Ectopic Pregnancy

Subject: Midwifery I (Theory)

Overview

An ectopic pregnancy occurs when the fertilized ovum implants and develops in a location other than the typical uterine cavity. The most common locations are the fallopian tube, the peritoneal cavity, the ovary, and the uterine neck. Ectopic pregnancy is caused by a history of pelvic inflammatory disease, sexually transmitted disease, previous history of ectopic pregnancy, prior to induced abortion, congenital abnormalities of a fallopian tube, use of fertility drugs, endometriosis, tubal spasm and surgery, and contraceptive failure such as IUCD. Lower abdomen and pelvic pain, amenorrhea, the bluish coloring of the vagina and cervix, nausea, tenderness, swelling of the breast, and other symptoms can occur. The initial step in management is to resuscitate the patient.

An ectopic pregnancy occurs when the fertilized ovum implants and develops in a location other than the uterine cavity. The most prevalent location is in the fallopian tube, peritoneal cavity, ovary, and uterine neck (cervix). It is also known as tubal pregnancy or eccyesis.

Etiology

  1. Idiopathic
  2. History of pelvic inflammatory disease, sexually transmitted disease
  3. Previous history of ectopic pregnancy
  4. Prior to induced abortion
  5. Congenital abnormalities of the fallopian tube
  6. Use of fertility drugs
  7. Endometriosis
  8. Tubal spasm and surgery
  9. Contraceptive failure like IUCD

Risk Factors

  1. History of infertility
  2. History of pelvic inflammatory disease
  3. Contraceptive failure
  4. Maternal age of 35- 44 years
  5. Smoking
  6. Endometriosis
  7. Pelvic or abdominal surgery
  8. Previous ectopic pregnancy

Signs and Symptoms

  1. Lower abdominal pain and pelvic pain
  2. Menorrhea bluish discoloration of vagina and cervix
  3. Nausea
  4. Tenderness swelling of the breast.

Site of Ectopic Pregnancy

  1. Extrauterine
  2. Fallopian tube
  3. Isthmus
  4. Ampulla
  5. Interstitial
  6. Infundibulum
  7. Ovary
  8. Abdominal
  9. Uterine
  10. Cervical
  11. Angular
  12. Cornella

Investigation

  1. Total blood count
  2. Hemoglobin, blood grouping, and cross match
  3. Ultrasonography
  4. An HCG test is used to confirm pregnancy.
  5. Culdocentesis
  6. Curettage and dilatation
  7. Laparoscopy
  8. Laparotomy

Prevention

  1. Advice on how to have safe sex
  2. Get a sexually transmitted disease diagnosis and treatment as soon as possible.
  3. Stop using tobacco, alcohol, and other hazardous chemicals.

Management

  1. The patient must be resuscitated as the initial step in treatment. It is accomplished through the use of intravenous fluids, blood transfusions, oxygen, and medicines.
  2. The importance of rapid diagnosis cannot be overstated. Because the patient's condition is stable, further inquiry is not required.
  3. Maintain the patient's flat position in the bed.
  4. Morphine 15mg injection is given intramuscularly as an IV infusion with 5% dextrose and saline water.
  5. Keep track of your vital indicators.
  6. Patient preparation for laparotomy
  7. Assuage the patient and the patient's party.
  8. The mother should be advised to come in for a follow-up appointment on time.
  9. Provide appropriate counseling and usage of family planning measures during discharge. And, as per the doctor's orders, a proper and appropriate scheduling time for the next visit.

References

  • HealthLine. 2005. 2017 http://www.healthline.com/health/pregnancy/ectopic-pregnancy
  • Tuitui R. 2002, A textbook of Midwifery A (Antenatal), 3rd edition, Vidyarthi Pustak Bhnadar (Publisher and Distributor), Bhotahity, Kathmandu
  • Medline Plus. 05 January 2017 https://medlineplus.gov/ency/article/000895.htm
  • NHS Choice. http://www.nhs.uk/conditions/Ectopic-pregnancy/Pages/Introduction.aspx
  • Web MD. 2005. 2017 http://www.webmd.com/baby/pregnancy-ectopic-pregnancy#1
Things to remember
  • Ectopic pregnancy occurs when the fertilized ovum implants and develops in a location other than the uterine cavity.
  • The most prevalent location is in the fallopian tube, peritoneal cavity, ovary, and uterine neck (cervix).
  • It is also known as tubal pregnancy or eccyesis.
  • Ectopic pregnancy is caused by a history of pelvic inflammatory disease, sexually transmitted disease, previous history of ectopic pregnancy, prior to induced abortion, congenital abnormalities of a fallopian tube, use of fertility drugs, endometriosis, tubal spasm, and surgery, as well as contraceptive failure such as IUCD.
  • Lower abdomen and pelvic pain, amenorrhea, the bluish coloring of the vagina and cervix, nausea, soreness, enlargement of the breast, and other symptoms can occur.
  • Extrauterine, fallopian tube, isthmus, ampulla, ovary, and other sites, such as the cervical site, are examples of ectopic pregnancy sites.
  • The patient must be resuscitated as the initial step in treatment.
  • It is accomplished through the use of intravenous fluids, blood transfusions, oxygen, and medicines.
  • The importance of rapid diagnosis cannot be overstated. Because the patient's condition is stable, no further examination is required.
Questions and Answers

Ectopic pregnancy refers to implantation and development of the fertilized ovum outside of the normal uterine cavity. The peritoneal cavity ovary, the neck of the uterus, and the fallopian tube are the common locations (cervix). Other names for it include eccyesis and tubal pregnancy.

Etiology

  • Idiopathic
  • Sexually transmitted diseases and history of pelvic inflammatory disease
  • Prior experience with an ectopic pregnancy
  • Before an artificial abortion
  • Congenital fallopian tube anomalies
  • Medication use for fertility
  • Endometriosis
  • Both surgery and tubal spasm
  • IUCD-like contraceptive failure

Risk Factors

  • A background of infertility
  • Pelvic inflammatory disease past.
  • Contraception not working.
  • 35 to 44 years old for mothers.
  • Smoking.
  • Endometriosis.
  • Abdominal or pelvic surgery
  • Ectopic pregnancy in the past.

Site of ectopic pregnancy

  • Extrauterine
  • Fallopian tube
  • Isthmus
  • Ampulla

Interstitial

  • Infundibulum
  • Ovary
  • Abdominal
  • Uterine
  • Cervical
  • Angular
  • Cornula

Management

  • Reviving the patient is the first stage in treatment. Utilizing intravenous fluids, blood transfusions, oxygen, and pharmaceuticals, it is accomplished.
  • The most crucial factor is prompt diagnosis. The appropriate inquiry should be conducted because the patient's condition is stable.
  • Maintain the patient's flat position in bed.
  • IM injection of 15 mg of morphine is given, along with an IV infusion of 5% dextrose and saline solution.
  • Keep track of the vital indicators.
  • Getting the patient ready for a laparotomy.
  • Boost patient and patient party's confidence.
  • Mother should be told to arrive for the follow-up appointment on time.
  • Provide the appropriate counseling and usage of family planning techniques at the time of release. And as per the doctor's instructions, properly and appropriately schedule time for the subsequent visit.

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