Bondad, Shehada.

M
BSN-3A

ECTOPIC PREGNANCY

Ectopic pregnancy is the result of a flaw in human reproductive physiology that allows the conceptus
to implant and mature outside the endometrial cavity (see the image below), which ultimately ends in
the death of the fetus. Without timely diagnosis and treatment, ectopic pregnancy can become a life-
threatening situation.

Signs and symptoms

The classic clinical triad of ectopic pregnancy is as follows:
 Abdominal pain
 Amenorrhea
 Vaginal bleeding
Unfortunately, only about 50% of patients present with all 3 symptoms.
Patients may present with other symptoms common to early pregnancy (eg, nausea, breast fullness).
The following symptoms have also been reported:
 Painful fetal movements (in the case of advanced abdominal pregnancy)
 Dizziness or weakness
 Fever
 Flulike symptoms
 Vomiting
 Syncope
 Cardiac arrest
The presence of the following signs suggests a surgical emergency:
 Abdominal rigidity
 Involuntary guarding
 Severe tenderness
 Evidence of hypovolemic shock (eg, orthostatic blood pressure changes, tachycardia)
Findings on pelvic examination may include the following:
 The uterus may be slightly enlarged and soft
 Uterine or cervical motion tenderness may suggest peritoneal inflammation
 An adnexal mass may be palpated but is usually difficult to differentiate from the ipsilateral ovary
 Uterine contents may be present in the vagina, due to shedding of endometrial lining stimulated
by an ectopic pregnancy
Case #: 672839
Name of the Patient: Acusan, Annie A.

Operation Performed: Emergency Exploratory Laparotomy, Salpingectomy.

Preparation
Preoperative Evaluation
Optimal surgical management of an ectopic pregnancy depends on several factors,
including the following:
 The patient’s age, history, and desire for future fertility
 History of previous ectopic pregnancy or pelvic inflammatory disease (PID)
 The condition of the ipsilateral tube (ie, ruptured or unruptured)
 The condition of the contralateral tube (eg, adhesions, tubal occlusion)
 The location of the pregnancy (eg, interstitium, ampulla, isthmus)
 The size of the pregnancy
 The presence of confounding complications
In a patient who has completed childbearing and no longer desires fertility, in a patient
with a history of an ectopic pregnancy in the same tube, or in a patient with severely
damaged tubes, total salpingectomy is the procedure of choice. The presence of
uncontrolled bleeding and hemodynamic instability warrants the choice of radical surgery
over conservative methods. The preferred approach varies according to the location of the
pregnancy.
In all instances, regardless of desired fertility, fully inform the patient of the possibility of a
laparotomy with bilateral salpingectomy.