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Ectopic Pregnancy Lecture at 1nurses.Com

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http://1nurses.com Here's an ectopic pregnancy lecture at 1nurses.com. Grab more free nursing resource materials.

http://1nurses.com Here's an ectopic pregnancy lecture at 1nurses.com. Grab more free nursing resource materials.

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Ectopic Pregnancy Lecture at 1nurses.Com Ectopic Pregnancy Lecture at 1nurses.Com Presentation Transcript

  • Nursing Lecture Brought to you by: http://1nurses.com
    • Occurs when the site of implantation is outside of the womb.
    • It can occur in several places
        • Ovary
        • Abdomen
        • Cornua
        • Cervix
        • Fimbria
        • Fallopian tube
    • Pregnancy can even occur in both the womb and the tube at the same time (heterotopic pregnancy), but this is rare (about 1/10,000 pregnancies).
  •  
    • Any mechanism that interferes with the normal function of the fallopian tube during this process increases the risk of ectopic pregnancy.
    • The mechanism can be:
      • Anatomic – scarring that blocks transport of the egg
      • Functional – impaired tubal mobility
    • Pelvic Inflammatory Disease
      • the most common risk factor for ectopic pregnancy
      • 8x increased risk
      • infection causes scar tissue adhesions in the tube and may damage the cilia.
    • Previous ectopic pregnancy
      • the chances of another one in the same Fallopian tube and in the other tube are increased.
      • 5x increased risk
    • Tubal ligation in the past 2 years
    • Previous tubal surgery
    • Intrauterine device in place
    • Prolonged infertility
    • Diethystilbestrol (DES) exposure in utero
      • This is a drug that was once used during pregnancy
      • Female babies of women who used it were at risk of developmental abnormalities of the genital system.
      • Their tubes are more likely to be abnormal and predispose to ectopic pregnancy.
    • After the fertilization of the ovum, its transport to the uterine cavity is arrested.
    • The growing egg burrows through the tubal mucosa with subsequent implantation in the muscular layer.
    • Meantime, the proliferating trophoblast invade the muscularis and maternal blood vessels.
    • Blood accumulates into the spaces within the trophoblasts or between it.
    • The natural progression of tubal pregnancy is either of three ways:
      • Expulsion from the fimbriated ends (tubal abortion)
      • Involution of conceptus
      • Tubal rupture
    • Once an ectopic is diagnosed, there are several different treatments.
    • It is not possible to take the pregnancy from the tube and put it into the womb.
    • The options are as follows:
    • A proportion of all ectopics will not progress to tubal rupture, but will regress spontaneously and be slowly absorbed.
    • This may be appropriate if the level of hCG is falling and a woman is clinically well.
    • With a drug called methotrexate, which is given by injection.
    • This makes the ectopic pregnancy shrink away by stopping the cells dividing.
      • Methotrexate – a folic acid antagonist that is metabolized in the liver and excreted in the kidney
    • salpingiectomy
    • salpingotomy
    • salpingostomy
    • The most common symptoms and findings of ectopic pregnancy are:
      • an overdue period (suggesting pregnancy)
      • positive pregnancy test
      • lower abdominal pain
      • fainting
      • sharp pain in the abdomen or pelvis
      • signs of early pregnancy
      • vaginal bleeding
      • tender abdomen
      • dizziness or fainting and generally not feeling well
    • Any of the following additional symptoms can suggest an ectopic pregnancy:
      • vaginal spotting or bleeding
      • dizziness or fainting (caused by blood loss)
      • low blood pressure (caused by blood loss)
      • lower back pain
    • Amenorrhea
    • Abdominal pain
    • Abnormal vaginal bleeding
    • The diagnosis of an ectopic pregnancy can be difficult.
    • Your doctor may perform some tests to help confirm suspected ectopic pregnancy.
    • These tests include:
        • Pelvic exam
        • Blood tests
        • Ultrasound
      • Culdocentesis
          • determines if there is blood in the space behind the uterus
      • Laparoscopy
          • a telescope is inserted through a small incision in the woman’s abdomen
          • this allows the doctor to see the fallopian tubes and other organs
          • this takes place in an operating room with anesthesia
    • Failure to identify risk factors is cited as a common and significant reason for misdiagnosis
    • A proper history and physical examination remain the foundation for initiating an appropriate work-up that will result in the accurate and timely diagnosis of an ectopic pregnancy
    • Identification of risk factors can raise the index of suspicion and lend significance to otherwise minor physical findings
    • Monitor the mother’s vital signs, heart rate and rhythm, blood pressure, and effectiveness of breathing.
    • Monitor the fetal heart tones and assess fetal movement.
    • Monitor blood loss volume.
    • Monitor therapy closely for the patient’s therapeutic response
    • Monitor closely for the development of adverse reactions to therapy
    • Keep the patient, family, and caregivers well informed of the plan of care and the remaining time anticipated before disposition.
    • Monitor the patient’s laboratory and x-ray results and notify the physician of critical abnormalities.
    • Notify the physician when all diagnostic results are available for review.
    • Ask for establishment of a medical diagnosis and disposition.
  • Thank You!
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