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VII.

Medical Management

TREATMENT FOR ECTOPIC PREGNANCY

In most cases, an ectopic pregnancy is treated right away to avoid rupture and severe
blood loss. The decision about which treatment to use depends on how early the pregnancy is
detected and your overall condition. For an early ectopic pregnancy that is not causing bleeding,
you may have a choice between using medicine or surgery to end the pregnancy.

Medication

Using methotrexate to end an ectopic pregnancy spares you from an incision and general
anesthesia. But it does cause side effects and can take several weeks of hormone blood-level
testing to make sure that treatment has been successful. Methotrexate is most likely to work:

• When your pregnancy hormone levels (human chorionic gonadotropin, or hCG) are low
(less than 5,000).
• During the first 6 weeks of pregnancy.
• When the embryo has no heart activity.

Surgery

If you have an ectopic pregnancy that is causing severe symptoms, bleeding, or high
hCG levels, surgery is needed. This is because medicine is not likely to work and a rupture
becomes more likely as time passes. Whenever possible, laparoscopic surgery that uses a small
incision is done. For a ruptured ectopic pregnancy, emergency surgery is needed.

Expectant management

For an early ectopic pregnancy that appears to be naturally miscarrying (aborting) on its
own, you may not need treatment. Your health professional will regularly test your blood to
make sure that your pregnancy hormone (hCG, or human chorionic gonadotropin) levels are
dropping. This is called expectant management.
Ectopic pregnancies can be resistant to treatment.

• If hCG levels do not drop or bleeding does not stop after taking methotrexate, your next
step may be surgery.
• If you have surgery, you may take methotrexate afterward.

If your blood type is Rh-negative, Rh immunoglobulin is used to protect any future pregnancies
against Rh sensitization.
II. Patient’s Profile and History

NURSING HISTORY

A. PERSONAL DATA

Name: Modrigo, Marilyn Alvaro

Age: 31

Date of Birth: November 21, 1977

Sex: Female Civil Status: Married

Religion: Roman Catholic

Nationality: Filipino

Room number: 3034 A

Attending physician: Dr. Dizon

B. HISTORYOF PRESENT ILLNESS

This is a case of Marilyn Modrigo, 31 years old, female, Roman Catholic admitted due to
bleeding on May 16, 2009 at East Avenue Medical Center.

Three days prior to admission, the patient already complains of pain at her flank. The
pain ceased that day, however, was felt again after 2 days, May 15. On the following
morning, the patient went to the market when she suddenly sensed pain on her lower
abdomen that was intolerable. She described the pain she to be the same as the pain
during labor. She noticed that she was bleeding, thus, opted to go to the hospital. The
patient underwent pregnancy test which resulted positive. Then, ultrasound was done
after and showed that there was a 10- week old fetus found at the right fallopian tube of
the patient. It was only then, when the patient knew that she was pregnant, and having an
ectopic gestation.

C. PAST MEDICAL HISTORY


The patient had no other hospitalizations except when she gave birth to her 3 children.

D. FAMILY HISTORY

The patient has history of hypertension and diabetes mellitus, both of which her mother
has.

E. SOCIAL HISTORY

The patient does not drink alcohol nor smoke cigarette.

F. OBSTETRIC AND GYNECOLOGIC HISTORY

1. Menstrual history

The patient had her menstruation when she was 13 years old at a regular interval and
usually lasts for 5 to 6 days. The amount was moderate. She experiences
dysmenorrheal every time she has menstruation. In addition, the patient had her
coitarche at the age of 19. She had two sexual partners.

G. OBSTETRIC HISTORY

G4P3/T3P0A0L3

Pregnancy and Course of Delivery

G1 Normal Spontaneous Delivery 1996 Lying-in

G2 Normal Spontaneous Delivery 1998 Lying-in

G3 Caesarean Section 1999 Jose Reyes Medical Center

G4 Ectopic pregnancy 2009 East Avenue Medical Center

H. GYNE HISTORY

The patient uses oral contraceptives since 2004. The patient has no vaginal discharge.
VI. Pathophysiology

ECTOPIC PREGNANCY

Predisposing factors

- Salpingitis
- Previous ectopic pregnancy
- Multiple previous abortion
- Tumors that distort tubes
- Smoking
- Use of intrauterine device


Dysfunction of the cilia which normally propel the
fertilized ovum through the tube into the uterine cavity/
stimulation of contractions in the fallopian tubes because of nicotine

damage to the mucosal surface of the fallopian tube/


scarring or disruption of the fallopian tubes

intraluminal adhesions

blocks or slows the movement of a fertilized egg


through the fallopian tubes to the uterus

fertilized egg attaches to an area outside the uterus


(ampullary area of the fallopian tubes) where it implants

↓ ↓ ↓

sudden severe pain

abnormal bleeding from the vagina Abnormal ultrasound findings:


usually scanty amounts or spotting -no intrauterine gestational sac
identified
-hcG level is greater than 6500mlU
per mL or 6500 IU/L