By Fiona Ying

1
Ectopic Pregnancy

• By Fiona Ying
• MED 672

2
Objectives

• The family nurse practitioner students will be
  able to explain in writing what ectopic pregnancy
  is on a test with 90 accuracy.
• The family nurse practitioner students will be
  able to identify the risk factors for ectopic
  pregnancy on a test with 90 accuracy.
• The family nurse practitioner students will be
  able to identify the common signs and symptoms of
  ectopic pregnancy on a test with 90 accuracy.
• The family nurse practitioner students will be
  able to write out the necessary physical
  examination and laboratory tests required to rule
  out ectopic pregnancy on a test with 80 accuracy.

3
Objectives

• The family nurse practitioner students will be
  able to identify the pharmacological and surgical
  treatment for ectopic pregnancy on a test with a
  80 accuracy.
• The family nurse practitioner students will be
  able to write out 2 or more differential
  diagnosis and possible complications of ectopic
  pregnancy on a test with a 80 accuracy.
• The family nurse practitioner students will be
  able to write out the major goal of treatment of
  ectopic pregnancy on a test with 90 accuracy.

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Definition

• Ectopic pregnancy is any pregnancy in which the
  fertilized ovum implants outside the intrauterine
  cavity (Tenore, 2000).

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Epidemiology

• gt 95 percent occur in fallopian tubes.
• 19.7 cases per 1,000 pregnancies in North
  America.
• Leading cause of maternal mortality.
• 10 to 15 percent of all maternal deaths.

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Risk Factors

• Previous Ectopic Pregnancy
• Pelvic Inflammatory Disease
• Endometriosis
• Previous tubal surgery
• Previous pelvic surgery
• Infertility and infertility treatments
• Uterotubal anomalies
• History of in utero exposure to
  diethylstilbestrol
• Cigarette smoking

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Signs and Symptoms

• Abdominal pain with spotting
• Pain radiating to the shoulder
• Vaginal bleeding
• Syncope
• Hypovolemic shock

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Physical Examination

• Pelvic exam
• Normal or slightly enlarged uterus
• Pelvic pain with movement of cervix
• Palpable adnexal mass
• Vital signs may show hypotension
• Abdominal exam
• Marked abdominal tenderness
• Guarding and rebound tenderness

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Differential Diagnosis

• Uterine Abortion
• Appendicitis
• Salpingitis
• Ovarian Tumor
• Endometrioma
• Cervical Cancer
• Placenta Previa

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Diagnostic Steps

• Careful history Physical Examination
• Obtain urine hCG levels
• Obtain quantitative ß-hCG levels
• Abdominal Ultrasound

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Diagnostic Procedure

• Laparoscopy
• Laparatomy

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Pharmacological Treatment

• Methotrexate
• Leucovorin

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Surgical Treatment

• Laparotomy
• Curettage
• Possible hysterectomy
• Salpingostomy
• Laparoscopy

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Possible Complications

• Hemmorrhage hypovolemic shock
• Infection
• Loss of reproductive organs
• Infertility
• Urinary and/or intestinal fistulas
• Need for blood transfusions
• Disseminated Intravascular coagulation

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Goal for Treatment

• Early detection
• Early diagnosis treatment
• Prevent rupture
• Prompt Referral to gynecologist

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References

• Tenore, J. (2000). Ectopic Pregnancy. American
  Family Physician, 61(4). Retrieved on 6/13/06
  from http//www.aafp.org/afp/20000215/1080.html
• www.fpnotebook.com