ECTOPIC PREGNANCY

 Any pregnancy that develops outside the uterus. 99% of ectopic pregnancies are tubal
(fallopian tube); they are more common on the right side. Approximately one of every 300
pregnancies is ectopic.

 80% - ampullar portion ------------ 12% - isthmus ---------- 8% - interstitial or fimbrial

 Sites of ectopic pregnancy - Fallopian tube, cervix, ovary and intestine

 2% of pregnancies are ectopic – 2nd cause of bleeding early in pregnancy

 Increasing

- Pelvic inflammatory disease (chronic salpingitis) – lead to tubal scarring

- in vitro fertilization (because of tubal scarring) ------------- women who smoke

 Webbing (fibrous bands) – a congenital anomalies that block a fallopian tube may also occur
in both tubes.

 MRI - Magnetic resonance imaging

 Ampullar area (the distal third) – happen to be the highest incidence of tubal pregnancies

 Cullen sign - bluish-tinged hue ---- ambilicus – before seeking help

 Sonogram – advantage, the tube is left intact, with no surgical scarring that could cause a
second ectopic implantation.

 Laparoscopy - therapy for ruptured ectopic pregnancy --- ligate the bleeding vessels and to
remove or repair the damaged fallopian tube.

Risk Factors

 Any condition that causes scarring or obstruction of the fallopian tubes (PID, gonorrheal
infections, postabortion salpingitis)

Diagnostics

1. Ultrasonography

2. Culdocentesis: assesses intraperitoneal bleeding by needle puncture of the cul-de-sac of

Douglas.

3. Laparoscope: an instrument that provides visualization of the pelvic organs via a small
external incision on the abdomen; if affected tube is found, a laparotomy can be performed for
treatment.

Clinical Manifestations

1. If tube is unruptured, slow, chronic bleeding usually occurs, and the abdomen gradually
becomes rigid and very tender.

2. If a tube ruptures, sudden excruciating pain is felt in the lower abdomen, usually over the
mass; referred shoulder pain is possible as the abdomen fills with blood; vaginal bleeding and
shock may also occur.
Treatment

 SURGICAL: Laparoscopy, Laparotomy,salpingectomy

 MEDICAL: Methotrexate

HYPEREMESIS GRAVIDARUM

 A severe and excessive nausea and vomiting during pregnancy which leads to electrolyte,
metabolic and nutritional imbalances in the absence of other medical problems.

Causative factors

 High levels of hCG in early pregnancy

 Metabolic or nutritional deficiencies
 More common in unmarried white women and first pregnancies
 Ambivalence toward the pregnancy or family-related stress
 Thyroid dysfunction

Clinical Manifestations

 Unremitting nausea and vomiting

 Vomitus initially containing undigested food, bile, and mucus; later containing blood and
material that resembles coffee grounds
 Weight loss
 Pale, dry skin
 Rapid pulse
 Fetid, fruity breath odor from acidosis
 Central nervous system affects such as confusion, delirium, headache and lethargy, stupor or
coma.

Nursing Management

1. Promote resolution of the complications.

 Make sure that the client is NPO until cessation of vomiting.

 Administer intravenous fluids as prescribed.
 Measure and record fluid intake and output
 Encourage small frequent meals and snacks once vomiting has subsided,
 Antiemetics as prescribed.

2. Address emotional and psychosocial needs

 Maintain a nonjudgmental atmosphere in which the client express concerns and resolve
some of their fears.