Ectopic Pregnancy Nursing Care Management

Description

• Implantation of products of conception in a site other than the uterine cavity (e.g., fallopian tube, ovary, cervix, or peritoneal cavity.)

Etiology

• Ectopic pregnancy can result from conditions that hinder ovum passage through the fallopian tube and into the uterine cavity, such as:
  1. Salpingitis
  2. Diverticula
  3. Tumors
  4. Adhesions from previous surgery
  5. Transmission of the ovum from one ovary to the opposite fallopian tube.

Sites of ectopic pregnancy. Numbers indicate the order of prevalence.

Pathophysiology

• The uterus is the only organ capable of containing and sustaining a pregnancy. When the fertilized ovum implants in other locations the body is unable to maintain the pregnancy.

Assessment Findings

1. Associated findings

• Suspect ectopic pregnancy in a client whose history includes a missed menstrual period, spotting, or bleeding pelvic or shoulder pain, use of intrauterine device, pelvic infections, tubal surgery, or previous ectopic pregnancy.
• Be aware of grief and lost manifestations in the client and family.

2. Common clinical manifestations. (The client with ectopic pregnancy may report signs and symptoms of a normal pregnancy or may have no symptoms at all.)

• Dizziness and syncope (faintness)
• Sharp abdominal pain and referred shoulder pain
• Vaginal bleeding
• Adnexal mass and tenderness
• A ruptured fallopian tube can produce life –threatening complications, such as hemorrhage, shock, and peritonitis.

3. Laboratory and diagnostic study findings

• Blood samples for hemoglobin value, blood type, and group, and crossmatch.
• A pregnancy test reveals elevated serum quantitative beta hCG.
• Ultrasound will confirm extrauterine pregnancy.

Nursing Management

1. Ensure that appropriate physical needs are addressed and monitor for complications. Assess vital signs, bleeding, and pain.

2. Provide client and family teaching to relieve anxiety.

• Explain the condition and expected outcome.
  • Maternal prognosis is good with early diagnosis and prompt treatment, such as laparotomy, to ligate bleeding vessels and repair or remove the damaged fallopian tube.
  • Pharmacologic agents, such as methotrexate followed by leucovorin, may be given orally when ectopic pregnancy is diagnosed by routine sonogram before the tube has ruptured. A hysterosalpingogram usually follows this therapy to confirm tubal patency.
  • Rh-negative women must receive RhoGAM to provide protection from isoimmunization for future pregnancies
• b. Describe self-care measures, which depend on the treatment.

3. Address emotional and psychosocial needs.

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