July 10, 2009 · Leave a Comment
- Implantation of a fertilized ovum outside the uterine cavity, most commonly in the fallopian tube.
- Good maternal prognosis with prompt diagnosis, appropriate surgical intervention, and control of bleeding.
- Poor fetal diagnosis (rare incidence of survival to term with abdominal implantation).
- About 33 % chance of giving birth to a live neonate in a subsequent pregnancy.
- Incidence: about 1 to 200 pregnancies in whites; about 1 of 120 pregnancies on nonwhites.
- Complications: rupture of fallopian tube, hemorrhage, shock, peritonitis, infertility, disseminated intravascular coagulation, and death.
- Transport of a blastocyst to the uterus is delayed.
- The blastocyst implants at another available vascularized site, usually the fallopian tube lining.
- Normal signs of pregnancy are initially present.
- Uterine enlargement occurs in about 25% cases.
- Human chorionic gonadotropin (hCG) hormonal levels are lower than in uterine pregnancies.
- If not interrupted, internal hemorrhage occurs with rupture of the fallopian tube.
- Congenital defects in the reproductive tract
- Ectopic endometrial implants in the tubal mucosa
- Intrauterine device
- Previous surgery, such as tubal ligation or resection
- Sexually transmitted tubal infection
- Transmigration of the ovum
- Tumors pressing against the tube
- Abnormal menses (after fallopian tube implantation)
- Slight vaginal bleeding
- Unilateral pelvic pain over the mass
- If fallopian tube ruptures, sharp lower abdominal pain, possibly radiating to the shoulders and neck.
- Possible extreme pain when cervix is moved and adnexa palpated.
- Boggy and tender urine
- Possible enlargement of adnexa
- Serum hCG is abnormally low; when repeated in 49 hours, the level remains lower than the levels found in a normal intrauterine pregnancy.
- Ultrasonography may show an intrauterine pregnancy or ovarian cyst.
- Culdocentesis shows free blood in the peritoneum
- Laparoscopy may reveal a pregnancy outside the uterus.
- Initially, in the event of pelvic-organ rupture, management of shock
- Diet determined by clinical status
- Activity determined by clinical status
- Transfusion with whole blood or packed red blood cells
- Broadspectrum I.V. antibiotics
- Methotrexate (Rheumatrex)
- Laparotomy and salpingectomy if culdocentesis shows blood in the peritoneum; possibly after laparoscopy to remove affected fallopian tube and control bleeding.
- Micro-surgical repair of the fallopian tube for patients who wish to have children.
- Oophorectomy for ovarian pregnancy
- Hysterectomy for interstitial pregnancy
- Laparotomy to remove the fetus for abdominal pregnancy.
- Determine the date and description of the patient’s last menstrual period.
- Monitor vital signs for changes.
- Assess vaginal bleeding, including amount and characteristics
- Assess pain level
- Monitor intake and output
- Assess for signs of hypovolemia and impending shock
- Prepare the patient with excessive blood loss for emergency surgery.
- Administer prescribed blood transfusions and analgesics.
- Provide emotional support.
- Administer Rh (D) immune globulin (RhoGAM), as ordered, if the patient is Rh negative.
- Provide a quiet, relaxing environment
- Encourage the patient to express feelings of fear, loss, and grief.
- Help the patient develop effective coping strategies.
- Refer the patient to a mental health professional, if necessary, prior to discharge.