Complications: Ectopic pregnancy What Am I ? Fetal growth somewhere outside of the uterus, usually within the fallopian tubes. ASSESSMENT ❖ Pain ❖ Referred shoulder pain ❖ Spotting ❖ Bleeding into the peritoneum ❖ Bleeding from vagina if rupture occurs ❖ Normal signs/ symptoms of pregnancy Diagnostics ❖ H&H: Low if rupture occurs. ❖ Diagnosable with ultrasound. ❖ Human chorionic gonadotropin level (serum) (hCG) is abnormally low; when the test is repeated in 48 hours, the level remains lower than usual for a normal (intrauterine) pregnancy. ❖ Progesterone level (plasma) is lower than expected for an intrauterine pregnancy. Causes ❖ Congenital defects in reproductive tract ❖ Diverticula ❖ Ectopic endometrial implants in the tubal mucosa ❖ Endosalpingitis ❖ History of multiple elective abortions ❖ Intrauterine device ❖ Previous surgery, such as tubal ligation or resection ❖ Sexually transmitted tubal infection ❖ Transmigration of the ovum ❖ Tumor pressing against the tube ❖ Hormonal imbalance Risk Factors ❖ History of tubal surgery ❖ Previous ectopic pregnancy ❖ History of pelvic inflammatory disease ❖ Pelvic adhesions ❖ Use of intrauterine device ❖ History of endometritis ❖ Progesterone-only contraceptive use ❖ Use of assisted reproductive technologies ❖ Diethylstilbestrol exposure in utero ❖ Cigarette smoking ❖ Age between 35 and 44 ❖ Multiple sexual partners ❖ Vaginal douching ❖ Young age at first sexual intercourse Complications ❖ Rupture of fallopian tube ❖ Hemorrhage ❖ Shock ❖ Peritonitis ❖ Infertility ❖ Disseminated intravascular coagulation ❖ Death Treatments ❖ Transfusion with whole blood or packed red blood cells to treat hypovolemic shock if the tube has ruptured. ❖ IV fluid replacement ❖ Supplemental iron if anemia occurs from blood loss ❖ Methotrexate sodium (Trexall) as primary treatment for unruptured ectopic pregnancy (single I.M. dose or multidose treatment via I.M. or IV route) ❖ Leucovorin I.N. between doses of multi dose methotrexate therapy ❖ Rh o (D) immune globulin, human, if the patient is Rh-negative Interventions ❖ Vital signs ❖ Vaginal bleeding ❖ Pain level and effectiveness of interventions ❖ Fluid balance status ❖ Intake and output ❖ Signs and symptoms of hypovolemia and impending shock ❖ Surgical site (postoperatively)