INTRODUCTION

Ectopic pregnancy also called extra-uterine pregnancy is any pregnancy in which the fertilized ovum
implants outside the intrauterine cavity. It causes life-threatening bleeding and needs medical care right
away. Most of the time, an ectopic pregnancy happens within the first few weeks of pregnancy.
Often, the first warning signs of an ectopic pregnancy are light vaginal bleeding and pelvic pain. If blood
leaks from the fallopian tube, you may feel shoulder pain or an urge to have a bowel movement. Your
specific symptoms depend on where the blood collects and which nerves are irritated.
The incidence of Ectopic Pregnancy is estimated to account for 1.3% to 2.4% of all pregnancies.
Emergency symptoms include major pain, with or without severe bleeding. Ruptured ectopic pregnancy is
a true medical emergency. It is the leading cause of maternal mortality in the first trimester and accounts
for 10 to 15 percent of all maternal deaths. Between 40 and 50 percent of ectopic pregnancies are
misdiagnosed at the initial visit to an emergency department. More than 95 percent of ectopic pregnancies
occur in the fallopian tubes this is called a tubal pregnancy. Another 2.5 percent occur in the cornea of the
uterus, and the remainder is found in the ovary, cervix, or abdominal cavity. Because none of these
anatomic sites can accommodate placental attachment or a growing embryo, the potential for rupture and
hemorrhage always exists.
Failure to identify risk factors is cited as a common and significant reason for misdiagnosis. A proper
history and physical examination remain the foundation for initiating an appropriate work-up that will
result in the accurate and timely diagnosis of an ectopic pregnancy. Modern advances in ultrasound
technology and the determination of serum beta-subunit human chorionic gonadotropin (β-hCG) levels
have made it easier to diagnose ectopic pregnancy. Recent technologic improvements have made it
possible to diagnose ectopic pregnancy earlier. This has altered the clinical presentation from that of a
life-threatening surgical emergency to a less severe constellation of signs and symptoms. Nonetheless, the
diagnosis remains a challenge. This study involves a case of 8 weeks pregnant mother who has suffered
from ectopic pregnancy right tubal ruptured.

OBJECTIVES
■ To fully understand the case of ectopic pregnancy
■ To find out the diagnostic signs and symptoms of ectopic pregnancy
■ To plan a midwifery intervention for ectopic pregnancy
■ To educate women about ectopic pregnancy
PATIENTS PROFILE
■ Name: Mrs. X
■ Age:31
■ Address: Macatcatud Magsingal Ilocos Sur
■ Civil status: Married
■ Gender: Female
■ LMP: March 2, 2021
■ AOG: 8 weeks
■ No. of children: 2
■ GPTPAL: 3 2 2 0 1 2
HISTORY OF PAST AND PRESENT ILLNESS
PAST ILLNESS: Patient X past obstetric history included a normal uncomplicated vaginal delivery,
followed by a second vaginal delivery that was diagnosed prolapsed umbilical cord. On the 20 th of April
2021, 3 am presented to the emergency department at Magsingal District Hospital, she complained of
generalized severe cramping which was of sudden onset, continuous, not radiating, and not relieved by
analgesia. At Tolentino Clinic and Hospital at 6 am was confirmed of right ruptured tubal ectopic
pregnancy by the signs of bluish-tinged umbilicus-intraperitoneal bleeding, sharp, knifelike severe pain,
shoulder pain, shivering, difficulty of urinating, and fever with 38.5 of temperature. She transferred to
Ilocos Sur General Hospital, Gabriela Silang for an urgent operation to remove her ectopic pregnancy.
Upon clinical examination, her Blood Pressure was 80/60 mm Hg, respiratory rate was 35 per minute
with a pulse rate of 150 per minute. She has low hemoglobin and hematocrit. Lastly, the patient
diagnosed with an 8-week fetus found and removed together with the ovary of the patient, which was
resulted to ectopic pregnancy.
PRESENT ILLNESS: Patient X stated that she sometimes experiences mild pain in her inner wound.
Aside from that, she stated that she is not currently associated with any illnesses or diseases.
PHYSICAL ASSESSMENT
Vital signs:
 Blood Pressure: 80/60 mm Hg
 Respiratory Rate: 35 beats per minute
 Pulse Rate: 150 beats per minute
 Temperature: 38.5°C

Head to Toe Assessment:

Assessment Normal Findings Abnormal Findings Actual Findings
Head  Normo-cephalic  Sebaceous cysts;
without scalp local deformities
lesions. from trauma;
 Sensation intact masses; nodules
over face. No  Lack of symmetry,
facial increased skull size
asymmetry, with more
muscles of prominent nose and
facial expression forehead; longer
intact. mandible.
 Hair is evenly  Asymmetric facial
distributed movements (e.g.,
covers the eye cannot close
whole scalp. No completely);
evidence of dropping of lower
Alopecia. eyelid and mouth;
Maybe thick or involuntary facial
thin, coarse or movements (i.e., tics
smooth. Neither and tremors)
brittle nor dry.  Increased facial
  Ears and nose hair; low hair line;
without thinning of
deformity, eyebrows;
external asymmetric features;
tenderness or exophthalmos;
discharge myxedema facies;
 Hearing intact moon face
bilaterally by  Peri-orbital edema;
rough testing sunken eyes
(or: to whisper
Eyes Evenly placed and in  Unequal alignment  Eye redness
line with each other. and movement of
None protruding. Equal eyebrows
palpebral fissure.  Eyelashes turned
Eyelashes inward
Evenly distributed.  Redness, swelling
Turned outward. flaking, crusting
Conjunctivae pink, plaques, discharge,
sclerae white, without nodules, lesions
jaundice.  Jaundiced sclera
No en- or exophthalmos (e.g., in liver
or ptosis of lids. disease); excessively
External ocular pale sclera (e.g., in
movements (EOM’s) anemia); reddened
intact (or: full), no sclera; lesions or
strabismus or nodules (may
nystagmus. indicate damage by
Pupils equal round, react mechanical,
to light and chemical, allergenic,
accommodation or bacterial agents)
(PERRLA).  Lids close
Visual fields intact to asymmetrically,
confrontation. incompletely, or
painfully. Rapid,
monocular, absent,
or infrequent
blinking between lid

Mouth and Throat  Lips normal  Pallor; cyanosis  Lips are dark-
color, without  Missing teeth; ill- bluish color and
lesions. fitting dentures shivering.
 Teeth present,  Excessively red
good dental gums
hygiene.  Blisters; generalized
 Gums (or: or localized
gingiva) and swelling: fissures,
 mucous crusts, or scales
membranes pink (may result from
without excessive moisture,
bleeding, lesions nutritional
or inflammation. deficiency, or fluid
 Tongue normal deficit
size and  Tongue is abnormal
papillation, in size. There is a
midline presence of lumps
protrusion, and bumps.
symmetrical,  Brown or black
moist, possibly discoloration of the
with a thin, enamel (may
whitish coating. indicate staining or
 Tonsils not the presence of
enlarged (or: caries)
absent),
 Palate elevates
symmetrically,
gag intact.
Neck  Neck supple  Unilateral neck
with full range swelling; head tilted
of motion to one side
(ROM). (indicates presence
 No masses or of masses, injury,
tenderness. muscle weakness,
Jugular venous shortening of
distension sternocleidomastoid
(JVD) normal. muscle, scars)
 Trachea muscle tremor,
midline. spasm, or stiffness
 Thyroid not  Limited range of
palpable (or: motion; painful
normal size and movements;
consistency). involuntary
 Carotic pulses movements (e.g.,
full and equal, up-and-down
without bruits. nodding movements
associated with
Parkinson’s disease)
 Enlarged, palpable,
possibly tender
lymph nodes
(associated with
infection and
tumors)
  Deviation to one
side, indicating
possible neck tumor;
thyroid enlargement;
enlarged lymph
nodes
Lymph Nodes  Occipital, pre-  Diminished or
and absent hilum,
postauricular, thickened cortex,
submandibular, not circumscribed
anterior or margins, increased
posterior size or interval
cervical, or change.
supraclavicular  Enlarged and tender.
nodes.
 Not swollen,
enlarged or
tender. Mobile,
which means
that when
pressed on they
move around,
rather than fixed
or "matted".
Chest & back:  No abnormal  Have a spine  There is a
curvature of curvature. Restricted feeling of
spine. Full range movement due to severe pain on
of motion, no frequent muscle the patient’s
muscle spasm or spasm or tenderness. back.
tenderness.  A recent increase in
 Breasts (female) the size of one
symmetrical, breast.
normal size; no  Asymmetry venous
dimpling, pattern
masses,  There is a dimpling
tenderness, or or retraction that is
skin changes. usually cause by a
No nipple malignant tumor.
deformity or
discharge.
Lungs  Respiratory  Increased (louder) 
excursions full breath sounds often
and occur when
symmetrical. consolidation or
 Lungs resonant compression results
to percussion & in a denser lung area
 vesicular breath that enhances the
sounds transmission of
throughout sound.
peripheral lung  Adventitious lung
fields (an sounds, such as
accepted crackles (formerly
abbreviation for called rales) and
normal lung wheezes (formerly
percussion and called rhonchi) are
auscultation: evident.
“Clear to
A&P”).
 No rales, ronchi,
wheezes, or
rubs. Vocal and
tactile fremitus
normal.
 No abnormal  The cardiac valves 
heaves or lifts. fail to close or open
No thrill. properly (valvular
 Sinus rhythm. 1st disease)
and 2nd sounds  the heart muscle
normal intensity pumps inefficiently
(2nd sound or relaxes
physiologically inadequately
split). (myocardial disease)
 No extra sounds  the heart beats too
or murmurs. slowly, too rapidly,
or irregularly
(arrhythmia)
Abdomen  Scaphoid  Hard stools in the  Severe, sharp,
without scars. colon appear as a knife-like
 General localized distention. stabbing pain in
tympany Percussion over the the right lower
 Normal bowel area discloses quadrant
sounds, no dullness. radiating to the
bruits.  Dullness - distended shoulder.
 Superficial & bladder, adipose  Abdominal
deep palpation tissue, fluid or a rigidity
without mass
organomegaly hyperresonance -
or masses; no gaseous distention
direct or  Presence of Bulges,
rebound masses or hernia
tenderness, (enlarged liver or
rigidity, or spleen may show)
 guarding.  Lesions (surgical
 Liver edge soft scars - significant
(or: not location) or rashes
palpable), liver present (skin
span 10 cm. breakdown: older or
Spleen normal obese)
size (or: not
palpable),
kidneys not
palpable
Extremities  Equal in size  Do not have the  Pain and
both sides of the same contour with cramping in
body, smooth the prominences of patient’s lower
coordinated joints extremities.
movements,  Involuntary  Patient can’t
100% of normal movements, move her legs
full movement temperature is and feet.
against gravity abnormal, color is
and full uneven.
resistance.  Cannot perform
 No deformities complete range of
or swelling, motions
joints move
smoothly.
 Normal skin
temperature. No
edema, or
superficial
varicosities.
 No asymmetry
or muscle
atrophy
ANATOMY AND PHYSIOLOGY OF THE ORGAN INVOLVED

Normal Implantation Abnormal Implantation

■ Uterus (womb): The uterus is a hollow, pear-shaped organ that is the home to a developing fetus.
The uterus is divided into two parts: the cervix, which is the lower part that opens into the vagina,
and the main body of the uterus is called the corpus. The corpus can easily expand to hold a
developing baby. A channel through the cervix allows sperm to enter and menstrual blood to exit.
■ Ovaries: The ovaries are small, oval-shaped glands that are located on either side of the uterus.
The ovaries produce eggs and hormones.
■ Fallopian tubes: These are narrow tubes that are attached to the upper part of the uterus and
serve as tunnels for the ova (egg cells) to travel from the ovaries to the uterus. Conception, the
fertilization of an egg by a sperm, normally occurs in the fallopian tubes. The fertilized egg then
moves to the uterus, where it implants into the lining of the uterine wall.
■ Cervix: acts as the door to the uterus, which sperm can travel through to fertilize eggs. When the
body is not carrying a child, cervix helps keep unhealthy things out of the body, like tampons and
bath water. If pregnant, the cervix helps keep the baby in place until it's fully developed.
■ The fimbriae of the uterine tube, also known as fimbriae tubae, are small, fingerlike projections at
the end of the fallopian tubes, through which eggs move from the ovaries to the uterus.
PATHOPHYSIOLOGY
PARTHOGRAGH
■ Expelled Product of conception

LABORATORY AND DIAGNOSTIC PROCEDURES

Before After
o Pregnancy blood test (positive result) o Low in HGB and HCT
o Blood transfusion 2 bags of 500 cc.
o Biopsy result
Specimen consist of the fallopian tube, 6 cm in
length up to the fimbriae. The lumen is dilated to
3×2.5×2 cm,1.5 cm away from the proximal
resection margin. The dilated portion contains
blood clots and is ruptured with an extruded
portion of the placenta.

CARE OF PLAN

Assessment Planning Midwifery Rationale Evaluation/outcome

intervention
Subjective cues: -After 2 hours of Dependent: Reduction of -After 2 hours of
“nasakit jay rendering -Administer anxiety or fear rendering midwifery
puson ko, midwifery Celecoxib to treat that can promote intervention the goal
mangrugi ti sakit intervention the the pain as relaxation and was meet as
na jay abdomen patient will be ordered. comfort. evidenced by:
ko ingana pababa able to verbalize The patient was able
ken madik relief or control Independent: -Reduces muscle to verbalize relief or
maikuti ajay baba of pain and will -Assess pain with tension, promotes control of pain and
ti bagik.” as be able to gain the scale of (0- relaxation and was able to gain her
verbalized by the her energy. 10) may enhance energy.
patient coping abilities
-Provide Comfort
Objective cues: measure like back -Relieves pain,
-weak in rub or deep enhances comfort
appearance breathing and promotes
- Her face exercise rest.
crumpled because
of pain -Encourage the
-fever patient to have
VS: Rest
Blood pressure: -after 4 hours of Dependent: - may help reduce -after 4 hours of
80/60 mmHg rendering -administer fever rendering midwifery
Temp: 38.9 midwifery Paracetamol as intervention the goal
PR: 150 per intervention the ordered was met as
minute patient will be evidenced by:
RR: 35 per able to Independent: The patient will be
minute demonstrate -Monitor Patients able to demonstrate
LAB Result: temperature temperature temperature within
Low CBC and within normal normal range (37.3)
Low HCT range and free -Provide sponge and free from chills.
from chills. baths and avoid
the use of ice
water and alcohol

Name of Mechanism of Indication Contraindication Dosag Adverse Nursing alert

the drug action s e reaction

Brand Celecoxib/ CELEBRE Celecoxib is 500mg Commonly Patients

Names: Celebrex has X is contraindicated in /1 reported side should
Celebrex, analgesic, anti- indicated for patients with capsule effects of discontinue
Consensi, inflammatory, and the salicylate celecoxib to celecoxib and
Elyxyb antipyretic management hypersensitivity or include: notify health
properties. It is of acute NSAID diarrhea, care
Generic believed to be due pain in hypersensitivity hypertension professionals
Name: to inhibition of adults after who have , and if signs and
Celecoxi prostaglandin surgery. experienced abnormal symptoms of
b synthesis, primarily asthma, urticaria, hepatic hepatotoxicit
via inhibition of or other allergic function y (nausea,
COX-2 or vitro. reactions after tests. Other fatigue,
Celecoxib taking aspirin or side effects lethargy,
concentrations other NSAIDs. include pruritus,
reached during Severe, rarely abdominal jaundice,
therapy have fatal, pain, upper right
produced in vivo anaphylactoid dyspepsia, quadrant
affects. reactions to gastro tenderness,
Prostaglandins are NSAIDs have esophageal flu-like
mediators of been reported in reflux symptoms)
inflammation. such patients. disease, occur. May
peripheral cause
edema, hypertension.
vomiting,
and
increased
liver
enzymes.

DRUG STUDY

Name of Mechanism of Indication Contraindications Dosage Adverse Nursing

the drug action reaction alert

Brand Cefuroxime is a Cefuroxime Cefuroxime is 500mg/ Nausea, Monitor

Name: bactericidal agent is a contraindicated in 1 vomiting, signs of
Zinacef that acts by cephalosporin patients with capsule diarrhea, allergic
inhibition of (SEF a low cephalosporin strange reactions
Generic bacterial cell wall spor in) hypersensitivity or taste in the and
name: synthesis. antibiotic that cephamycin mouth or anaphylaxis,
Cefuroxime Cefuroxime has is used to hypersensitivity. stomach including
activity in the treat bacterial Cefuroxime should pain may pulmonary
presence of some infections. be used cautiously occur. symptoms
beta-lactamases, in patients with Dizziness (tightness in
both penicillinases hypersensitivity to and the throat
and penicillin. The drowsiness and chest,
cephalosporinases, structural may occur wheezing,
of Gram-negative similarity between less cough
and Gram-positive cefuroxime and frequently, dyspnea) or
bacteria. penicillin means especially skin
 that cross- with reactions
reactivity can higher (rash,
occur. doses. If pruritus,
any of urticaria).
these Notify
effects physician or
persist or nursing staff
worsen, immediately
notify your if these
doctor or reactions
pharmacist occur.
promptly.

Name Mechanism of Indication Contraindication Dosage Adverse Nursing alert

of the action s reaction
drug

Brand -Iron This An overload of 300mg/1 Constipation, Monitor Closely

Name: combines with medication iron in the blood. tablet diarrhea, (1) ferrous sulfate
Iron, porphyrin and is an iron A type of blood stomach decreases levels of
Feosol globin chains supplement disorder where the cramps, or levodopa by
to form used to red blood cells upset inhibition of GI
Generic hemoglobin, treat or burst called stomach may absorption.
Name: which is prevent low hemolytic anemia. occur. These Applies only to
Ferrous critical for blood levels An ulcer from too effects are oral form of both
sulfate oxygen of iron much stomach usually agents. Use
delivery from (such as acid. A type of temporary Caution/Monitor.
the lungs to those stomach irritation and may Oral administration
other tissues. caused by called gastritis. disappear as of iron salts should
-Iron anemia or your body be separated from
deficiency pregnancy). adjusts to levodopa by at
causes a Iron is an this least 2 hours.
microcytic important medication.
anemia due to mineral that If any of
the formation the body these effects
of small needs to persist or
erythrocytes produce red worsen,
with blood cells contact your
insufficient and keep doctor or
hemoglobin. you in good pharmacist
health. promptly.

DISCHARGE PLANNING
M- Medication

Name of Indication Contraindications Dosage Adverse Nursing alert

the drug reaction

Celecoxib CELEBREX is Celecoxib is 500mg /1 Commonly Patients should

indicated for the contraindicated in capsule reported side discontinue
management of patients with effects of celecoxib and
acute pain in salicylate celecoxib to notify health care
adults. hypersensitivity or include: diarrhea, professionals if
NSAID hypertension, and signs and
hypersensitivity who abnormal hepatic symptoms of
have experienced function tests. hepatotoxicity
asthma, urticaria, or Other side effects (nausea, fatigue,
other allergic include lethargy, pruritus,
reactions after taking abdominal pain, jaundice, upper
aspirin or other dyspepsia, gastro right quadrant
NSAIDs. Severe, esophageal reflux tenderness, flu-
rarely fatal, disease, like symptoms)
anaphylactoid peripheral occur. May cause
reactions to NSAIDs edema, vomiting, hypertension.
have been reported in and increased
such patients. liver enzymes.

Name of the Indication Contraindications Dosage Adverse Nursing alert

drug reaction
 Cefuroxime Antibiotic drug Cefuroxime is 500mg/1 Nausea, Monitor signs of
use to treat contraindicated in capsule vomiting, allergic
bacterial patients with diarrhea, reactions and
infections. cephalosporin strange taste in anaphylaxis,
hypersensitivity or the mouth or including
cephamycin stomach pain pulmonary
hypersensitivity.
may occur. symptoms
Cefuroxime should be
Diaper rash (tightness in the
used cautiously in
patients with may occur in throat and chest,
hypersensitivity to young wheezing,
penicillin. The children. cough dyspnea)
structural similarity Dizziness and or skin
between cefuroxime drowsiness reareactionsrash,
and penicillin means may occur less The patients,
that cross-reactivity frequently, urticaria).
can occur. especially with Notify physician
An overload of iron in higher doses. or unexercised
the blood. A type of If any of these immediately if
blood disorder where effects persist these reactions
the red blood cells
or worsen, occur.
burst called hemolytic
anemia. An ulcer from notify your
too much stomach doctor or
acid. A type of pharmacist
stomach irritation promptly.
called gastritis.

E-Exercise
The Patient is not encouraged to do any form of exercise or activity after the operation. It is also
not advisable to have sexual contact until your healthcare provider says it is okay because these activities
may cause infection. This is also may put too much stress on the incision. Breathing exercise is
recommended. Wait for the doctor’s advice if it is okay to do exercise or 1 year until it’s full recovery.
T-Treatment
Preventing infection is one of the most important things do to have an excellent outcome from
the procedure. Washing hands before touching incision is one of the easiest and most important things to
do during recovery. Encourage the patient to use abdominal binder helps to reduce postoperative pain,
distress, and hemorrhage after her salpingectomy operation.
H- Health Teaching
• After your treatment, you may have vaginal bleeding that is similar to a period. It may last for up to a
week. Use pads instead of tampons. You may use tampons during your next period. It should start in 3 to
6 weeks.
• Do not have sex until after the bleeding stops. Bleeding aistreated with methotrexate: Your doctor will
let you know if you can take over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen
(Advil, Motrin), anaproxen (Aleve). Read and follow all instructions on the label.
• Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain
medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• Do not drink alcohol.
• Do not take vitamins that contain folic acid, such as prenatal vitamins. • Get plenty of rest. You may be
more tired than normal for a few weeks.
• Take it easy and avoid lifting until your doctor tells you it is safe to do your normal activities. Give
yourself and your partner time to grieve. You may have feelings of loss. You may wonder why it
happened and blame yourself.
• Talking to family members, friends, or a counsellor may help you cope with your loss.
• If you feel sad for longer than 2 weeks, tell your doctor or a counsellor.
• Talk to your doctor if you are worried about having children in the future. Most doctors suggest waiting
until you have had at least one normal period before you try to get pregnant.
• If you do not want to get pregnant, ask your doctor about birth control. You can get pregnant again
before your next period starts.
O- Outpatient Referral
Most people are discharged that same day, normally within two hours. Recovery usually takes
between two and five days. Your doctor will likely ask you to return for a follow-up appointment one
week after the procedure.
Call your local emergency number for any of the following:
 You feel lightheaded, short of breath, and have chest pain.
 You cough up blood.
 You have trouble breathing.
Seek care immediately if:
 Your arm or leg feels warm, tender, and painful. It may look swollen and red.
 Blood soaks through your bandage.
 Your stitches come apart.
 You soak through 1 sanitary pad in 1 hour.
 You have trouble urinating or cannot urinate at all.
Call your doctor or surgeon if:
 You have a fever or chills.
 Your wound is red, swollen, or draining pus.
 You have pus or a foul-smelling odor coming from your vagina.
 Your pain does not get better after you take your medicine.
 You have nausea or are vomiting.
 Your skin is itchy, swollen, or you have a rash.
D-Diet
The liquid diet food contains all clear liquid varieties of food like soup or broth, milk, curd,
pudding, etc. In addition to these, you can also include cream of rice, creamy soup after straining it,
custard, and sherbet. Make sure to avoid food with seeds and nuts. To prevent constipation, avoid foods
like dried or dehydrated foods, processed foods, cheese and dairy products, red meats and sweets.

EVALUATION
■ An ectopic pregnancy is a pregnancy that happens outside of the uterus. This happens when a
fertilized egg implants in a structure that can’t support its growth. On April 20, 2021, Mrs. X was
8 weeks pregnant but she has an urgent operation, which was right Salpingectomy to remove her
ruptured tubal ectopic pregnancy specifically at the right fallopian tube site was successfully
done. Her vital signs most especially her blood pressure became stable. She undergoes a blood
transfusion to increase her HGB and HCT and after 2 days of her operation, she has a bloody
discharge with a blood clot.
■ The doctor gave her medications to take after the operation, which was Celecoxib, Cefuroxime,
and Ferrous Sulfate. More than a day of her confinement in the hospital, she was already
discharged in the hospital. Her doctor advised her for follow up check-up after 1 week, to clean
every day the site of surgery with cotton balls and betadine then cover it with sterile gauze, and
lastly, use an abdominal binder to help Mrs. X reduce the postoperative pain, distress, and
hemorrhage after the cesarean section.
SUMMARY
A 31-year-old Ilocano patient, G3P2 presented to the emergency department on the 20th of April
2021, 3 am at Magsingal District Hospital complaining of sharp, knifelike severe pain, shoulder pain,
associated with shivering, hard to urinate, and fever with 38.5 °C temperature. She was medically free
and her past obstetric history included a normal uncomplicated vaginal delivery, followed by a second
vaginal delivery that was diagnosed prolapsed umbilical cord. She is taking a contraceptive pill straight
without a pap smear test. Upon presentation, she complained of generalized severe cramping which was
of sudden onset, continuous, not radiating, and not relieved by analgesia. She was immediately
transferred to Tolentino Clinic and Hospital at 6 am and confirmed of right ruptured tubal ectopic
pregnancy by the signs of bluish-tinged umbilicus-intraperitoneal bleeding, sharp, knifelike severe pain,
shoulder pain, shivering, difficulty of urinating, and fever with 38.5 of temperature. The pain was
associated with severe abdominal or pelvic pain, dizziness or fainting, pain in the lower back, but there
was no history of loss of consciousness, gastrointestinal or urinary tract symptoms.
She was transferred to Ilocos Sur General Hospital, Gabriela Silang for an urgent operation to
remove her ectopic pregnancy. Upon clinical examination, her Blood Pressure was 80/60 mmHg,
respiratory rate was 35 per minute with a pulse rate of 150 per minute. She has low hemoglobin and
hematocrit. The possibility of a ruptured ectopic pregnancy was explained to the patient, and she
consented to an emergency with possible salpingectomy. A total of 5 IV fluid with 1000 ml was inserted
and blood transfusion with 2 bags containing 500 ccs. A live 8-week fetus was found and removed
together with the ovary of the patient. Specimen consist of the fallopian tube, 6 cm in length up to the
fimbriae. The lumen is dilated to 3×2.5×2 cm,1.5 cm away from the proximal resection margin. The
dilated portion contains blood clots and is ruptured with an extruded portion of the placenta. It was
revealed that the causes are swelling on the tube because of using contraceptive pills straight in 4 years
without a pap smear test, and Congenital malformations on the right fallopian tube.
The doctor gave her medications to take after the operation, which was Celecoxib, Cefuroxime,
and Ferrous Sulfate. More than a day of her confinement in the hospital, she was already discharged in
the hospital. Her doctor advised her for a follow-up checkup after 1 week, to clean every day the site of
the surgery with cotton balls and betadine then cover it with sterile gauze, and lastly, use an abdominal
binder to help reduce the postoperative pain, distress, and hemorrhage after the operation. Detection of
ectopic pregnancy in early gestation has been achieved mainly due to enhanced diagnostic capability.
Despite all these notable successes in diagnostics and detection techniques ectopic pregnancy remains a
source of serious maternal morbidity and mortality worldwide, especially in countries with poor prenatal
care.
REFERENCES
■ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667717/
■ https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-
20372088
■  https://www.google.com/url?q=https://www.aafp.org/afp/2000/0215/
p1080.html&usg=AOvVaw1ax2TlMi_ZLnDFk8Rz421U