IMPLANTATION BLEEDING & ECTOPIC PREGNANCY Flashcards
Refers to light bleeding (spotting) that occurs when a fertilized egg (zygote) attaches to the lining of the uterus (implantation)
Implantation Bleeding
When does implantation bleeding usually happen?
6-12 days after ovulation and fertilization
Often before the expected menstrual period.
Color of Implantation Bleeding
Light pink to brown
What is the flow of implantation bleeding?
Very light, often just spotting or a small amount of dischareg with no blood clots.
How long does implantation bleeding usually last?
Lasts a few hours to 1-2 days (shorter than a period)
When to take a pregnancy test if implantation bleeding is suspected?
Wait3-5 days after it stops
Why? For accurate results
Symptoms of Implantation Bleeding
- Mild cramping (less intense than period cramps)
- May be accompanied by early pregnancy symptoms
When to seek medical attention when experiencing implantation bleeding?
- A heavy bleeding or bright red flow may indicate an early miscarriage or other issues
- Severe pain, dizziness, or passing large clots - evaluated by HC provider
Is the 2nd most common cause of bleeding during the 1st trimester.
Ectopic Pregnancy
This refers to a pregnancy in which implantation occurs outside the uterine cavity.
Ectopic pregnancy
Why is ectopic pregnancy life-threatening?
Can cause bleeding & hypovolemic shock.
This happens when the fertilized egg is unable to travel down the fallopian tube to implant in the uterus
Tubal Pregnancy
Risk Factors of Ectopic Pregnancy
- Pelvic Inflammatory Disease
- Smoking
- Advanced Age >35 yrs old
- History of Ectopic Pregnancy
- Previous Pelvic Surgeries
- Tubal myomas/fibroids
Is an infection of the upper/internal female reproductive organs (ovaries, salpinges/FT, uterus)
Pelvic Inflammatory Disease
Why is smoking a risk factor of ectopic pregnancy?
Vasoconstriction decreases blood flow to the FT impairs ciliary function & affect movement of the egg & sperm stuck in the tube.
Sites of ectopic pregnancy
1) **Fallopian tube ** -most common (90%)
2) Ovary - (1-3%)
3) Abdominal cavity or intestine - (1-2%)
4) Cervix (1% - very rare)
Signs and symptoms of Ectopic pregnancy
1) Missed period
2) Positive hCG results
3) Nausea & vomiting (morning sickness)
4) Severe, sharp, stabbing pain
5) Scanty or heavy vaginal bleeding
6) Signs of shock : (lightheadedness, rapid pulse & resp, falling BP, pallor)
7) **Leukocytosis ** is present due to trauma
8) Ultrasound scan reveals ruptured fallopian tube & blood in the peritoneum.
9) On vaginal exam, a tendar mass is palpable in the cul-de-sac of Douglas (pouch between the uterus and the rectum)
Why is the cul-de-sac of Douglas often used in OB-GYN as a reference point?
Since this is where fluids such as pus or blood may collect in cases of infection or after a woman experiences trauma to surrounding structures.
How to diagnose ectopic pregnancy?
1) Transvaginal ultrasound
2) Serial hCG levels
3) Progesterone levels
In a transvaginal ultrasound, there is suspected ectopic pregnancy if?
- no gestational sac in the uterus
- adnexal mass in the FT
- fluid in the cul-de-sac of Douglas
What to look for in Serial hCG levels and progesterone that would indicate that pregnancy is ectopic?
If hCG rises abnormally slow and progesterone levels are low indicating a non-viable pregnancy
Management/Treatment for Early-Stage Ectopic Pregnancy
1) Methotrexate
2) Mifepristone
3) Misoprostol
An oral drug that is a folic acid antagonist, chemotherapy drug (inhibits DNA synthesis & cell division) cells die & stops embryo from developing. Most common drug used to treat ectopic pregnancy.
Methotrexate
Treatment qualification when managing ectopic pregnancy using Methotrexate.
Ectopic mass must be very small
If embryo is already big, heartbeat may be gone but will cause obstruction in the tube; unruptured ectopic pregnancy
A prostaglandin derivative that induces uterine contractions to help expel the embryo. Maybe used in combination with methotrexate & mifepristone in some cases.
Misoprostol
A progesterone antagonist that sheds off the uterine lining.
Mifepristone
Surgical Treatment for Ectopic Pregnancy
1) Salpingectomy
2) Salpingostomy
3) Laparoscopic
4) Laparotomy
This surgery involves removal of the affected fallopian tube.
- For ruptured / large ectopics
Salpingectomy
This surgery involves opening of the tube & removal of the ectopic mass while preserving the FT; scarring is possible
Salpingostomy
Also called keyhole surgery
- gold standard / preferred surgical management.
- minimally invasive procedure that involves a thin, lighted camera (laparoscope) inserted thru small abdominal insertion
Laparoscropic
Advantages of a laparoscopic surgery
1) Faster recovery - shorter hospital stay
2) Minimal scarring
3) Less post-op pain
4) Lower risk for infection
An open surgery approach that opens the abdomen and remove the POC
- used as an alternative to laparoscopy
Laparotomy
Nursing Management for Ectopic Pregnancies
1) Monitor: vital signs, intensity of pain, bleeding, signs of shock
2) Pain management
3) Administer fluids & BT as ordered
4) Provide emotional supporty
5) Help educate patient on the importance of hCG level monitoring
6) Prepare the patient for emergency operation if needed.
7) Educate on future pregnancy risks & ask medical help regarding her future pregnancies
- seek advice on contraceptive options
A woman experiences light pink spotting 8 days after ovulation. She has mild cramping but no other symptoms. What is the most likely cause of this spotting?
a) Menstrual period
b) Ectopic pregnancy
c) Implantation bleeding
d) Pelvic inflammatory disease
C) Implantation bleeding
How long does implantation bleeding typically last?
a) 3-5 days
b) 1-2 days
c) 5-7 days
d) More than a week
B) 1-2 days
What color is implantation bleeding typically?
a) Bright red
b) Dark brown
c) Light pink to brown
d) Yellowish
C) Light pink to brown
What is the most common location for an ectopic pregnancy?
a) Uterus
b) Fallopian tube
c) Ovary
d) Cervix
B) Fallopian tube
Which of the following is a risk factor for ectopic pregnancy?
a) Regular exercise
b) Pelvic inflammatory disease (PID)
c) High-fiber diet
d) Low BMI
B) Pelvic inflammatory disease (PID)
A 37-year-old woman with a history of smoking presents with severe abdominal pain and light vaginal bleeding. What condition should be suspected?
a) Implantation bleeding
b) Ectopic pregnancy
c) Menstrual cramps
d) Urinary tract infection
B) Ectopic pregnancy
Which of the following is a sign of shock in a patient with a ruptured ectopic pregnancy?
a) High blood pressure
b) Slow pulse
c) Rapid pulse and falling blood pressure
d) Increased urine output
C) Rapid pulse and falling blood pressure
What is Cullen’s sign in the context of ectopic pregnancy?
a) A bluish tinge around the umbilicus
b) A red rash on the abdomen
c) Yellowing of the skin
d) Swelling of the legs
A) A bluish tinge around the umbilicus
What is the primary action of methotrexate in treating ectopic pregnancy?
a) Induces uterine contractions
b) Inhibits DNA synthesis and cell division
c) Increases progesterone levels
d) Prevents ovulation
B) Inhibits DNA synthesis and cell division
Which drug is a progesterone antagonist used in ectopic pregnancy treatment?
a) Methotrexate
b) Mifepristone
c) Misoprostol
d) Oxytocin
b) Mifepristone
What is the most common location for fluid collection in a ruptured ectopic pregnancy?
a) Uterus
b) Cul-de-sac of Douglas
c) Ovary
d) Cervix
b) Cul-de-sac of Douglas
What is the most important nursing intervention for a patient with a ruptured ectopic pregnancy?
a) Administering antibiotics
b) Preparing for emergency surgery
c) Encouraging fluid intake
d) Providing a high-protein diet
b) Preparing for emergency surgery
What is the role of ciliary function in the fallopian tubes?
a) To produce hormones
b) To move the egg and sperm
c) To prevent infection
d) To regulate blood flow
b) To move the egg and sperm
