Pathophysiology Of Ruptured Ectopic Pregnancy 23l5

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PATHOPHYSIOLOGY PREDISPOSING FACTORS

PRECIPITATING FACTORS Multiple sexual partner

Age (more than 35 years old)22 multiparity

ETIOLOGY unknown disruption/scarring of the tissue especially in the fallopian tube dysfunction of the cilia which normally propels the fertilized ovum through the tube onto the uterine cavity impaired tubal motility slows the movement of a fertilized egg through the fallopian tube to the uterus/ zygote cannot travel the length of the tube fertilized egg attaches or lodges to an area outside the uterus where it implants or grows (cornual (2-3%), isthmus (12%), ampullary (78%), infundibular (5%), ovarian (1%),, abdominal (1-2%), or cervical (0-5%) ) 2-8 weeks after missed menstrual period, the zygote grows large enough

use of IUD or Progestin-only contraceptives lifestyle (smoking) Past ectopic pregnancy Past infection in the fallopian clomid DES (diethylstilbestrol)

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tube becomes more and more distended

A

A

B

limited decidual reaction failing pregnancy

progesterone and HCG levels from the corpus luteum on the ovary

hemorrhage from the affected tube internal bleeding

external bleeding death of fetus

free blood tracking up the abdominal cavity

blood does not flow to the body properly

hematoperitoneum/ intraperitoneal bleeding

irritation of the diaphragm

shock

peritoneal reaction to blood escaping from the tube

irritation of the phrenic nerve generalized pain in the abdomen and radiates to the shoulder and neck

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lightheadedness nausea vomiting Cullen’s sign (superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus)

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cool, clammy skin sweating confusion bluish color of the fingernails and around the lips

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B

rupture the slender fallopian tube or the trophoblast cells actually break through the narrow base

tearing and destruction of the blood vessels in the tube

placental dislodgement, progesterone secretion stops, and uterine decidua sloughs off

product of conception from the ruptured tube and the accompanying blood expelled into the pelvic cavity rather than into the uterus

additional bleeding

blood does not reach the vagina scant vaginal spotting (dark red/ brown) hemorrhage

shock

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subnormal temperature tachycardia (rapid and thready) tachypnea hypotension

trauma

circulating blood

leukocytosis

perfusion in the brain

white blood cell count

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dizziness faintness