HOW TO EXCALIBRATE

medically by oral administration of methotrexate and leucovorin. Methotrexate, a folic acid antagonist
chemotherapeutic agent that attacks and destroys fast-growing cells. Because trophoblast and zygote
growth is rapid, the drug is drawn to the site of ectopic pregnancy. Women are treated until a negative
hCG titer is achieved. A hestrosalpingogram or sonogram is usually performed after the chemotherapy to
assess whether the tube is fully patent. Mifepristone, an abortifacient, is also effective at causing
sloughing of the tubal implantation site. The advantage of these therapies is that the tube is left intact,
with no surgical scarring that could cause second ectopic implantation.

If an ectopic pregnancy ruptures, it is an emergency situation. Keep in mind that the amount of blood
evident is a poor estimate of the actual blood loss. A blood sample needs to be drawn immediately for
hemoglobin level, tying, and cross-matching, and possibly hCG level for immediate pregnancy testing, if
pregnancy has not yet been confirmed. Intravenous fluid using a large-gauge catheter to restore
intravascular volume is begun. Blood then can be administered through this same line when matched.

The therapy for ruptured ectopic pregnancy is laparoscopy to ligate the bleeding vessels and to remove
or repair the damaged uterine tube. A rough suture line on the uterine tube may lead to another tubal
pregnancy, so either the tube will be removed or suturing on the tube is done with microsurgical
technique.

If a tube is removed, a woman is theoretically only 50% fertile, because every other month, when she
ovulates next to the removed tube, sperm cannot reach the ovum on that side. However, this is not
reliable contraceptive measure. Research in rabbits has shown that translocation of ova can occur –that
is, an ovum released from the right ovary can pass through the pelvic cavity to the opposite (left) uterine
tube and become fertilized and vice versa.(salphigictomy-removal of the fallopian tube.)
As with miscarriage, women with Rh-negative blood should receive Rh (D) immune globulin (RhIG) after
an ectopic pregnancy fro isoimmunization protection in future childbearing.

(See Appendix for illustrations)

II. OBJECTIVES

Generally, later than three weeks of orientation and exposure at the Perpetual Succour Hospital
–Station 3B, the proponents should contribute to the practice of managing ectopic pregnancy
cases in any clinical setting by utilizing the acceptable notions, skills, and outlooks that they will
be achieving from this study.

Specifically, later than three weeks, the proponents should:

1) devise a complete output on the specified client and condition through obtaining apt
orientation and clear instructions from the clinical instructor on how to devise the
study.

2) pool all data for printing and binding and finish the study before March 5, 2010, Friday,
the scheduled date of presentation.

3) submit the final hard and soft copies of the output to the clinical instructor.

4) gather as a group for brainstorming of ideas making use of individual researches about
the disease condition.

5) present the case study on the scheduled date.

6) defend the case study in front the panelists by answering the relevant questions thrown
by them.

7) identify and describe the signs and symptoms of ectopic pregnancy.

8) map out and explain the disease process of ectopic pregnancy.

9) identify and describe the various managements –especially nursing management –for
ectopic pregnancy.

10) gather again as a group for pointers and reactions from each member and from the
clinical instructor after the case presentation.