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What is Ectopic pregnancy and Its Assessment:Nursing Case Study

Friday, 7 March 2014

Ectopic pregnancy
An ectopic pregnancy is the implantation of a fertilized ovum outside the uterine cavity. Most ectopic pregnancies occur in a fallopian tube; other sites include the cervix, ovary, or abdominal cavity. Ectopic pregnancies are the second most common cause of vaginal bleeding during pregnancy and are a significant cause of maternal death due to hemorrhage.

Pathophysiology
Ectopic pregnancies can result from any condition that prevents or retards the passage of a fertilized ovum through the fallopian tube to the uterus. Hormonal factors, tubal damage from previous pelvic or tubal surgery, damage from pelvic inflammatory disease (PID) or endosalpingitis, tubal atony, tubal spasms, and malformed fallopian tubes are risk factors. Such conditions as endometriosis, diverticula of the fallopian tube, and sexually transmitted diseases (STDs) can also cause an ovum to implant in a tube.
wikipedia.common: Ectopic Pregnancy showing embryo in fallopian tube

Possible complications
■ Hemorrhage
■ Shock
■ Peritonitis
■ Infertility

Assessment

Nutrition and metabolism
■ Nausea and vomiting

Cognition and perception
■ Unilateral or bilateral cramping pain in the pelvic area
■ Shoulder pain if acute rupture and abdominal hemorrhaging

Self-perception and self-concept
■ Sadness due to lost pregnancy
■ Anxiety
■ Helplessness

Sexuality and reproduction
■ Amenorrhea
■ Vaginal bleeding
■ Adnexal fullness

Physical examination

Integumentary
■ Diaphoresis
■ Pallor

Cardiovascular
■ Occasional tachycardia
■ Hypotension
■ Syncope

Gastrointestinal
■ Diarrhea
■ Possible nausea and vomiting
■ Cullen's sign

Neurologic
■ Vertigo

Reproductive
■ Amenorrhea or abnormal menses followed by spotting or cramping (bleeding may be mistaken for menses)
■ Scant, dark brown vaginal bleeding
■ Increased uterine size (nearly the same size as gestational age would warrant during first 3 months)
■ Unilateral or bilateral pelvic tenderness or pain, notably on movement of the cervix during pelvic examination ("chandelier effect")
■ Palpable mass on the fallopian tube or in the cul‑de‑sac on pelvic examination
■ Asymmetrical uterus in interstitial pregnancy
■ Pelvic distention or feeling of fullness
■ Sudden and acute abdominal or pelvic pain
■ Referred shoulder or neck pain
■ Rebound tenderness and guarding
■ Breast tenderness

Diagnostic studies

■ Serum human chorionic gonadotropin qualitative test is positive for pregnancy. The quantitative test shows the actual amount of hormone, which rises in a predictable pattern; low or falling levels may indicate ectopic pregnancy.
■ White blood cell (WBC) count may increase if infection is present.
■ Red blood cell (RBC) count decreases with bleeding or rupture.
■ Hemoglobin (Hb) level and hematocrit (HCT) decrease with bleeding or rupture.
■ Erythrocyte sedimentation rate (ESR) may increase with inflammation.
■ Ultrasonography (pelvic and transvaginal) may reveal extrauterine pregnancy or absence of intrauterine pregnancy.
■ Laparoscopy visualizes extrauterine pregnancy and an enlarged or ruptured fallopian tube.



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