Ward Class

An Online Resource Site For Student Nurses

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Ward Class is an online resource for student nurses. Created with the aim of helping student nurses cope with the demands of nursing school and clinicals, it offers free downloads, notes, sample NCPs, sample drug studies, study aids, news and updates, and practical tips to its users.

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Complications of Pregnancy: Ectopic Pregnancy

possible sites of implantation in an ectopic pregnancy
  • any gestation occurring outside the uterine cavity (the fertilized egg implants somewhere else)
  • usually occurs in one of the fallopian tubes (called tubal pregnancy) as the fertilized egg gets stuck on its way to the uterus, but may occur in the abdomen, ovary, or cervix
  • an ectopic pregnancy does not proceed normally as the site cannot accommodate the growing tissue; in undetected tubal pregnancies, the fallopian tube ruptures usually before the 12th week of pregnancy
  • risk factors include a history of a previous ectopic pregnancy, PID, salpingitis, endometriosis, gonorrhea, chlamydia, and structural fallopian tube defects (misshapen, scarred tubes); also includes use of medications that stimulate ovulation, use of birth control methods such as pills, IUD, and tubal ligation
Assessment Findings
  • vaginal bleeding-->may lead to shock if severe
  • lower abdominal pain, may be one-sided
  • abdominal cramping, localized to one side if the pelvis
  • signs of fallopian tube rupture: sharp, stabbing pelvic pain which may radiate to the abdomen and neck, dizziness, lightheadedness
  • low hemoglobin and hematocrit
  • rising WBC
  • low HCG titers than is expected in normal pregnancies
Medical Management
  • administration of methotrexate--> to stop cell growth and dissolve existing cells
Surgical Management
  • laparoscopic surgery--> performed if the patient does not respond to methotrexate and the fallopian tube has not ruptured; the ectopic tissue is removed and the fallopian tube is repaired
  • laparotomy--> for ectopic pregnancies causing heavy bleeding and/or ruptured ectopic pregnancies; typical includes removal of the ruptured fallopian tube
Nursing Management
  1. provide care for the preoperative or postoperative client
  2. monitor for shock, if bleeding is severe
  3. provide psychological support for grieving client-->also allow client to express concerns regarding future pregnancies
Prognosis

Treatment for ectopic pregnancy may lead to infertility or removal of reproductive organs. Even with treatment, there is a 10% chance for the condition to recur in future pregnancies. If left untreated, an ectopic pregnancy may lead to life-threatening bleeding but with early detection and treatment, maternal mortality is reduced to 0.05%.

Prevention

An ectopic pregnancy cannot be prevented but risk factors may be reduced by limiting the number of sexual partners and by having protected sexual encounters to prevent STDs and pelvic inflammatory diseases.

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