Embryo attaches outside the uterus.

1. ECTOPIC PREGNANCY
• Prepared by Mononita
Bhattacharjee
• MSc. Nursing (Medical
Surgical Nursing)

2. Definition
Ectopic pregnancy, also known
as eccyesis or tubal pregnancy, is
a complication of pregnancy in which the
embryo attaches outside the uterus.
An ectopic pregnancy occurs when the
fertilized egg attaches itself in a place other
than inside the uterus.

4. Etiology
• inflammation and scarring of the fallopian
tubes from a previous medical condition,
infection, or surgery

5. Cont…
• hormonal factors
• genetic abnormalities or congenital
abnormalities
• medical conditions that affect the shape and
condition of the fallopian tubes and
reproductive organs

6. Risk factors
• maternal age of 35 years or older
• history of pelvic surgery, abdominal surgery, or
multiple abortions
• history of pelvic inflammatory disease
• history of endometriosis

7. Cont…
• conception occurred despite tubal ligation or
intrauterine device (IUD)
• conception aided by fertility drugs or
procedures
• smoking
• history of ectopic pregnancy

8. Cont…
• history of sexually transmitted diseases
(STDs), such as gonorrhea or chlamydia
• having structural abnormalities in the
fallopian tubes that make it hard for the egg
to travel

9. 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

10. Cont…
• severe pain that occurs on one side of the
abdomen
• light to heavy vaginal spotting or bleeding
• dizziness or fainting
• rectal pressure

11. Assessment & Diagnosis

12. 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

16. LAPARASCOPY

18. COLLABORATIVE
MANAGEMENT

19. Pharmological 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.

20. 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

21. OR

22. • 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

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

25. NURSING MANAGEMENT

26. 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.

27. COMPLICATION
Rupture with internal bleeding
which may lead to hypovolemic shock
Life threatening condition or Death

28. THANKS for LISTENING