign/symptoms
 Vaginal bleeding.
 Pain in your lower abdomen, pelvis and lower back.
 Dizziness or weakness.
If your Fallopian tube ruptures, the pain and bleeding could be severe enough to cause
additional symptoms. These can include:
 Fainting.
 Low blood pressure (hypotension).
 Shoulder pain.
 Rectal pressure or bowel problems.
Diagnostic:
To diagnose an ectopic pregnancy, your provider will perform several tests. This may
include a pelvic exam and confirmation of pregnancy. These tests include:
 A urine test: This test involves either peeing on a test strip or into a cup in your
provider’s office and then having a test strip dipped into the urine sample.
 A blood test: You provider may test your blood to see how much of the
hormone human chorionic gonadotropin (HCG) you have in your body.
 An ultrasound exam: An ultrasound uses sound waves to create a picture of your
body’s internal structures.
Management:
 Exploratory Laparotomy followed by Salpingectomy (removal of the fallopian tube
through an abdominal incision) was the standard therapy for managing ectopic
pregnancy.
 Laparoscopy with salpingostomy, without fallopian tube removal, has become the
preferred method of surgical treatment.
DRUG STUDY
Drug:
Generic Name: Otrexup/Methotrexate Classification:
Antimetabolites
Dose: Single dose IM 50 mg/ Multiple dose 1 mg
Action: This drug stops cells from growing, which ends the pregnancy. Methotrexate
acts on rapidly dividing cells at the implantation site, most notably trophoblast cells.
Indications: Patient hemodynamically stable, absence of tubal rupture sign
and hemoperitoneum, an adnexal mass with a diameter < or = 5 cm. an
amenorrhea < or = 6 weeks and HCG levels < oI = 10,000 mlU/ml.
Contraindications: Hemodynamically unstable, - Suspected ruptured EP,Sensitivity to
MTX Intrauterine pregnancy, Breastfeeding, Unable to comply with visits and follow-up
Adverse Effects: Abdominal pain or cramping. Nausea and/or vomiting for 24 hours.
Upset stomach, decreased appetite. Diarrhea.
Nursing Considerations: Observe for Gl toxicity, Arrange for frequent, regular medical
follow-up visits, including blood tests to follow the drug's effects.
Priority NCP
Risk for hemorrhage (if ruptured)
• Monitor VS - To detect signs of shock or other complications,
• Monitor presence and amount of bleeding - Assessing for signs of hemorrhage and determining the need for
immediate intervention
• Monitor for increase and pain and abdominal distention and rigidity - Indicates possible rupture of the
fallopian tube
• Monitor complete blood count(CBC) - for signs of anemia or changes in white blood cell count, which may
indicate internal bleeding or infection.
• Provide comfort measure like back rubs, deep breathing - alleviate discomfort and promote relaxation
• Administer analgesics as indicated - To manage pain
Medication:
 Prescribe analgesics to manage postoperative pain and antibiotics to prevent or treat infection.
 Instruct the patient on proper administration and potential side effects of medications.
Environment:
 Ensure the patient's recovery space is clean and free from potential sources of infection.
 Provide a quiet environment to facilitate rest and recovery.
Treatment:
 Recommend surgical intervention, such as laparoscopic surgery or laparotomy, to remove the ectopic
pregnancy and control bleeding.
 Discuss the risks and benefits of surgery with the patient.
Hygiene:
 Instruct the patient on proper wound care techniques, including cleaning the incision site and changing
dressings.
 Emphasize the importance of keeping the incision clean and dry to prevent infection.
Outpatient Care:
 Schedule follow-up appointments with healthcare providers to monitor wound healing, assess recovery
progress, and address any ongoing symptoms or concerns.
 Provide contact information for emergency situations or questions.
Diet:
 Encourage the patient to maintain adequate hydration by drinking plenty of fluids, especially if they
experienced significant blood loss during the ectopic pregnancy rupture.
 Recommend a well-balanced diet rich in iron and protein to support healing and replenish lost nutrients.
Safety:
 Advise the patient to avoid strenuous activities and heavy lifting for a specified period following surgery to
prevent complications such as wound dehiscence or recurrence of bleeding.
 Educate on fall prevention strategies, especially if the patient experiences dizziness or weakness due to
anemia or postoperative effects.
Health Teaching
 After your treatment, you may have vaginal bleeding that's similar to a period. It may last for up to a
week. Use pads instead of tampons. You may use tampons during your next period. It should start in 3
to 6 weeks.
 Do not have sex until after the bleeding stops.
 Get plenty of rest. You may be more tired than normal for a few weeks.
 Take it easy and avoid lifting until your doctor tells you it is safe to do your normal activities.

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ECTOPIC PREGNANCY

 An IUD in place at the time of conception.

 A history of smoking tobacco.

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