MIDWIFERY MANAGEMENT GUIDELINE FOR ANTEPARTUM ECTOPIC PREGNANCY

A. Definition

An ectopic pregnancy is a pregnancy that occurs outside the womb (uterus).

B. Predisposing Factors

Birth defect in the fallopian tubes, Scarring after a ruptured appendix, Endometriosis, Having had a
previous ectopic pregnancy, Scarring from past infections or surgery of the female organs, Age over 35,
Getting pregnant while having an intrauterine device (IUD), tubal ligation, untie tubes, Many sexual
partners, Some infertility treatments, Polycystic Ovarian Syndrome

C. Diagnostic Criteria

Subjective Symptoms

Abnormal vaginal bleeding, Low back pain, Mild cramping on one side of the pelvis, No periods, Pain in
the lower belly or pelvic area, Fainting or feeling faint, Intense pressure in the rectum, Pain in the
shoulder area, Severe, sharp, and sudden pain in the lower abdomen, Displaced Uterus, Painful vaginal
exam, Cul-de-sac full of blood, posterior vagunal forniix bulge, Tender boggy mass on one side of the
uterus, Fetal parts feel like they are just under the skin, Gastrointestinal symptoms

Objective Signs

Low blood pressure, Bleeding, Shock, Fever, Tachycardia, Adnexal enlargement, Low or slow to rise
beta-hCG, Inability to outline the uterus

Differential

Appendicitis, Salpingitis, Ruptured corpus luteum cyst or ovarian follicle, Spontaneous abortion or
threatened abortion, Ovarian torsion, Urinary tract disease, Intrauterine pregnancies with other
abdominal or pelvic problems, Postabortion bleeding, Retained products of abortion, Molar pregnancy,
Cornual myoma or abscess, Ovarian tumor, Endometrioma, Cervical phase of uterine abortion, Abortion
Complications, Cervical Cancer, Dysmenorrhea, Early Pregnancy Loss, Hemorrhagic Shock, Hypovolemic
Shock, Placenta Previa

D. Assessment

Antepartum Ectopic Pregnancy

E. Plan

Midwife might:

Do a pelvic exam (The exam may show tenderness in the pelvic area)

Order pregnancy test,

vaginal ultrasound

quantitative HCG blood test

Risk client out of care

F. Client teaching/ education

http://www.reproductivefacts.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_S
heets_and_Info_Booklets/EctopicPregnancy.pdf

http://familydoctor.org/familydoctor/en/diseases-conditions/ectopic-pregnancy.printerview.all.html

G. Documentation

Midwife may document all signs and symptoms, lab results and patient education

provided.

H. Follow-up (What to do when symptoms pass)

Counseling for miscarriage and possibly salpingectomy

Ectopic pregnancy is life-threatening. The pregnancy cannot continue to birth (term). The developing
cells must be removed.

Treatment may include:

Surgery, Methotrexate to end the pregnancy, Possible removal of the fallopian tube, Blood transfusion,
Fluids given through I.V., Keeping warm, Oxygen, Raising the legs

I. Resources (APA citation format, 2-5 references w/ 1-2 internet)

Ogilvie, I. (2016, April 5). Ectopic Pregnancy (E. Burd & D. Zieve, Eds.). Retrieved October 11, 2016, from
https://medlineplus.gov/ency/article/000895.htm

Wang, J., Wei, Y., Diao, F., Cui, Y., Mao, Y., Wong, W., & Liu, J. (2013). The association between polycystic
ovary syndrome and ectopic pregnancy after in vitro fertilization and embryo transfer. Retrieved
October 11, 2016, from http://www.ajog.org/article/S0002-9378(13)00479-1/abstract
By Donna M. Peretin, RN. (A) Ampullary, 80%; (B) Isthmic, 12%; (C) Fimbrial, 5%; (D) Cornual/Interstitial,
2%; (E) Abdominal, 1.4%; (F) Ovarian, 0.2%; and (G) Cervical, 0.2%. (2016, July 5). Ectopic Pregnancy.
Retrieved October 11, 2016, from http://emedicine.medscape.com/article/2041923-overview

King, Tekoa / Kriebs, Jan M. / Brucker, Mary / Fahey, Jenifer / Gegor, Carolyn L. (n.d.). Varney's
Midwifery (5th ed.). Jones & Bartlett Learning.

Frye, A. (2006). Holistic Midwifery. a comprehensive textbook for midwives in homebirth practice (Vol. 1
Care During Pregnancy). Portland, OR: Labrys Press.