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Ectopic Pregnancy Lecture at 1nurses.Com

Ectopic Pregnancy Lecture at 1nurses.Com



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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