* ectopic-pregnancy 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
* culdocentesis thumb Ectopic PregnancySerum 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.
