Ectopic pregnancy

Question 1

What is ectopic pregnancy?

Answer 1

The abnormal implantation of a fertilized ovum outside of the uterine cavity. Usually in the fallopian tube.

Question 2

What are the potential outcomes of an ectopic pregnancy?

Answer 2

• Tubal rupture
• Fatal Hemorrhage
• Infertility

Question 3

What are the risk factors for ectopic pregnancy?

Answer 3

• STI
• Assisted reproductive technology
• Tubal surgery
• IUD
• Anything compromising tubal patency

Question 4

How does ectopic pregnancy present?

Answer 4

• Unilateral stabbing pain and tenderness in lower abdominal quadrant
• Menses delayed (1-2 weeks) lighter than usual or irregular
• Scant, dark red or brown spotting 6-8 weeks after menses
• red vaginal bleeding if rupture has already occured
• Referred shoulder pain due to blood in peritoneal cavity irritating diaphragm or phrenic nerve
• Findings of hemorrhage and shock if rupture has occurred

Question 5

Which Laboratory tests do we use to determine whether an ectopic pregnancy has occurred?

Answer 5

• Serum progesterone levels
• HCG
  Both help to determine whether a pregnancy has occurred an whether it is likely to be ectopic

Question 6

Which Diagnostic procedures are used to determine ectopic pregnancy?

Answer 6

Transvaginal ultrasound to determine empty uterus in combination with positive HCG

Question 7

What is the non- surgical treatment for ectopic pregnancy?

Answer 7

Methotrexate
inhibits cell division and embryo enlargement dissolving the pregnancy, preserving the fallopian tube if rupture has not occurred

DC folic acid immediately to avoid toxic response to med

photosensitivity also a side effect

Question 8

What are the surgical treatment options for Ectopic pregnancy?

Answer 8

• Salpingostomy - is done to salvage the fallopian tube if not ruptured
• Laparascopic salpingectomy - is performed when tube has ruptured

Question 9

What further Lab testing is required as part of treatment regime for ectopic pregnancy

Answer 9

• Serial HCG to determine client is no longer pregnant
• Liver and renal function studies
• CBC (pre and post surgery)
• Blood typing including RH (pre surgery in case of hemorrhage )

Question 10

Nursing care for ectopic pregnancy

Answer 10

• Replace fluids and maintain electrolyte balance
• Provide client education and psychological support
• Administer medications as prescribed
• Provide referral for client and partner to pregnancy loss support services