IMPLANTATION BLEEDING & ECTOPIC PREGNANCY

Question 1

Refers to light bleeding (spotting) that occurs when a fertilized egg (zygote) attaches to the lining of the uterus (implantation)

Answer 1

Implantation Bleeding

Question 2

When does implantation bleeding usually happen?

Answer 2

6-12 days after ovulation and fertilization

Often before the expected menstrual period.

Question 3

Color of Implantation Bleeding

Answer 3

Light pink to brown

Question 4

What is the flow of implantation bleeding?

Answer 4

Very light, often just spotting or a small amount of dischareg with no blood clots.

Question 5

How long does implantation bleeding usually last?

Answer 5

Lasts a few hours to 1-2 days (shorter than a period)

Question 6

When to take a pregnancy test if implantation bleeding is suspected?

Answer 6

Wait3-5 days after it stops

Why? For accurate results

Question 7

Symptoms of Implantation Bleeding

Answer 7

• Mild cramping (less intense than period cramps)
• May be accompanied by early pregnancy symptoms

Question 8

When to seek medical attention when experiencing implantation bleeding?

Answer 8

• A heavy bleeding or bright red flow may indicate an early miscarriage or other issues
• Severe pain, dizziness, or passing large clots - evaluated by HC provider

Question 9

Is the 2nd most common cause of bleeding during the 1st trimester.

Answer 9

Ectopic Pregnancy

Question 10

This refers to a pregnancy in which implantation occurs outside the uterine cavity.

Answer 10

Ectopic pregnancy

Question 11

Why is ectopic pregnancy life-threatening?

Answer 11

Can cause bleeding & hypovolemic shock.

Question 12

This happens when the fertilized egg is unable to travel down the fallopian tube to implant in the uterus

Answer 12

Tubal Pregnancy

Question 13

Risk Factors of Ectopic Pregnancy

Answer 13

• Pelvic Inflammatory Disease
• Smoking
• Advanced Age >35 yrs old
• History of Ectopic Pregnancy
• Previous Pelvic Surgeries
• Tubal myomas/fibroids

Question 14

Is an infection of the upper/internal female reproductive organs (ovaries, salpinges/FT, uterus)

Answer 14

Pelvic Inflammatory Disease

Question 15

Why is smoking a risk factor of ectopic pregnancy?

Answer 15

Vasoconstriction decreases blood flow to the FT impairs ciliary function & affect movement of the egg & sperm stuck in the tube.

Question 16

Sites of ectopic pregnancy

Answer 16

1) **Fallopian tube ** -most common (90%)
2) Ovary - (1-3%)
3) Abdominal cavity or intestine - (1-2%)
4) Cervix (1% - very rare)

Question 17

Signs and symptoms of Ectopic pregnancy

Answer 17

1) Missed period
2) Positive hCG results
3) Nausea & vomiting (morning sickness)
4) Severe, sharp, stabbing pain
5) Scanty or heavy vaginal bleeding
6) Signs of shock : (lightheadedness, rapid pulse & resp, falling BP, pallor)
7) **Leukocytosis ** is present due to trauma
8) Ultrasound scan reveals ruptured fallopian tube & blood in the peritoneum.
9) On vaginal exam, a tendar mass is palpable in the cul-de-sac of Douglas (pouch between the uterus and the rectum)

Question 18

Why is the cul-de-sac of Douglas often used in OB-GYN as a reference point?

Answer 18

Since this is where fluids such as pus or blood may collect in cases of infection or after a woman experiences trauma to surrounding structures.

Question 19

How to diagnose ectopic pregnancy?

Answer 19

1) Transvaginal ultrasound
2) Serial hCG levels
3) Progesterone levels

Question 20

In a transvaginal ultrasound, there is suspected ectopic pregnancy if?

Answer 20

• no gestational sac in the uterus
• adnexal mass in the FT
• fluid in the cul-de-sac of Douglas

Question 21

What to look for in Serial hCG levels and progesterone that would indicate that pregnancy is ectopic?

Answer 21

If hCG rises abnormally slow and progesterone levels are low indicating a non-viable pregnancy

Question 22

Management/Treatment for Early-Stage Ectopic Pregnancy

Answer 22

1) Methotrexate
2) Mifepristone
3) Misoprostol

Question 23

An oral drug that is a folic acid antagonist, chemotherapy drug (inhibits DNA synthesis & cell division) cells die & stops embryo from developing. Most common drug used to treat ectopic pregnancy.

Answer 23

Methotrexate

Question 24

Treatment qualification when managing ectopic pregnancy using Methotrexate.

Answer 24

Ectopic mass must be very small

If embryo is already big, heartbeat may be gone but will cause obstruction in the tube; unruptured ectopic pregnancy

Question 25

A **prostaglandin derivative** that induces uterine contractions to help expel the embryo. Maybe used in combination with methotrexate & mifepristone in some cases.

Answer 25

Misoprostol

Question 25

A **progesterone antagonist** that sheds off the uterine lining.

Answer 25

Mifepristone

Question 26

Surgical Treatment for Ectopic Pregnancy

Answer 26

1) Salpingectomy 2) Salpingostomy 3) Laparoscopic 4) Laparotomy

Question 27

This surgery involves removal of the affected fallopian tube. - For ruptured / large ectopics

Answer 27

Salpingectomy

Question 28

This surgery involves opening of the tube & removal of the ectopic mass while preserving the FT; scarring is possible

Answer 28

Salpingostomy

Question 29

Also called **keyhole surgery** - **gold standard** / preferred surgical management. - minimally invasive procedure that involves a thin, lighted camera (laparoscope) inserted thru small abdominal insertion

Answer 29

Laparoscropic

Question 30

Advantages of a laparoscopic surgery

Answer 30

1) Faster recovery - shorter hospital stay 2) Minimal scarring 3) Less post-op pain 4) Lower risk for infection

Question 31

An open surgery approach that opens the abdomen and remove the POC - used as an **alternative to laparoscopy**

Answer 31

Laparotomy

Question 32

Nursing Management for Ectopic Pregnancies

Answer 32

1) Monitor: vital signs, intensity of pain, bleeding, signs of shock 2) Pain management 3) Administer fluids & BT as ordered 4) Provide emotional supporty 5) Help educate patient on the importance of hCG level monitoring 6) Prepare the patient for emergency operation if needed. 7) Educate on future pregnancy risks & ask medical help regarding her future pregnancies - seek advice on contraceptive options

Question 33

A woman experiences light pink spotting 8 days after ovulation. She has mild cramping but no other symptoms. What is the most likely cause of this spotting? a) Menstrual period b) Ectopic pregnancy c) Implantation bleeding d) Pelvic inflammatory disease

Answer 33

C) Implantation bleeding

Question 33

How long does implantation bleeding typically last? a) 3-5 days b) 1-2 days c) 5-7 days d) More than a week

Answer 33

B) 1-2 days

Question 34

What color is implantation bleeding typically? a) Bright red b) Dark brown c) Light pink to brown d) Yellowish

Answer 34

C) Light pink to brown

Question 35

What is the most common location for an ectopic pregnancy? a) Uterus b) Fallopian tube c) Ovary d) Cervix

Answer 35

B) Fallopian tube

Question 36

Which of the following is a risk factor for ectopic pregnancy? a) Regular exercise b) Pelvic inflammatory disease (PID) c) High-fiber diet d) Low BMI

Answer 36

B) Pelvic inflammatory disease (PID)

Question 37

A 37-year-old woman with a history of smoking presents with severe abdominal pain and light vaginal bleeding. What condition should be suspected? a) Implantation bleeding b) Ectopic pregnancy c) Menstrual cramps d) Urinary tract infection

Answer 37

B) Ectopic pregnancy

Question 38

Which of the following is a sign of shock in a patient with a ruptured ectopic pregnancy? a) High blood pressure b) Slow pulse c) Rapid pulse and falling blood pressure d) Increased urine output

Answer 38

C) Rapid pulse and falling blood pressure

Question 39

What is Cullen’s sign in the context of ectopic pregnancy? a) A bluish tinge around the umbilicus b) A red rash on the abdomen c) Yellowing of the skin d) Swelling of the legs

Answer 39

A) A bluish tinge around the umbilicus

Question 40

What is the primary action of methotrexate in treating ectopic pregnancy? a) Induces uterine contractions b) Inhibits DNA synthesis and cell division c) Increases progesterone levels d) Prevents ovulation

Answer 40

B) Inhibits DNA synthesis and cell division

Question 41

Which drug is a progesterone antagonist used in ectopic pregnancy treatment? a) Methotrexate b) Mifepristone c) Misoprostol d) Oxytocin

Answer 41

b) Mifepristone

Question 42

What is the most common location for fluid collection in a ruptured ectopic pregnancy? a) Uterus b) Cul-de-sac of Douglas c) Ovary d) Cervix

Answer 42

b) Cul-de-sac of Douglas

Question 43

What is the most important nursing intervention for a patient with a ruptured ectopic pregnancy? a) Administering antibiotics b) Preparing for emergency surgery c) Encouraging fluid intake d) Providing a high-protein diet

Answer 43

b) Preparing for emergency surgery

Question 44

What is the role of ciliary function in the fallopian tubes? a) To produce hormones b) To move the egg and sperm c) To prevent infection d) To regulate blood flow

Answer 44

b) To move the egg and sperm