Ectopic Gestation (Pregnancy) Lecture Notes PDF

ECTOPIC GESTATION (PREGNANCY) LECTURE NOTES BY DR PAULINE ATSER (PhD, FWAPCNM) 2024  Ectopic Pregnancy - Definition An ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the normal uterine cavity. OR An ectopic pregnancy is a medical...

ECTOPIC GESTATION (PREGNANCY) LECTURE NOTES BY DR PAULINE ATSER (PhD, FWAPCNM) 2024  Ectopic Pregnancy - Definition An ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the normal uterine cavity. OR An ectopic pregnancy is a medical condition wherein the zygote fails to attach to the uterus and will either be on the fallopian tubes, the cervix, or any other part of the female reproductive system. Ectopic pregnancy contributes significantly to the cause of maternal mortality and morbidity.  SITES OF ECTOPIC PREGNANCY A. Extra-uterine i. Tubal – 97% (Ampulla-55%, isthmus 25% infundibulum 18%, interstitial 20%) ii. Ovarian 0.5% iii. Abdominal 1% (intra-peritoneal, common, Extra- peritoneal-broad ligament, rare) B. Uterine (Rare) i. Cervical ii. Angular iii. Cornua. SITES OF ECTOPIC PREGNANCY…  CAUSES OF ECTOPIC GESTATION 1. Factors delaying migration of fertilized ovum to the uterine eg pelvic inflammatory disease (PID). PID may lead to loss of cilia and impairment of peristalsis, narrowing of tube lumen and formation of adhessions. 2. Contraceptive Failure eg IUCD - may prevents intrauterine pregnancy Tubal ligation – 15 – 20 % chance of ectopic gestation exist if pregnancy occurs after tubal sterilization.3. Oral pills of progestion only has chance of tubal pregnancy due to impaired tubal mortility. 3. Oral pills of progestion only has chance of tubal pregnancy due to impaired tubal mortility. 4. Assisted reproductive therapy (ART) ovulation induction, IVF-ET fertilization embryo transfer procedure increases chance of ectopic pregnancy. 5. Previous ectopic gestation 6. Previous induced abortion. 7. Congenital/development defect of the tube 8. Tubal endometriosis 9. Scar tissue from pelvic surgery or pelvic inflammatory diseases. 10. Growth in fallopian tube (ii) Fallopian tube infection  RISK FACTORS Maternal age Smoking Severe induced abortion History of sexually transmitted infections Appendicitis Hormonal imbalance  SIGNS AND SYMPTOMS Abdominal pain Sharp pain in the pelvis shoulder, neck Amenorhoea Vaginal bleeding heavier or lighter than normal period Weakness, dizziness, fainting, pallor, fatigue Breast fullness Rectal pressure GIT symptoms-nausea and vomiting Shock in case of ruptured ectopic with hemorrhage  Diagnosis 1. History taking 2. Physical examination, Abdominal examination 3. Transvaginal ultra sound 4. Blood tests for pregnancy (HCG levels) and progestin levels)  Complications of ectopic pregnancy Hemorrhage Anaemia Recurrent ectopic pregnancy Hemorrhagic shock Infection Infertility Death  MANAGEMENT OF RUPTURED (ACUTE) ECTOPIC PREGNANCY The basic principle in the management of ruptured ectopic is resuscitation and surgery - laparotomy. (a) Resuscitation Anti- shock measures are taken urgently and simultaneously with urgent preparation for surgery eg Administration of IV ringers solution Grouping and crossmatching Blood transfusion  LAPAROTOMY Surgery (Laparotomy) is performed under general anesthesia by an obstetrician-gynecologist. The decision depends on a number of factors, including the condition of the tube, the size of the ectopic pregnancy, whether any bleeding is present, and surgeon comfort or preference. The surgery is performed using the following approaches: Salpingectomy: indicated when there is a ruptured or extensively damaged fallopian tube, large ectopic pregnancy, and/or uncontrolled bleeding. Pregnancy tissue is removed along with part or all of the fallopian tube. excised tube is sent to the laboratory for histological examination Salpingostomy: Pregnancy tissue is removed and the fallopian tube is repaired. Oophorectomy is done if ovary is badly damaged or pathological Subtotal hysterectomy is done in case of interstitial ectopic pregnancy.  Nursing Management Pre-operative- Identified nursing diagnoses may include: Deficient fluid volume related bleeding from rupture ectopic Risk for shock Acute pain related to ectopic pregnancy evidenced by verbalization of pain and faint mask. Deficient knowledge Anxiety related to threat of death. Grieving related to loss of feotus Risk for complicated grieving etc  PRE-OPERATIVE NURSING MANAGEMENT Admission Admit patient are prepare for emergency operation History Taking Obtain past and present history to confirm diagnosis Observations Vital signs BP, Temp, Pule and Reap 1/4hrmmy and record Observe for signs of dehydration, during vomiting and fluid loss Monitor/observe level of consciousness amount of bleeding Monitor intake and output chart (which helps to diagnose hemorrhage and need for IV therapy. Observe for abdominal distension Maintain aseptic techniques and standard precautions measures to prevent cross infection eg hand washing Observe, vaginal bleeding and type of pain Keep patient upright to enable proper gastric emptying and prevent aspiration of vomiting  Pre-operative nursing management… Physical examination Inspection for skin colour, palpitation eg for abd distension, percussion and auscultation to confirm diagnosis. Feeding/Rehydration Administer prescribed IV fluids and blood products to restore hydration Ensure nil per oral to keep stomach empty Pass NG tube, aspirate 1/2hrmmy to decompress the stomach and prevent vomiting Psychotherapy To relieve grief and anxiety Reassure the patient/relative Be available and provide emotional support listen to patients/relatives concerns and provide support  PRE-OPERATIVE NURSING MANAGEMENT Investigations-Ensure lab investigation done Consent form – signing of consent from should be done to provide legal backing to surgeon, anesthetists and protect patient from unauthorized procedure. Personal hygiene-eg bad bath, vulva toilet Shaving – shave patient from the nipple to pubic region Catheterization – catheterize the patient to empty bladder. Medication Give medication as prescribed by physician. Remove dentures before taking to theatre Accompany patient to the theatre with case note, laboratory results and x-ray Make up post-Op bed with resuscitation tray, vital signs tray and suction machine in place.  POST OPERATIVE NURSING MANAGEMENT Reception : receive patient in the post - Operative bed Position: keep patient in dorsal position with head tunnel to one side until she regains consciousness. Cleaning of airway Maintain patient airway Ensure adequate ventilation Wipe patient with tissue paper and or gauge if she vomits or pour secretions Suction when necessary.  POST OPERATIVE NURSING MANAGEMENT… Observations Vital signs – BP, Temperature, Pulse, Respiration 1/4hrhy then ½ hrly at least the first 4hrs and until stable. Observe for bowel sound or return of peristalsis Observe bladder for urinary retention Observe for bleeding or infection from Op site. observe catheter if insitu Elimination Ensure that patient voids after surgery, encourage fluid intake. Maintain intake and output chart  POST OPERATIVE NURSING MANAGEMENT… Medication – Administer prescribed analgesics, antibiotics, hematinics Exercises – encourage early ambulation deep breathing exercises Wound Care- maintain aseptic techniques, dryness and cleanliness of wound to aid healing. Remove stiches 7th day Feeding – NPO until bowel sound resumes. Continue IV fluid until oral or nutrition feed is recommended. Psychological care- Provide support to patient and relations. Personal hygiene- bed bath, vulva toilet, mouth care. Advise on discharge Patient to avoid strenuous exercises or activities, follow up appointment family planning,.  Further reading: https://nursestudy.net/ectopic-pregnancy-nursing-diagn osis/ https://nursing.com/lesson/nursing-care-plan-for-ectopic -pregnancy https://www.verywellfamily.com/treatment-of-ectopic- pregnancy-2371468