ECTOPIC PREGNANCY

What is Ectopic pregnancy? Ectopic means out of place. In an ectopic pregnancy, a fertilized egg has implanted outside the uterus. The egg settles in the fallopian tubes in more 2than 95% of ectopic pregnancies. This is why ectopic pregnancies are commonly calledtubal pregnancies.

Causes:
An ectopic pregnancy is usually caused by a condition that blocks or slows the movement of a fertilized egg through the fallopian tube to the uterus. This may be caused by a physical blockage in the tube.

Most cases are a result of scarring caused by: Past ectopic pregnancy Past infection in the fallopian tubes Surgery of the fallopian tubes

Signs and Symptoms:

abdominal and pelvic pain vaginal spotting or light bleeding

Anatomy and Physiology

Vagina
The vagina is a canal that joins the cervix (the lower part of uterus) to the outside of the body. It also is known as the birth canal.

Uterus (womb)
is a hollow, pear-shaped organ that is the home to a developing fetus. The uterus is divided into two parts: the cervix, which is the lower part that opens into the vagina, and the main body of the uterus, called the corpus. The corpus can easily expand to hold a developing baby. A channel through the cervix allows sperm to enter and menstrual blood to exit.

Ovaries
The ovaries are small, oval-shaped glands that are located on either side of the uterus. The ovaries produce eggs and hormones.

Fallopian tubes
These are narrow tubes that are attached to the upper part of the uterus and serve as tunnels for the ova (egg cells) to travel from the ovaries to the uterus. Conception, the fertilization of an egg by a sperm, normally occurs in the fallopian tubes. The fertilized egg then moves to the uterus, where it implants into the lining of the uterine wall.

Broad Ligaments
Two wing-like structures that extend from the lateral margins of the uterus to the pelvic walls and divide the pelvic cavity into an anterior and a posterior compartment.

Fimbriae
Fringes; especially the finger-like ends of the fallopian tube.

Endometrium
- is the mucosal layer lining the cavity of the uterus.

Myometrium
is the middle layer of the uterine wall consisting of smooth muscle cells and supporting stromal and vascular tissue.

Perimetrium
is the outer serosa layer of the uterus, equivalent to peritoneum.

Mesovarium
is the portion of the broad ligament of the uterus that covers the ovaries.

Round Ligament
of the uterus originates at the uterine horns, in the parametrium. It leaves the pelvis via the deep inguinal ring, passes through the inguinal canal and continues on to the labia majora where its fibers spread and mix with the tissue of the mons pubis.

Uterine Cavity
The Cavity of the Body in the uterus is a mere slit, flattened antero-posteriorly.

Ovarian Ligament
(also called the utero-ovarian ligament or proper ovarian ligament) - is a fibrous ligament that connects the ovary to the lateral surface of the uterus.

Infundibulum
(Latin for funnel; plural, infundibula) - is a funnel-shape cavity or organ.

Fundus of the Uterus is the top portion, opposite from the cervix. Fundal height, measured from the top of the pubic bone, is routinely measured in pregnancy to determine growth rates.

Uterine Artery
- is an artery in females that supplies blood to the uterus.

Labia majora
The labia majora enclose and protect the other external reproductive organs. Literally translated as "large lips," the labia majora are relatively large and fleshy, and are comparable to the scrotum in males. The labia majora contain sweat and oil-secreting glands. After puberty, the labia majora are covered with hair.

Labia minora
Literally translated as "small lips," the labia minora can be very small or up to 2 inches wide. They lie just inside the labia majora, and surround the openings to the vagina (the canal that joins the lower part of the uterus to the outside of the body) and urethra (the tube that carries urine from the bladder to the outside of the body).

Bartholin's glands
These glands are located beside the vaginal opening and produce a fluid (mucus) secretion.

Clitoris
The two labia minora meet at the clitoris, a small, sensitive protrusion that is comparable to the penis in males. The clitoris is skin, called the prepuce, which is similar to the foreskin at the end of the penis. Like the penis, the clitoris is very sensitive to stimulation and can become erect.

PATHOPHYSIOLOGY

Predisposing factors: Age lifestyle

Dysfunction of the cilia w/c normally propels the fertilized ovum through the tube into the uterine cavity.

Precipitating Factor: History o pelvic inflammatory disease Uterine curettage Previous tubal surgery Endometriosis

Disruption of the scarring of the fallopian tube

Blocks or slows the movement of a fertilized egg though the fallopian tube to the uterus.

Fertilized ovum implants outside the uterus.

Painless bleeding

Tubal ectopic pregnancy

Blastocyst burrows into the epithelium of the tubal wall (usually in the distal / ampullary two or thirds of the fallopian tube. 1.Decrease resistance of the invading trophobalstic tissue by the fallopian tube. 2. Decreased muscle mass lining of the fallopian tube. 3. Decreased HCG.

Tapping of blood vessels in the tube.

Before Rupture 1.Abdominal pain 2. Abdominal vaginal bleeding. 3. Abdominal tenderness.

Embryonic death

Abortion, spontaneous regression or rupture (depends on gestational age and location of implantation

During Rupture: Exacerbation of pain.

After Rupture: Faintness/dizziness Abdominal pain Sign of shock

Maternal hemorrhage

Excessive bleeding occurs.

Maternal Death

Drug Study

NURSING CARE PLAN

Discharge Plan

MEDICATION nstruct pt to take medication within prescribed time and osage eligiously to maintain health improvement. Home meds: . zinnat 500mg 3x a day . termin C 1 capsule once a day . cataflam 3x a day . aplosyn apply 3x a day EXERCISE Encourage pt to exercise as tolerated. Educate pt on the enefits f exercise towards health particularly to improvement of tolerance activities.

DIET A high-protein, high-calorie diet is recommended for the patient as well as iron-rich foods. Patient should also avoid foods that are high in sodium. HEALTH TEACHING Educate the pt on the nature of Ectopic pregnancy.