Ectopic Pregnancy

DEFINITION: An ectopic pregnancy is one in which the fetus is implanted outside the uterine cavity. TUBAL PREGNANCY: Tubal pregnancy develops when the transport of the fertilised ovum into the uterine cavity is interfered with.Implantation can occur at any point along the tube,although the ampulla is the common site. CAUSE OF TUBAL PREGNANCY Congenital abnormalities of the tube such as hypoplacia,and tubal diverticula. Previous infection such as post-abortal sepsis, puerperal sepsis and tuberculosis. OUTCOMES OF TUBAL PREGNANCY  Tubal abortion  Tubal mole  Tubal rupture  Abdominal pregnancy CLINICAL PRESENTATION  Ammenorrhoea  Pelvic pain  Acute lower abdominal pain  Dizziness,  Nausea, and vomiting  Shoulder pain,  Bleeding into the perineal cavity,  Severe pallor,faintness  Rapid and thread pulse ,tachypnea and low blood pressure.  Abdominal examination will show lower abdominal tenderness, rebound tenderness, guarding and shifting dullness due to ha emoperitoneum.

DIAGNOSIS  Missed period and or a positive pregnancy test.  Abdominal pain which occurs on one side only and is situated low, down in the abdomen.  Vaginal bleeding which starts after a bout of lower abdominal pain.  Those with an IUD (Coil) in place are taking the progestogen only pill or PID.



An ultrasound showing a gestational sac with fetal heart in the fallopian tube is clear evidence of ectopic pregnancy.

TREATMENT FOR ECTOPIC PREGNANCY:

Ectopic pregnancy may be treated in several ways depending on whether the fallopian tube has ruptured or not, the development level of the pregnancy, and the mother's hormone levels. Treatments may include: • medications - such as methotrexate can be used for some very early ectopic pregnancies in mothers who are asymptomatic. surgery (possibly including laparoscopy with salpingostomy or salpingectomy) - a surgical procedure to make a small opening in the fallopian tube and remove the pregnancy. If the tube is damaged, total or partial salpingectomy may be necessary - the removal of all or a part of the fallopian tube. In rare cases, a laparotomy may be necessary. This is a surgical procedure in which an incision is made in the mother's abdomen to remove the ectopic pregnancy or damaged fallopian tube. •

NURSING PROCESS ASSESSMENT Sharp localised pain in lower abdomen Syncope and referred shoulder pain Irregular vaginal bleeding Abdominal rigidity and distention Shock-decreased blood pressure increased heart rate. Disorientation and lack of cooperation due to severe pain. NURSING DIAGNOSIS Risk for foetal injury Risk for infection Ineffective airway clearance Actual /risk for aspiration Anxiety IMPLEMENTATION Provide pain relief Manage shock  Administer oxygen intravenous fluids  Type and cross-match blood.

Prepare for surgery, laparotomy with removal of the ectopic pregnancy, and perhaps the affected fallopian tube. Provide post operative • Give routine post operative care • Assess vaginal bleeding • Offer emotional support

SUBMITTED TO: MS SUBHASHINI G. HOD OBG NURSING P.I.O.N

SUBMITTED BY: MS DIMSEY.R.MARAK MSC NURSING 1ST YEAR P.I.ON