Ectopic Pregnancy Diagnostic Test Findings:

There are four parts of the fallopian tube from the ovary to the  Blood test: Leukocytosis
uterus:  Transvaginal UTZ: ruptured tube and collection of
blood in peritoneum
 Fimbria
 Drop in HCG and progesterone level
 Infundibulum
 Laparoscopy
 Ampulla – where the ovum is fertilized
 Culdoscopy
 Isthmus
 Culdocentesis detects free blood in the peritoneum
Common locations:
Medical Management:
 Tubal 95-96%
 Laparoscopic removal of rupture tube
 Ampullary 70%
(salphingectomy); if ovarian pregnancy,
 Isthmic 12%
oophorectomy
 Fimbrial 11%
 Methotrexate administered to stop division of embryo
 Interstitial and cornual 2-3%
 Blood values for high count, typing and cross-
 Ovarian 3% matching
 Cesarean scar <1%  IV fluid with large-gauge catheter to prepare for blood
 Cervical <1% transfusion, IV antibiotics, supplemental iron, high
 Abdominal 1% protein diet
Risk/Etiologic Factors:  Emotional support for grieving parents
 Treatment for ruptured tube: Laparoscopy to ligate
 History of STDs (gonorrhea, chlamydial infection) the bleeding and remove or repair the damaged
 History of pelvic inflammatory disease (chronic fallopian tube
salpingitis)
 Congenital malformations Nursing Interventions:
 Scars from tubal surgeries
 Assess VS and monitor bleeding for extent of fluid
 Uterine tumor pressing on the proximal end of the
loss
tube
 Withhold oral food or fluid in anticipation of possible
 Previous ectopic pregnancy
surgery
 Cigarette smoking
 Assess the patient for signs of hypovolemic shock
Signs and Symptoms: (monitor urine output)
 Administer blood transfusion for replacement as
Early pregnancy: ordered.
 Nausea and vomiting, +HCG  Record the location and character of pain, administer
 UTZ and MRI, reveals wrong implantation analgesic as ordered
 6-12 weeks AOG: tearing and destruction of blood  Provide a quiet, relaxing environment, and offer
vessels, bleeding emotional support
 To prevent recurrent ectopic pregnancy, urge patient
Delayed treatment: Rupture of fallopian tube to have infections treated promptly.
 Rigid abdomen Possible Complications:
 Cullen’s sign
 Extensive dull vaginal and abdominal pain  Rupture of the tube can cause hemorrhage, shock
 Severe abdominal pain radiating to the shoulder as and peritonitis
the abdomen fills with blood  Infertility results if the uterus or both fallopian tubes or
 Extreme pain with movement of the cervix both ovaries or removed
 Uterus boggy and tender
 Rectal pressure if blood collects Cervical Insufficiency (Premature Cervical Dilatation):
 Nausea and vomiting  Formerly known as incompetent cervix
 Shock with profuse hemorrhage  Refers to a cervix that dilates prematurely therefore
Pathophysiology: cannot retain a fetus until term
 Occurs in 1% of women
Ruptured of the fallopian tube:  Dilatation is painless
 Pink-stained vaginal discharge
Sharp stabbing pain in the lower abdominal quadrant – scant
vaginal spotting – blood and products of conception, expelled Etiology:
into the pelvic cavity – blood does not reach the vagina to
become evident – placenta dislodges – progesterone secretion  Associated with congenital structure defects
stops – uterine decidua starts to slough off – additional  Previous cervical trauma resulting from surgery or
bleeding occurs – hypotension; lightheadedness; rapid pulse, delivery
s/s of hypovolemic show  Associated with increasing maternal age
Assessment Findings:
 History of repeated 2nd trimester spontaneous
abortion
 Cervical dilatation in the absence of contraction or
pain
 Pink-stained vaginal discharge
 Increase pelvic pressure with possible ruptured
membranes and release of amniotic fluid
Diagnostic Test Findings:
 UTZ revealing the defect
 Nitrazine test results indicates rupture of membranes
(if occurred)
Medical Management:
 Placement of cerclage (cervical stitch) in the cervix
o Mcdonald – use nylone sutures horizontally and
vertically to close the cervix to only a few mm in
size
o Shirodkar – using sterile tape in a purse-string
fashion to close off cervix entirely
 Bed rest after surgery
 Removal of sutures at 37-39 weeks of gestation
Nursing Interventions:
 Assess complains of vaginal drainage and investigate
history for previous cervical surgeries
 Prepare patient for cervical cerclage placement under
regional anesthesia: monitor maternal VS and FHR
 Maintain bed rest after surgery as ordered (slight or
modified Trendelenburg position)
 Encourage follow-up to evaluate progress of
pregnancy
 Advise that the sutures will be removed around 37-39
weeks of pregnancy
Complications:
 Spontaneous abortion
 Preterm birth
Gestational Trophoblastic Disease (Hydatidiform Mole):
 An abnormal proliferation and then depression of the
trophoblastic villi
 Incidence: 1 in every 1,500 pregnancies
 Cause is unknown but associated with:
- Poor maternal nutrition (insufficient intake of
protein and folic acid)
- Defective ovum, chromosomal abnormalities
- Hormonal imbalances
Two Types of Moles:
1. Complete Mole
- Characterized by swelling and cystic formation of
trophoblastic cells
- No fetal blood is present
- If embryo did develop, only 1 to 2 mm size
- Highly associated with choriocarcinoma (form of
cancer in the uterus)
2. Partial Mole
- Characterized by edema of a layer of the
trophoblastic villi with some of the villi forming
normally
- Fetal blood maybe present in the villi and embryo
up to the size of 9 weeks’ gestation
- Has 69 chromosome (3 chromosomes for every
pair)
Etiology:
 Low protein intake
 Women older than 35 years of age
 Asian heritage
 Type A women marrying Type O men
Pathophysiology:
As the cells degenerate – cells become filled with fluid –
appears as clear fluid-filled grape-sized vesicles – embryo fails
to develop beyond a primitive start – abnormal trophoblast
cells are identified – associated with choriocarcinoma – a
rapidly metastasizing malignancy
Signs and Symptoms:
 Disproportionate enlargement of the uterus; possible
grape-like structure noted in the vagina on pelvic
examination
 Excessive nausea and vomiting
 Intermittent or continuous bright red or brownish
vaginal bleeding by the 12th week of gestation
Diagnostic Test Findings:
 Radioimmunoassay of HCG level extremely for early
pregnancy
 Ultrasound reveal a grape-like clusters rather than a
fetus
 Abnormal level of hemoglobin, hematocrit, RBC,
prothrombin time, partial thromboplastin, fibrinogen
level
 Hepatic and renal functions are abnormal
Medical Management:
 Induced abortion
 Follow-up care because of the risk for developing
choriocarcinoma
 Weekly monitoring of HCG until they remain normal
for 3 consecutive weeks
 Periodic follow-up for 1 up to 2 years
 Avoidance of pregnancy until HCG levels are normal
Nursing Management:
 Prepare the client for surgery
 Monitor VS, fluid intake and output and signs of
hemorrhage
  Encourage the aptient and family to express their  Decrease maternal hemoglobin levels
feelings about the disorder  Transvaginal UTZ scanning is used to determine
 Stress the need for regular monitoring of HCG levels placental position
and chest x-ray to detect malignant changes
Medical Management:
 She must use contraceptives to prevent pregnancy
for 1 year after HCG level return to normal  Bed rest
Placenta Previa:  Monitoring relevant VS
 Rectal and vaginal examination is not performed
 Occurs when the placenta implants in the lower  Vaginal delivery if bleeding is minimal and the
segment where it encroaches on the internal cervical placenta previa is marginal
os  CS in the case of intervening hemorrhage
 One of the most common cause of bleeding during
the 2nd half of pregnancy Nursing Interventions:

Types of Placenta Previa:  If bleeding occurs, continuously monitor VS, intake

and output, amount of bleeding
1. Low Implantation – the placenta implants in the lower  Monitor FHR or attach to electronic fetal monitoring
uterine segment  Have oxygen ready in cases of fetal dstress
2. Partial Placenta Previa – the placenta partially
 Prepare patient and family for possible CS
occludes the cervical os
 Provide emotional support to the family
3. Total Placenta Previa – the placenta totally occludes
 Tactfully discuss the possibility of neonatal death
the cervical os
Possible Complications:

 Postpartum hemorrhage
 Infection

Predisposing Factors:

 Increasing parity
 Advanced maternal age
 Past CS birth
 History of D7C
 Multiple gestation
 Male fetus
Factors that may affect the site of the placenta’s attachment to
the uterine wall:
 Defective vascularization of the decidua
 Multiple gestations
 Previous uterine surgery
 Multiparity
 Advanced maternal age
Pathophysiology:
The lower uterine segment of the uterus fails to provide as
much nourishment as the fundus – Placenta tends to spread
out, seeking the blood supply it needs, becoming larger and
thinner than normal – Placental villi are torn from the uterine
wall as the lower uterine segment contracts and dilates in the
3rd trimester – Internal cervical os effaces and dilates, uterine
vessels are torn – Uterine sinuses are exposed at the placental
site and bleeding occurs
Diagnostic Test Findings:

 Pelvic examination under a double set-up