Ectopic Pregnancy

Implantation of a fertilized ovum outside the uterine cavity

Definition

An ectopic pregnancy is one in which a fertilized ovum implants outside the uterine cavity, most commonly in a fallopian tube (95%). It cannot progress to a viable pregnancy and is a life-threatening emergency if it ruptures.

Risk Factors

Previous ectopic or PID
IUD use
Tubal surgery or ligation
Assisted reproduction
Smoking
Endometriosis

Signs and Symptoms

Unilateral stabbing lower abdominal/pelvic pain, amenorrhea, vaginal spotting/bleeding, referred shoulder pain (from diaphragmatic irritation by intraperitoneal blood). Rupture: severe pain, hypotension, tachycardia, signs of shock.

Diagnostics

Serum beta-hCG (abnormally low for gestational age), transvaginal ultrasound showing no intrauterine pregnancy.

Treatment

Methotrexate (early, unruptured, stable). Surgery (salpingostomy or salpingectomy) for rupture or methotrexate failure. Rh-negative women receive RhoGAM.

NCLEX Relevance

Emergency priority: assess for shock. Shoulder pain is a classic referred pain cue.