ECTOPIC PREGNANCY

• When does ectopic pregnancy occur?

  1st trimester: 4th to 12th week gestation
• ECTOPIC PREGNANCY

  • This is a condition where pregnancy develops outside of the uterine cavity
  • Implantation of products of conception in a site than the uterine cavity
  • Caused by high levels of progesterone which can alter mobility of the egg cells within the uterine cavity
• ABNORMAL SITES (FFOCAIII)

  F: Fallopian tube (ampulla) – most common site

  F: Fimbriae

  O: Ovarian

  C: Cervical os

  A: Abdominal viscera

  I: isthmus

  I: Interstitial – the most dangerous

  I: Infindibular
• ETIOLOGY OF ECTOPIC PREGNANCY

  • congenital anatomic irregularity – malformed
  • Advance maternal age
  • Use of ovulation inducing drugs – CLOMID
  • Salpingectomy (removal of fallopian tube due to infection and inflammation)
  • Endometriosis – growth of endometrial cells in areas outside the uterus
  • A previous ectopic pregnancy due to tubal damage or scarring
• ETIOLOGY OF ECTOPIC PREGNANCY (2)

  • A history of pelvic inflammatory disease (PID), an infection that can cause scar tissue to form in your fallopian tubes, uterus, ovaries, and cervix.
  • HISTORY of surgery on your fallopian tubes (including tubal ligation) or on the other organs of your pelvic area. – SCARRING OF THE FALLOPIAN TUBE
  • A history of infertility. ISSUE ON REPRODUCTIVE SYSTEM
• OTHER ISSUES FOR ECTOPIC PREGNANCY

  • HISTORY of treatment for infertility
  • Endometriosis – inflammation and infection of the endometrial lining
  • Sexually transmitted infection (STIs)
  • Frequent UTI
  • An IUD in place at the time of conception
  • A history of smoking tobacco. EXPOSURE TO TERATOGENIC SUBSTANCES
• PATHOPHYSIOLOGY

  The mechanism responsible for ectopic implantation are unknown to considered the following:

  1.      Anatomic obstruction to the passage of the zygote – such as masses, nodes, narrowing of the tube-obstruction in the tube.

  2.      Abnormal concepts – issues on the fertilized egg

  3.      Abnormalities in the mechanisms responsible for tubal motility

  4.      Abnormal migration of the zygote
• • The uterus is the only organ capable of containing and sustaining a pregnancy
  • When the fertilized ovum implants in other locations the body is unable to maintain the pregnancy
  • A ruptured fallopian tube can produce life threatening complications such as hemorrhage, shock and peritonitis
• COMMON SITES: FALLOPIAN TUBE

  • Interstitial = most dangerous site
  • Isthmic
  • Ampullar – most common. This is the site where fertilization takes place
  • Fimbriae
• WARNING SIGNS

  • UNILATERAL – one side cramping pain with tenderness abdomen before rupture
  • VOMITTING – due to unbearable pain
  • SHARP ABDOMINAL PAIN AND REFERRED SHOULDER PAIN (KEHR’s SIGN)
  • FAINTNESS (DIZZINESS AND SYNCOPE)
  • Often the first warning signs of an ectopic pregnancy are light vaginal bleeding and pelvic pain
  • Specific symptoms depend on where the blood collects and which nerves are irritated
  • CULLEN’s SIGN – internal bleeding will cause bluish discoloration of the umbilicus
• EMERGENCY SIGNS

  • If the fertilized egg continues to grow in the fallopian tube, it can cause the tube to rupture. Heavy bleeding inside the abdomen is likely
  • Symptoms of this life-threatening event include extreme lightheadedness, fainting and shock. HYPOVOLEMIC SHOCK
• MANAGEMENT

  • Ultrasound – for confirmation of ectopic pregnancy
  • Vital signs – lead to hypovolemic shock
  • Monitoring, bleeding and pain
  • Start IVF – replace fluid and electrolyte and blood transfusion in case of severe blood loss
  • FOWLER’S POSITION is recommended. Not left lateral position may cause vena cava syndrome – depletes the blood flow from the vena cava cause more severe oxygen supply
• Management (2)

  • Address emotional and psychosocial needs
  • Assess signs of dehydration: poor skin turgor
  • Educate patient about risk factors and lifestyle changes to avoid ectopic pregnancies: smoking, multiple sexual partners since it increases the risk of pelvic infections and ectopic pregnancies
  • Ensure that appropriate physical needs are addressed and monitor for complications: 
  • Hemorrhage – blood flow
  • Infection – ruptured fallopian tube 
  • Pain – abnormal implantation
  • Shock – severe blood loss
• SURGICAL PROCEDURES

  • Oophorectomy, historically also called ovariotomy, is the surgical removal of an ovary or ovaries
  • Salpingo-oophorectomy is the removal of one (unilateral) or both (bilateral) of your ovaries and fallopian tubes
  • Laparoscopic surgery is a minimally invasive surgery technique that only uses a few small incisions on your lower abdomen
• TOTAL ABDOMINAL HYSTERECTOMY BILATERAL SALPINGO-OOPHORECTOMY


  • Surgery procedure entailing the removal of a woman’s uterus, fallopian tubes and ovaries due to disease infection of the area i.e. ovarian cancer.
• BLOOD WORKS

  • A urine test TO CONFIRM PREGNANCY
  • A blood test: Your provider may test your blood to see how much of the hormone human chorionic gonadotropin (HCG) you have in your body. Your body only make HCG during pregnancy. A low amount may indicate an ectopic pregnancy because HCG levels increase dramatically when a fertilized egg implants in your uterus. HCG – ABOVE 6000 MU.MI. TO CONFIRM PREGNANCY
• • An ultrasound exam:
  • If your provider suspects the ectopic pregnancy has ruptured, they can also perform culdocentesis, MEDICAL PROCEDURE USED TO DIAGNOSE WITHIN THE PELVIS, TO DETECT FLUID IN THE PELVIC CAVITY THAT MAY INDICATE RUPTURED ECTOPIC PREGNANCY.