Understanding Ectopic Pregnancy (High-Yield Topic)

A clear, visual breakdown of ectopic pregnancy — its sites, symptoms, diagnosis, and management. High-yield for NORCET and clinical practice.

Transcript

1. Ectopic Pregnancy A high-yield topic for Obstetrics and NORCET preparation 4 covering pathophysiology, diagnosis, and management of this life-threatening condition.
2. What Is Ectopic Pregnancy? An ectopic pregnancy occurs when a fertilised ovum implants outside the uterine cavity. The vast majority (95%) implant in the fallopian tubes, making tubal pregnancy the most common variant. These pregnancies cannot proceed to term and pose a life- threatening risk due to potential rupture and haemorrhage. Early recognition is critical to prevent maternal morbidity and mortality.
3. Common Sites of Ectopic Pregnancy Tubal ( %) Ampullary (70%) Isthmic (12%) Fimbrial (11%) Interstitial (2%) Non-tubal (Rare) Cervical Ovarian Abdominal Caesarean scar
4. Risk Factors for Ectopic Pregnancy Pelvic Inflammatory Disease PID causes tubal damage and scarring, significantly increasing ectopic pregnancy risk. Previous Tubal Surgery History of tubal surgery, sterilisation failure, or previous ectopic pregnancy. Assisted Reproductive Technology Use of IVF and other ART procedures increases the likelihood of ectopic implantation. Smoking Tobacco use impairs tubal motility and ciliary function, delaying embryo transport. Contraceptive Failure IUD failure or progesterone-only contraception may alter tubal function. Congenital Abnormalities Structural tubal defects or endometriosis affecting normal anatomy.
5. Pathophysiology of Ectopic Pregnancy Impaired Tubal Transport Damage or obstruction prevents normal embryo migration to the uterus. Abnormal Implantation The fertilised ovum implants in the tubal wall or other ectopic site. Trophoblastic Invasion Trophoblastic tissue erodes into vessels, causing bleeding and weakening the wall. Risk of Rupture Progressive growth leads to tubal rupture and haemorrhagic shock.
6. Clinical Features of Ectopic Pregnancy Early Symptoms Missed menstrual period Positive pregnancy test Mild lower abdominal pain Vaginal spotting or light bleeding Classic Triad Amenorrhoea 1. Abdominal pain (often unilateral) 2. Vaginal bleeding 3. Occurs in approximately 50% of cases. Ruptured Ectopic (Emergency) Sudden severe abdominal pain Shoulder-tip pain (referred diaphragmatic irritation) Dizziness, syncope, or collapse Signs of shock: hypotension, tachycardia, pallor
7. Diagnosis and Investigations Serum ³-hCG Levels Slow-rising or plateauing levels. Normal pregnancy: ³-hCG doubles every 48 hours. Failure to double suggests ectopic pregnancy. Transvaginal Ultrasound Empty uterus with positive pregnancy test. Adnexal mass or extrauterine gestational sac. Free fluid in pelvis suggests rupture. Additional Tests Serum progesterone levels (low in ectopic). Culdocentesis (older method) indicates haemoperitoneum if non-clotting blood aspirated.
8. Management of Ectopic Pregnancy Medical Management Methotrexate therapy for stable, unruptured cases with ³-hCG <5,000 mIU/mL and no cardiac activity. Single or multi-dose regimen Serial ³-hCG monitoring until non-pregnant levels Avoid folic acid, intercourse, and strenuous activity Surgical Management Laparoscopic salpingostomy (tube-preserving) or salpingectomy (tube removal). Indicated for ruptured ectopic or haemodynamic instability Failed medical management Patient preference or contraindications to methotrexate Expectant Management Observation only for highly selected cases with declining ³-hCG levels and stable vitals. ³-hCG <1,000 mIU/mL and falling Minimal symptoms Close monitoring essential
9. Complications of Ectopic Pregnancy Tubal Rupture Life-threatening surgical emergency requiring immediate intervention. Massive Haemorrhage Internal bleeding into peritoneal cavity leading to hypovolaemic shock. Future Infertility Tubal damage increases risk of subsequent infertility or recurrent ectopic pregnancy. Recurrence Risk 10320% risk of another ectopic pregnancy in future conceptions. Maternal Death Preventable with early diagnosis and treatment. Remains a cause of maternal mortality if untreated.
10. Nursing Management and Care Vital Signs Monitoring Continuous assessment of blood pressure, pulse, respiratory rate, and oxygen saturation. Monitor for signs of shock or deterioration. Haemorrhage Assessment Monitor vaginal bleeding and abdominal pain. Assess for peritoneal signs and abdominal distension indicating internal bleeding. Emergency Preparedness Establish IV access and administer fluids. Prepare patient for emergency surgery if rupture suspected. Ensure blood products available. Psychological Support Provide emotional support for pregnancy loss. Offer counselling services and allow grieving. Address concerns about future fertility. Patient Education Explain importance of follow-up ³-hCG monitoring. If on methotrexate: avoid folic acid, alcohol, and sun exposure. Avoid intercourse and strenuous activity until resolved.