The document discusses tubal ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus in one of the fallopian tubes. Common risk factors include pelvic inflammatory disease, previous ectopic pregnancy, and intrauterine devices. Symptoms include abdominal pain, vaginal bleeding, and shoulder pain. Diagnosis is made through ultrasound and physical exam showing adnexal masses and abdominal tenderness. Treatment involves surgery to remove the ectopic pregnancy due to risks of tubal rupture and bleeding. Nursing care focuses on monitoring for deficient fluid volume and supporting the patient through the early loss of pregnancy.

1. SUBJECT:
MIDWIFERY AND OBSTETRICAL NURSING
ASSIGNMENT-I
TOPIC :
TUBAL ECTOPIC PREGNANCY
Submitted to:
Mrs. Nagalakshmi
Asst. Lecturer
RINER
Submitted by:
Dorjee Pema Thungon
Gireesha. B.S
J. Evlin Petescia
4th
year B.sc(N)
RINER
DATE OF SUBMISSION:

2. Definition:
Ectopic pregnancy :
An ectopic pregnancy is one in which the fertilized ovum is implanted and develops
outside the normal endometrial cavity.
Tubal Ectopic pregnancy :
Tubal pregnancy develops when the transport of the fertilized ovum into the uterine
cavity is interfered with Implantation can occur at any point along the tube although
the ampulla is the common site
Sites of implantation in tubal ectopic pregnancy :
1.Ampulla
2.Isthmus
3.Infundibulum
4.Interstitial

3. Etiology:
1.Salpingitis and pelvic inflammatory disease[PID]
2.Iatrogenic :
 Contraceptive failure:
 IUD
 sterilization procedure
 use of progestin only pill
 Tubal surgery
 Intrapelvic adhesion’s
 ART- Assisted Reproductive Technology
3.Others :
 Previous ectopic pregnancy
 Prior induced abortion
 Developmental defect of the tube
i. Elongation
ii. Diverticulum
iii. Accessory Ostia
 Transperitoneal migration of the ovum

6. Outcomes :
The result of the tubal ectopic pregnancy may be any of the following
a)Tubal abortion
b)Tubal mole
c)Tubal rupture
Clinical presentation :
(Symptoms)
 Amenorrhea
 Acute lower abdominal pain
 Dizziness
 Nausea
 Shoulder pain
 Vaginal bleeding
 Vomiting
 Fainting attack
(Signs)
 Pallor
 Tachypnea
 Low blood pressure
Abdominal examination:
 Tenderness in the lower abdomen
 Rebound tenderness
 Cullen's sign
Pelvic examination:
 Tenderness and transverse cervical movements
 Forniceal tenderness
 Adnexal mass

7. Assessment:
Abdominal examination:
 lower abdominal tenderness
 Rebound tenderness
 Guarding and shifting dullness due to hemoperitoneum
Pelvic examination:
 Tenderness on transverse cervical movements
 Lateral forniceal tenderness
 Adnexal mass
 Vascular pulsations on the side of ectopic pregnancy
Investigations:
 Ultrasound

8. MANAGEMENT OF TUBAL ECTOPIC PREGNANCY

9. Nursing Diagnosis
Risk for deficient fluid volume related to bleeding from a ruptured ectopic
pregnancy.
Powerlessness related to early loss of pregnancy secondary to ectopic
pregnancy.
Bibliography:
 Annama Jacob,a comprehensive textbook of midwifery and gynaecological
nursing,fourth edition,Jaypee publication, Pgno:299-302
 Dc dutta ,textbook of obstetrics,8th edition,Jaypee brothers medical publishers
(p)ltd, Pgno :208-212