Ectopic Pregnancy

An ectopic pregnancy happens when a fertilized egg implants outside of the uterus.
Typically, an egg is fertilized in the fallopian tube during conception. This is the point
when the sperm meets the egg. The fertilized egg then travels down the tube to the
uterus, it settles (implants) in the lining of the uterus to begin developing.

In an ectopic pregnancy the fertilized egg doesn’t continue to the uterus. Instead, it
implants somewhere else in the body. An egg can implant on the cervix, ovary, and
peritoneal cavity (space in your abdomen). However most ectopic pregnancy happens
in the fallopian tube. This is called tubal pregnancy. Once implanted, the embryo begins
to develop and grow. The fallopian Tube can burst, causing internal bleeding.

What are the Causes?

 An infection or inflammation of the fallopian tube can cause it to become partially
or entirely blocked.
 Scar tissue from a previous infection or a surgical procedure on the tube may
also impede the egg’s movement.
 Previous surgery in the pelvic area or on the tubes can cause adhesions.
 Abnormal growths or a birth defect can result in an abnormality in the tube’s
shape.

Signs and Symptoms

It is important for both the pregnant woman and the health care provider to identify any
signs and symptoms of an ectopic pregnancy before rupture occurs. However, most
ectopic pregnancy does not show any unusual signs and symptoms at the time of
implantation, so it would be difficult to identify them at first.

 Sharp abdominal pain. A pregnant woman with possible ectopic

pregnancy might move suddenly, and as a result, the anterior uterine
support might be pulled and cause pain in the abdomen.
 Vaginal spotting. This would rarely occur in conjunction with the pain, but
this may be a sign that the ectopic pregnancy is nearing its rupture.
 Sharp, stabbing pain at the lower quadrant. This is one of the symptoms
which tell that the ectopic pregnancy has already ruptured.
 Vaginal bleeding. Bleeding occurs after the ectopic pregnancy has
ruptured. Tearing of the blood vessels and its destruction is the cause of
the bleeding, and the amount would not be determined fully because some
products of conception and blood might be expelled into the pelvic cavity.
Risk Factors

Several factors could contribute to the occurrence of an ectopic pregnancy, such as:

 Previous infection such as salpingitis or pelvic inflammatory

disease. Women who experience infection of the reproductive system
increase the incidences of having ectopic pregnancy because the scar from
these infections could cause adhesion in the fallopian tube.
 Scars from a tubal surgery. These scars cause an adhesion that would not
let the fertilized egg travel towards the uterus.
 Congenital malformations. Physical defects of the reproductive system
such as strictures in the fallopian tube could cause ectopic pregnancy.
 Uterine tumors. A tumor might be pressing at the proximal end of the
tubes, which would not allow access of the fertilized egg into the uterus.
 Use of intrauterine device. IUDs are contraceptive devices shaped like an
inverted T and inserted into the uterus of a woman. It may impede the
traveling fertilized egg to reach the ideal place of implantation if it is
inserted after conception.
 Smoking. Women who frequently smoke have a higher incidence of
ectopic pregnancy than non-smoking women.
 A recent in vitro fertilization. Following an in vitro fertilization, a zygote
may have slower transportation and lead to an increased incidence of tubal
or ovarian implantation.
 Previous ectopic pregnancy. Women who underwent ectopic pregnancy
are advised to avoid getting pregnant for a year after the incident because
there is a 10% to 20% chance of a subsequent ectopic pregnancy.
Diagnostic Tests

Tests to determine the possibility of ectopic pregnancy must be performed first before the
diagnosis.

 Pelvic Ultrasound. An early pregnancy ultrasound is the most common

determinant of an ectopic pregnancy.
 Magnetic Resonance Imaging. This is also another way to detect the
presence of ectopic pregnancy and it is safer than undergoing a CT scan for
pregnant women.
Medical Interventions

The medical management of a woman with an ectopic pregnancy should be initiated the
moment she is brought to the emergency room. Just a few moments of interval for action
would cause a big difference in the safety of the patient.
  Administration of methotrexate. Methotrexate is a chemotherapeutic
agent that is a folic acid antagonist. It destroys rapidly growing cells such
as the trophoblast and the zygote. This would be administered until a
negative hCg titer results have been produced.
 Administration of mifepristone. An abortifacient that causes sloughing
off of the tubal implantation site. Both of these therapies would leave the
tube intact and no surgical scarring.
 Intravenous therapy. This would be performed when the ectopic
pregnancy has already ruptured to restore intravascular volume due to
bleeding.
 Withdrawing of blood sample. A large amount of blood would be lost, so
blood typing and crossmatching must be done in anticipation of a blood
transfusion. The blood sample would also be used to determine the
hemoglobin levels of the pregnant woman.
Surgical Interventions

Surgical interventions would be performed after the rupture of the ectopic pregnancy to
ensure that the reproductive system would still be functional and no complications would
arise.

 Laparoscopy. This will be performed to ligate the bleeding blood vessels

and repair or remove the damaged fallopian tube.
 Salpingectomy. This intervention would be performed if the fallopian tube
is completely damaged. The affected tube would be removed and what
would be left would be sutured appropriately.
Nursing Interventions

 Upon arrival at the emergency room, place the woman flat in bed.
 Assess the vital signs to establish baseline data and determine if the patient
is under shock.
 Maintain accurate intake and output to establish the patient’s renal functions
 The goal of the evaluation is to ensure that maternal blood loss is replaced and
the bleeding would stop.
 The patient must maintain adequate fluid volume at a functional level as
evidenced by normal urine output at 30-60mL/hr and a normal specific
gravity between the ranges of 1.010 to 1.021.
 Vital signs, especially the blood pressure and pulse rate, should be stable and
within the normal range.
 Patient must exhibit moist mucous membranes, good skin turgor, and
adequate capillary refill.

Ectopic pregnancy is an emotional thing for the mother. However we may want to save
the zygote, it would be impossible because it has grown outside the usual site of
implantation and this is a life-threatening condition. The only thing that we could provide
to the woman and their families is proper education about ectopic pregnancy and ways on
how to prevent it from recurring.

How To Prevent an Ectopic Pregnancy

Unfortunately, the practices on how to prevent ectopic pregnancy are very limited.
Additionally, these practices do not really prevent the condition; rather, they only lower
the risk.

 Avoid smoking as it increases the risk of ectopic pregnancy.

 Take actions to prevent sexually transmitted diseases, like using a condom and being careful
with your sexual partners. This will lower your risk of developing PIDs (pelvic inflammatory
disease), which is one of the possible causes of ectopic pregnancy.