Complications: Ectopic pregnancy

What Am I ? Fetal growth somewhere outside of the uterus, usually within the fallopian tubes.

ASSESSMENT ❖ Pain❖ Referred shoulder pain❖ Spotting ❖ Bleeding into the peritoneum❖ Bleeding from vagina if rupture

occurs❖ Normal signs/ symptoms of

pregnancy

Diagnostics ❖ H&H: Low if rupture occurs.❖ Diagnosable with ultrasound.❖ Human chorionic gonadotropin

level (serum) (hCG) is abnormally low; when the test is repeated in 48 hours, the level remains lower than usual for a normal (intrauterine) pregnancy.

❖ Progesterone level (plasma) is lower than expected for an intrauterine pregnancy.

Causes❖ Congenital defects in reproductive tract❖ Diverticula❖ Ectopic endometrial implants in the tubal

mucosa❖ Endosalpingitis❖ History of multiple elective abortions❖ Intrauterine device❖ Previous surgery, such as tubal ligation

or resection❖ Sexually transmitted tubal infection❖ Transmigration of the ovum❖ Tumor pressing against the tube❖ Hormonal imbalance

Risk Factors❖ History of tubal surgery❖ Previous ectopic pregnancy❖ History of pelvic inflammatory disease❖ Pelvic adhesions❖ Use of intrauterine device❖ History of endometritis❖ Progesterone-only contraceptive use❖ Use of assisted reproductive technologies❖ Diethylstilbestrol exposure in utero❖ Cigarette smoking❖ Age between 35 and 44❖ Multiple sexual partners❖ Vaginal douching❖ Young age at first sexual intercourse

Complications❖ Rupture of fallopian tube❖ Hemorrhage❖ Shock❖ Peritonitis❖ Infertility❖ Disseminated intravascular

coagulation❖ Death

Treatments ❖ Transfusion with whole blood or packed red blood

cells to treat hypovolemic shock if the tube has ruptured.

❖ IV fluid replacement❖ Supplemental iron if anemia occurs from blood loss❖ Methotrexate sodium (Trexall) as primary treatment

for unruptured ectopic pregnancy (single I.M. dose or multidose treatment via I.M. or IV route)

❖ Leucovorin I.N. between doses of multi dose methotrexate therapy

❖ Rho(D) immune globulin, human, if the patient is Rh-negative

Interventions ❖ Vital signs❖ Vaginal bleeding❖ Pain level and effectiveness of

interventions❖ Fluid balance status❖ Intake and output❖ Signs and symptoms of hypovolemia and

impending shock❖ Surgical site (postoperatively)