Ectopic pregnancy || very Flawless.
Overview correct answers Implantation of a fertilized ovum outside the uterine cavity, most
commonly in the fallopian tube (see Implantation sites of ectopic pregnancy)
Good prognosis with prompt diagnosis, appropriate surgical intervention, and control of bleeding
Very few fetuses carried to term; rarely, with abdominal implantation, fetus survives to term
Overview-Pathophysiology correct answers Transport of a blastocyst to the uterus is delayed.
Disruption or scarring of the fallopian tubes leads to dysfunction of the cilia responsible for
propelling the fertilized ovum through the tube.
The blastocyst implants at another available vascularized site, usually the fallopian tube lining.
Normal signs of pregnancy may initially be present.
Uterine enlargement occurs in about 25% of cases.
Human chorionic gonadotropin (hCG) hormone levels are lower than in uterine pregnancies.
If not interrupted, internal hemorrhage occurs with rupture of the fallopian tube.
Overview-Causes correct answers 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
Tumors pressing against the tube
Overview-Risk Factors correct answers History of tubal surgery
Previous ectopic pregnancy
History of pelvic inflammatory disease (PID)
Pelvic adhesions
Use of intrauterine device
History of endometritis
Use of assisted reproductive technologies
Diethylstilbestrol exposure in utero
Cigarette smoking
Multiple sexual partners
Vaginal douching
Young age at first sexual intercourse
Overview-Incidence correct answers Approximately 2% of all pregnancies are ectopic.
More than 40% of ectopic pregnancies occur in women between the ages of 20 and 29.
Ectopic pregnancy is the leading cause of pregnancy-related death in the United States during the
first trimester.
Overview-Complications correct answers Rupture of fallopian tube
, Hemorrhage
Shock
Peritonitis
Infertility
Disseminated intravascular coagulation
Death
Assessment-History correct answers Amenorrhea
Abnormal menses (after fallopian tube implantation)
Slight vaginal bleeding
Unilateral pelvic pain over the mass
With ruptured fallopian tube, intense sharp lower abdominal pain, possibly radiating to the
shoulders and neck
GI disturbances, such as nausea and vomiting
Breast fullness
Fatigue
Assessment-Physical Findings correct answers Extreme pain possible when cervix is moved and
adnexa palpated
Boggy and tender uterus that is slightly enlarged
Enlarged adnexa possible
Pain radiating to neck and shoulder
Signs and symptoms of shock (if ruptured)
Diagnostic Test Results-Laboratory correct answers Serum hCG level is abnormally low; when
the test is repeated in 48 hours, the level remains lower than usual for a normal (intrauterine)
pregnancy.
Serum progesterone levels are lower than expected for an intrauterine pregnancy.
Diagnostic Test Results-Imaging correct answers Transvaginal ultrasound reveals absence of
gestational sac.
Diagnostic Test Results-Diagnostic Procedures correct answers Culdocentesis shows free blood
in the peritoneum.
Laparoscopy may reveal pregnancy outside the uterus.
Treatment-General correct answers Initially, in the event of pelvic-organ rupture, management of
shock
Treatment-Diet correct answers Determined by clinical status
Nothing by mouth if rupture occurs and emergency surgery is necessary
Treatment-Activity correct answers Determined by clinical status
Bed rest if rupture occurs
Overview correct answers Implantation of a fertilized ovum outside the uterine cavity, most
commonly in the fallopian tube (see Implantation sites of ectopic pregnancy)
Good prognosis with prompt diagnosis, appropriate surgical intervention, and control of bleeding
Very few fetuses carried to term; rarely, with abdominal implantation, fetus survives to term
Overview-Pathophysiology correct answers Transport of a blastocyst to the uterus is delayed.
Disruption or scarring of the fallopian tubes leads to dysfunction of the cilia responsible for
propelling the fertilized ovum through the tube.
The blastocyst implants at another available vascularized site, usually the fallopian tube lining.
Normal signs of pregnancy may initially be present.
Uterine enlargement occurs in about 25% of cases.
Human chorionic gonadotropin (hCG) hormone levels are lower than in uterine pregnancies.
If not interrupted, internal hemorrhage occurs with rupture of the fallopian tube.
Overview-Causes correct answers 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
Tumors pressing against the tube
Overview-Risk Factors correct answers History of tubal surgery
Previous ectopic pregnancy
History of pelvic inflammatory disease (PID)
Pelvic adhesions
Use of intrauterine device
History of endometritis
Use of assisted reproductive technologies
Diethylstilbestrol exposure in utero
Cigarette smoking
Multiple sexual partners
Vaginal douching
Young age at first sexual intercourse
Overview-Incidence correct answers Approximately 2% of all pregnancies are ectopic.
More than 40% of ectopic pregnancies occur in women between the ages of 20 and 29.
Ectopic pregnancy is the leading cause of pregnancy-related death in the United States during the
first trimester.
Overview-Complications correct answers Rupture of fallopian tube
, Hemorrhage
Shock
Peritonitis
Infertility
Disseminated intravascular coagulation
Death
Assessment-History correct answers Amenorrhea
Abnormal menses (after fallopian tube implantation)
Slight vaginal bleeding
Unilateral pelvic pain over the mass
With ruptured fallopian tube, intense sharp lower abdominal pain, possibly radiating to the
shoulders and neck
GI disturbances, such as nausea and vomiting
Breast fullness
Fatigue
Assessment-Physical Findings correct answers Extreme pain possible when cervix is moved and
adnexa palpated
Boggy and tender uterus that is slightly enlarged
Enlarged adnexa possible
Pain radiating to neck and shoulder
Signs and symptoms of shock (if ruptured)
Diagnostic Test Results-Laboratory correct answers Serum hCG level is abnormally low; when
the test is repeated in 48 hours, the level remains lower than usual for a normal (intrauterine)
pregnancy.
Serum progesterone levels are lower than expected for an intrauterine pregnancy.
Diagnostic Test Results-Imaging correct answers Transvaginal ultrasound reveals absence of
gestational sac.
Diagnostic Test Results-Diagnostic Procedures correct answers Culdocentesis shows free blood
in the peritoneum.
Laparoscopy may reveal pregnancy outside the uterus.
Treatment-General correct answers Initially, in the event of pelvic-organ rupture, management of
shock
Treatment-Diet correct answers Determined by clinical status
Nothing by mouth if rupture occurs and emergency surgery is necessary
Treatment-Activity correct answers Determined by clinical status
Bed rest if rupture occurs
