Ectopic Pregnancy Lecture at 1nurses.Com


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Ectopic Pregnancy Lecture at 1nurses.Com

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