ectopic pregnancy

1. Presentedby:
Ms. Jyoti Kumari
M.Sc Nursing 2nd year
Narayan Nursing College

2. introduction
An ectopic pregnancy is an early embryo (fertilized egg)
that has implanted outside of uterus (womb), the normal
site for implantation.

3. Definition
 An ectopic pregnancy is one in which the fertilized
ovum is implanted and develops outside the normal
uterine cavity

5. Implantations sites
Extra uterine uterine
Ovarian abdominal
primary secondary
intraperitoneal extraperitoneal
broad ligament
(rare)
TUBAL 95-
96%
• Ampulla
70%
• Isthmus
25%
Interstistial
18%
Infeundibulum
2%
1. Cervical <1
2. Angular
3. Caesarean
4. Cornual

7. incidence
I. increased due to PID, use of IUCD, Tubal surgeries,
and ART.
II. Ranges from 1:25 to 1:250
III. Average range is 1 in 100 normal pregnancies.

8. Tubal pregnancy
 The incidence rate varies from 1 in 300 to 1 in 150
deliveries.

9. risk factors
History of PID
History of tubal ligation
Contraception failure
Previous ectopic pregnancy

10. Previous ectopic pregnancy
History of infertility
IUD used
Previous induced abortion

11. Signs & Symptoms
 Nausea and breast soreness are common symptoms in both
ectopic and uterine pregnancies.
 The following symptoms are more common in an ectopic
pregnancy and can indicate a medical emergency:
 sharp waves of pain in the abdomen, pelvis, shoulder, or
neck
 severe pain that occurs on one side of the abdomen
 light to heavy vaginal spotting or bleeding
 dizziness or fainting
 rectal pressure

12. Assessment & Diagnosis
 History collection
 Physical examination –
pelvic exam to check for pain, tenderness, or a mass

13.  hCG ( human chorionic gonadotropin ) level.
The level of hCG double in early normal pregnancy every 3
days but are reduced in abnormal or ectopic pregnancy.
 Serum progesteron level.
Level less then 5ng/ml are considered abnormal; levels
greater than 25 ng/ml are associated with a normally
developing pregnancy.

14.  TRANSVAGINAL ULTRASONOGRAPHY

15. LAPARASCOPY

16. COLLABORATIVE MANAGEMENT

17. Pharmacological Management
 Methotrexate
It is a type of medicine that interferes with DNA synthesis
and stops cells from dividing or multiplying.
It can be used as a way (other than surgery) to treat a early,
small, unruptured ectopic pregnancy.

18. TREATMENT REGIMEN
 Day 1 Give methotrexate 50mg/m2 IM
 Day 4 Measure Quantitative hCG level (it is common to
see a rise in serum hCG levels from Day 1)
 Day 7 Measure Quantitative hCG level
 If there has been a decline of > or = to 15% from the Day
4 level, follow
 serum hCG levels weekly until <5mIU/ml

19. or
 If there has NOT been a decline of > or = to 15% from the
Day 4 level,
 a 2nd dose of methotrexate 50mg/m2 IM should be given
to the patient (new Day 1) and
 hCG levels should be measured again on Day 4 and Day 7
after the second dose. If values decline by > or = to 15%,
follow serum levels weekly until <5mIU/ml

20. Surgical Management
 Many surgeons suggest removing the embryo and
repairing any internal damage.
 This procedure is called a LAPAROTOMY.

21. Nursing diagnosis
 Risk for Deficient Fluid Volume related to bleeding from
a ruptured ectopic pregnancy.
 Powerlessness related to early loss of pregnancy
secondary to ectopic pregnancy

22. 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 function.

23. COMPLICATION
 The most common complication is rupture with internal
bleeding which may lead to hypovolemic shock.
 Death from rupture is still the leading cause of death in
the first trimester of the pregnancy.
 Rupture with internal bleeding which may lead to
hypovolemic shock Life threatening condition or Death

24. Conclusion
 Ectopic pregnancy can be diagnosed early ( before
rupture )
 Ectopic pregnancy is any pregnancy where the
fertilized ovum gets implanted & develops in a site
other than normal uterine cavity.