ECTOPIC PREGNANCY

CASE STUDY

PATIENT DATA:

A 30 years old woman with a child who had just given birth 2 years ago
presented to the Primary care centre with a heavy prolonged
menstruation. She said she started her cycle with normal flow.

She has been married for nine years and had three spontaneous vaginal
deliveries. She was already taking combined oral contraceptive pills for a
year and claimed to be on schedule with her medication. During the
previous menstrual cycle, no over-the-counter or prescribed medication
was taken. There had been no severe medical, surgical, or gynecological
issues in the past.

On inspection, she appeared to be in good health and showed no evidence

of anemia. Her blood pressure was 125/70 mmHg, and her pulse rate was
85 beats per minute. Mild pain around the lower abdomen was discovered
during an abdominal examination. Local causes of vaginal bleeding were
ruled out during a vaginal examination. There was discomfort at the
posterior fornix on digital examination. A pregnancy test in the urine came
back positive. This was complemented by the presence of fluid in Douglas'
pouch and an empty uterine cavity. The total white cell count was 7.5 x
109g/L and the hemoglobin count was 12.3 x 103g/L.
ANATOMY AND PHYSIOLOGY OF THE AFFECTED ORGAN
Ectopic pregnancy, also known as eccysis, is a pregnancy condition in
which the embryo implants outside of the uterine cavity. Ectopic
pregnancies, with a few exceptions, are not viable. Furthermore, they are
hazardous to the mother since internal bleeding is a potentially fatal
consequence. The Fallopian tube (so-called tubal pregnancies) is where the
majority of ectopic pregnancies occur, but implantation can also occur in
the cervix, ovaries, and abdomen. An ectopic pregnancy is a medical
emergency that, if left untreated, can result in death.

PATHOPHYSIOLOGY OR PATHOGENESIS

 Anatomic distortion and obstruction of the fallopian tube are widely

believed to be responsible for most ectopic implantations.

 An abnormal conceptus could theoretically result in defective

migration of premature implantation in an ectopic site.
 Abnormalities in the mechanisms responsible for tubal motility
 Transperitoneal migration of the zygote

LABORATORY INVESTIGATION
 A pelvic exam to check the size of your uterus and feel for growths or
tenderness in your belly.

 A blood test that checks the level of the pregnancy hormone (hCG). This
test is repeated 2 days later. During early pregnancy, the level of this
 hormone doubles every 2 days. Low levels suggest a problem, such as
ectopic pregnancy.

 An ultrasound. This test can show pictures of what is inside your belly.
With ultrasound, a doctor can usually see a pregnancy in the uterus 6
weeks after your last menstrual period.

MEDICATIONS
The most common treatments are medicine and surgery. In most cases, a
doctor will treat an ectopic pregnancy right away to prevent harm to the
woman.

Medicine can be used if the pregnancy is found early, before the tube is
damaged. In most cases, one or more shots of a medicine called methotrexate
will end the pregnancy. Taking the shot lets you avoid surgery, but it can
cause side effects. You will need to see your doctor for follow-up blood tests to
make sure the shot worked.

For a pregnancy that has gone beyond the first few weeks, surgery is safer and
more likely to work than medicine. If possible, the surgery will
be laparoscopy. This type of surgery is done through one or more small cuts
(incisions) in your belly. If you need emergency surgery, you may have a
larger incision.

NURSING CARE

 It is vital to diagnose an ectopic pregnancy early to prevent further

damage to the tube and reduce the likelihood of morbidity as well as
trying to preserve fertility.
 If an ectopic pregnancy is suspected the woman should attend hospital.
 An ultrasound scan and a pregnancy test should be performed.
 If the woman is well this can be done by serial blood tests every 48
hours to check the level of the pregnancy hormone, beta-HCG.
 If diagnosis is made early before the tube ruptures, keyhole surgery or
drug treatments such as methotrexate can be offered.

 This promotes a quicker recovery time and increases women’s chances

of future fertility.
 It also results in less morbidity, a shorter hospital stay and greatly
reduced costs.