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Ectopic Pregnancy

Egg-top Pregnant-woman
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An ectopic pregnancy is any pregnancy where the gestational sac is implanted outside of the uterine cavity. They are also called tubal pregnancies, because the majority of them (95%) occur in the fallopian tube. The gestational sac can implant in the ovary or abdominal cavity.
9 KEY FACTS
SIGNS AND SYMPTOMS
Lower Abdominal Pain
Lower Abdominal Pain-bolt

Lower quadrant abdominal pain can occur due to the fertilized egg developing within the confined space of the fallopian tube. This can be a very painful experience for the pregnant woman and can cause sharp stabbing pains when the tube stretches.

Delayed Menses
Delayed Man-Z's

Ectopic pregnancy can cause decreased menstruation or hypomenorrhea, as a result of the formation of uterine adhesions and scar tissue and may be a sign of injury within the fallopian tubes.

Abnormal Vaginal Bleeding
Abnormal Vagina-violet Blood

One major complication of an ectopic pregnancy is miscarriage because the egg is not able to develop appropriately within the fallopian tube. Vaginal bleeding can also occur as a result of damage to the tissue that is endured during an ectopic pregnancy.

Shock
Shocking

If the tubal pregnancy ruptures, the woman is at risk for hemorrhage. The woman should be monitored closely for signs of hypovolemic shock, as the woman is at risk for losing large volumes of blood. The nurse should monitor the patient’s blood pressure, heart rate, and oxygen saturations very closely.

Referred Shoulder Pain
Ruffled Shoulder Pain-bolt

When the fertilized egg grows too big for the fallopian tube to handle, the tube can rupture. This produces severe abdominal pain and often referred shoulder pain.

Cullen Sign
(:) Colon Symbol

In the event of a tubal pregnancy, the pregnant woman’s umbilicus may display an ecchymotic-bluish color, this is referred to as Cullen sign and is indicative of blood within the peritoneum. When this sign is present, it means that the tubal pregnancy has ruptured.

CONSIDERATIONS
Methotrexate
Moth-T-Rex-ate

If a tubal pregnancy is identified, the woman may be given methotrexate to dissolve the pregnancy as the tube will not be able to withstand the growth of the fetus. This medication is only recommended if the ectopic pregnancy has not ruptured yet.

Surgery
Surgeon

Surgery to remove the ectopic pregnancy may be recommended in order to prevent rupturing of the tube. If the woman would like to maintain fertility for the future, the surgeon can make a small incision on the tube to remove the fertilized egg, this is referred to as a salpingostomy.

RhoGAM
Rowing-groom

If the mother is identified to be Rh negative, RhoGam is administered. The woman with an ectopic pregnancy is at risk for rupture of the tube and/or miscarriage. Therefore, RhoGam is necessary to prevent sensitization to the fetal antibodies for the Rh negative mother.

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