Overview
This lecture covers ectopic and molar pregnancies, focusing on their clinical features, risks, treatments, and key points frequently tested on the NCLEX.
Ectopic Pregnancy
- Occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tube.
- Risk factors include tubal surgery, sexually transmitted infections (chlamydia, gonorrhea), and use of intrauterine devices.
- Classic symptom triad: missed period, vaginal spotting, and unilateral lower abdominal pain.
- Diagnosed via vaginal ultrasound showing no intrauterine pregnancy.
- Unruptured cases are treated with methotrexate; folic acid must be avoided during therapy.
- Monitor beta hCG levels until they become undetectable to confirm successful treatment.
- Avoid opioids for pain management; use acetaminophen to prevent masking signs of rupture.
- Signs of rupture: sudden sharp abdominal pain, referred shoulder pain, Cullen’s sign (bluish-reddish abdomen), hypotension, and tachycardia.
- Ruptured cases require emergency surgery, blood type/Rh testing, IV fluids, and possibly blood products.
- Pregnancy is possible with one tube; avoid pregnancy until beta hCG is zero.
- Rh-negative clients need Rho(D) immunoglobulin to prevent future complications.
Molar Pregnancy
- Caused by abnormal growth of placental tissue (trophoblastic tissue), resulting in a nonviable pregnancy.
- Symptoms: dark brown "prune juice" bleeding, passage of grape-like vesicles, excessive nausea, large-for-dates fundal height, and preeclampsia before 24 weeks.
- Very high beta hCG levels lead to pronounced pregnancy symptoms and hyperemesis gravidarum.
- Treated by uterine evacuation with vacuum aspiration and curettage.
- Uterine stimulants (e.g., oxytocin) are given after evacuation, not before.
- Monitor beta hCG levels for up to one year to detect possible gestational trophoblastic neoplasia (cancer).
- Rising or persistent beta hCG post-evacuation indicates possible malignancy; treat with methotrexate.
- Use oral contraceptives (not IUDs) to avoid pregnancy during monitoring.
Key Terms & Definitions
- Ectopic Pregnancy — Implantation of a fertilized egg outside the uterus, most commonly in the fallopian tube.
- Methotrexate — Medication used to treat unruptured ectopic pregnancy by stopping rapidly dividing cells.
- Beta hCG — Hormone detected in pregnancy; monitored to assess treatment success.
- Molar Pregnancy — Overgrowth of abnormal placental tissue without a viable fetus.
- Cullen’s Sign — Bluish discoloration of the abdomen due to internal bleeding.
- Hyperemesis Gravidarum — Severe nausea and vomiting in pregnancy.
- Gestational Trophoblastic Neoplasia — Malignancy arising from molar pregnancy tissue.
Action Items / Next Steps
- Review symptoms and management of ectopic and molar pregnancies.
- Memorize diagnostic triads and emergency interventions for both conditions.
- Study the significance of beta hCG monitoring after treatment.
- Know when to administer Rho(D) immunoglobulin and oral contraceptives.