hesi case study ectopic pregnancy

Ectopic Pregnancy Case Study (30 min)

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A 31-year-old female presents to the emergency room with sudden pain radiating from her mid abdomen to her right shoulder. The patient reports that she is also experiencing light vaginal bleeding. Upon questioning the nurse finds out the patient has an IUD and that she missed her last period. The patient is currently sexually active with multiple partners as well.

What is the first test the nurse should do on this patient?

What should the nurse be concerned about at this time.

• Ectopic pregnancy – the right shoulder pain is the main clue that this is more than just a UTI or pregnancy pains

The nurse starts an IV and draws blood work. The doctor orders morphine 2 mg IV q4h PRN moderate to severe pain, and an abdominal ultrasound. The nurse administers the morphine per orders and prepares the patient for an ultrasound by giving a prescribed IV fluid bolus of 1 L Normal Saline for bladder filling.  The UAP assists the patient to provide a urine sample, which is used for a point-of-care HCG urine pregnancy test – which comes back positive. The UAP and patient report to the RN that there was more bleeding when she went to the bathroom and the patient iis complaining of some upper shoulder pain now.

• Ectopic pregnancy- the right shoulder pain is the main clue that this is more than just a UTI or pregnancy pains.
• Referred pain to the right shoulder almost always indicates some sort of internal bleeding. This is concerning there has been a rupture of the fallopian tube from the ectopic pregnancy.

The nurse notifies the doctor who orders an abdominal ultrasound, which shows a tubal rupture. The patient is rushed to surgery. When the patient returns from surgery, the nurse assesses the patient. Vital signs are stable at this time, the patient is alert and oriented to person, place, time and situation (a little groggy) and the nurse notes no signs or symptoms of distress. While the patient was off the unit,  the complete blood count comes back and the hemoglobin is 6.2. The type and screen also result and shows the patient is blood type O and rH factor negative

Why would the patient have a low hemoglobin with only light vaginal bleeding?

• The patient has a low hemoglobin because she had internal bleeding. The blood loss was from the ruptured fallopian tube internally so this bleeding was not noted externally.

What else should the nurse ensure is administered to this patient?

• Rhogam- this patient has an Rh (-) and rhogam should be given anytime a mother is Rh (-) and the baby is Rh (+) or unknow
• This should be given within 72 hours of delivery or when there is a chance of blood mixture

Debrief: A ruptured ectopic pregnancy would cause internal bleeding, as opposed to external (vaginal) bleeding. The patient bleeds into the abdominal cavity as opposed to out through the uterus and vaginal canal. Ectopic pregnancies will start the same as a normal pregnancy with a missed period and then at around 6 weeks, there is spotting and abdominal pain because the cells have grown within the tube and are getting bigger but the tube does not stretch to accommodate this growth. This causes pain and relief in pain in addition to radiating pain to the shoulders signifies internal bleeding from a tubal rupture. The overall goal is to find the ectopic pregnancy and remove it to save the fallopian tube, but this doesn’t always happen.

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• Published: 07 August 2009

Primary abdominal ectopic pregnancy: a case report

• Recep Yildizhan 1 ,
• Ali Kolusari 1 ,
• Fulya Adali 2 ,
• Ertan Adali 1 ,
• Mertihan Kurdoglu 1 ,
• Cagdas Ozgokce 1 &
• Numan Cim 1  

Cases Journal volume  2 , Article number:  8485 ( 2009 ) Cite this article

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Introduction

We present a case of a 13-week abdominal pregnancy evaluated with ultrasound and magnetic resonance imaging.

Case presentation

A 34-year-old woman, (gravida 2, para 1) suffering from lower abdominal pain and slight vaginal bleeding was transferred to our hospital. A transabdominal ultrasound and magnetic resonance imaging were performed. The diagnosis of primary abdominal pregnancy was confirmed according to Studdiford's criteria. A laparatomy was carried out. The placenta was attached to the mesentery of sigmoid colon and to the left abdominal sidewall. The placenta was dissected away completely and safely. No postoperative complications were observed.

Ultrasound examination is the usual diagnostic procedure of choice. In addition magnetic resonance imaging can be useful to show the localization of the placenta preoperatively.

Abdominal pregnancy, with a diagnosis of one per 10000 births, is an extremely rare and serious form of extrauterine gestation [ 1 ]. Abdominal pregnancies account for almost 1% of ectopic pregnancies [ 2 ]. It has reported incidence of one in 2200 to one in 10,200 of all pregnancies [ 3 ]. The gestational sac is implanted outside the uterus, ovaries, and fallopian tubes. The maternal mortality rate can be as high as 20% [ 3 ]. This is primarily because of the risk of massive hemorrhage from partial or total placental separation. The placenta can be attached to the uterine wall, bowel, mesentery, liver, spleen, bladder and ligaments. It can be detach at any time during pregnancy leading to torrential blood loss [ 4 ]. Accurate localization of the placenta pre-operatively could minimize blood loss during surgery by avoiding incision into the placenta [ 5 ]. It is thought that abdominal pregnancy is more common in developing countries, probably because of the high frequency of pelvic inflammatory disease in these areas [ 6 ]. Abdominal pregnancy is classified as primary or secondary. The diagnosis of primary abdominal pregnancy was confirmed according to Studdiford's criteria [ 7 ]. In these criteria, the diagnosis of primary abdominal pregnancy is based on the following anatomic conditions: 1) normal tubes and ovaries, 2) absence of an uteroplacental fistula, and 3) attachment exclusively to a peritoneal surface early enough in gestation to eliminate the likelihood of secondary implantation. The placenta sits on the intra-abdominal organs generally the bowel or mesentery, or the peritoneum, and has sufficient blood supply. Sonography is considered the front-line diagnostic imaging method, with magnetic resonance imaging (MRI) serving as an adjunct in cases when sonography is equivocal and in cases when the delineation of anatomic relationships may alter the surgical approach [ 8 ]. We report the management of a primary abdominal pregnancy at 13 weeks.

The patient was a 34-year-old Turkish woman, gravida 2 para 1 with a normal vaginal delivery 15 years previously. Although she had not used any contraceptive method afterwards, she had not become pregnant. She was transferred to our hospital from her local clinic at the gestation stage of 13 weeks because of pain in the lower abdomen and slight vaginal bleeding. She did not know when her last menstrual period had been, due to irregular periods. At admission, she presented with a history of abdominal distention together with steadily increasing abdominal and back pain, weakness, lack of appetite, and restlessness with minimal vaginal bleeding. She denied a history of pelvic inflammatory disease, sexually transmitted disease, surgical operations, or allergies. Blood pressure and pulse rate were normal. Laboratory parameters were normal, with a hemoglobin concentration of 10.0 g/dl and hematocrit of 29.1%. Transvaginal ultrasonographic scanning revealed an empty uterus with an endometrium 15 mm thick. A transabdominal ultrasound (Figure 1 ) examination demonstrated an amount of free peritoneal fluid and the nonviable fetus at 13 weeks without a sac; the placenta measured 58 × 65 × 67 mm. Abdominal-Pelvic MRI (Philips Intera 1.5T, Philips Medical Systems, Andover, MA) in coronal, axial, and sagittal planes was performed especially for localization of the placenta before she underwent surgery. A non-contrast SPAIR sagittal T2-weighted MRI strongly suggested placental invasion of the sigmoid colon (Figure 2 ).

Pelvic ultrasound scanning . Diffuse free intraperitoneal fluid was seen around the fetus and small bowel loops.

T2W SPAIR sagittal MRI of lower abdomen demonstrating the placental invasion . Placenta (a) , invasion area (b) , sigmoid colon (c) , uterine cavity (d) .

Under general anesthesia, a median laparotomy was performed and a moderate amount of intra-abdominal serohemorrhagic fluid was evident. The placenta was attached tightly to the mesentery of sigmoid colon and was loosely adhered to the left abdominal sidewall (Figure 3 ). The fetus was localized at the right of the abdomen and was related to the placenta by a chord. The placenta was dissected away completely and safely from the mesentery of sigmoid colon and the left abdominal sidewall. Left salpingectomy for unilateral hydrosalpinx was conducted. Both ovaries were conserved. After closure of the abdominal wall, dilatation and curettage were also performed but no trophoblastic tissue was found in the uterine cavity. As a management protocol in our department, we perform uterine curettage in all patients with ectopic pregnancy gently at the end of the operation, not only for the differential diagnosis of ectopic pregnancy, but also to help in reducing present or possible postoperative vaginal bleeding.

Fetus, placenta and bowels .

The patient was awakened, extubated, and sent to the room. The patient was discharged on post-operative day five with the standard of care at our hospital.

In the present case, we were able to demonstrate primary abdominal pregnancy according to Studdiford's criteria with the use of transvaginal and transabdominal ultrasound examination and MRI. In our case, both fallopian tubes and ovaries were intact. With regard to the second criterion, we did not observe any uteroplacental fistulae in our case. Since abdominal pregnancy at less than 20 weeks of gestation is considered early [ 9 ], our case can be regarded as early, and so we dismissed the possibility of secondary implantation.

The recent use of progesterone-only pills and intrauterine devices with a history of surgery, pelvic inflammatory disease, sexually transmitted disease, and allergy increases the risk of ectopic pregnancy. Our patient had not been using any contraception, and did not report a history of the other risk factors.

The clinical presentation of an abdominal pregnancy can differ from that of a tubal pregnancy. Although there may be great variability in symptoms, severe lower abdominal pain is one of the most consistent findings [ 10 ]. In a study of 12 patients reported by Hallatt and Grove [ 11 ], vaginal bleeding occurred in six patients.

Ultrasound examination is the usual diagnostic procedure of choice, but the findings are sometimes questionable. They are dependent on the examiner's experience and the quality of the ultrasound. Transvaginal ultrasound is superior to transabdominal ultrasound in the evaluation of ectopic pregnancy since it allows a better view of the adnexa and uterine cavity. MRI provided additional information for patients who needed precise diagnosing. After the diagnosis of abdominal pregnancy became definitive, it was essential to determine the localization of the placenta. Meanwhile, MRI may help in surgical planning by evaluating the extent of mesenteric and uterine involvement [ 12 ]. Non-contrast MRI using T 2 -weighted imaging is a sensitive, specific, and accurate method for evaluating ectopic pregnancy [ 13 ], and we used it in our case.

Removal of the placental tissue is less difficult in early pregnancy as it is likely to be smaller and less vascular. Laparoscopic removal of more advanced abdominal ectopic pregnancies, where the placenta is larger and more invasive, is different [ 14 ]. Laparoscopic treatment must be considered for early abdominal pregnancy [ 15 ].

Complete removal of the placenta should be done only when the blood supply can be identified and careful ligation performed [ 11 ]. If the placenta is not removed completely, it has been estimated that the remnant can remain functional for approximately 50 days after the operation, and total regression of placental function is usually complete within 4 months [ 16 ].

In conclusion, ultrasound scanning plus MRI can be useful to demonstrate the anatomic relationship between the placenta and invasion area in order to be prepared preoperatively for the possible massive blood loss.

Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-chief of this journal.

Abbreviations

Magnetic Resonance Imaging

Spectral Presaturation Attenuated by Inversion Recovery.

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Department of Obstetrics and Gynecology, School of Medicine, Yuzuncu Yil University, Van, Turkey

Recep Yildizhan, Ali Kolusari, Ertan Adali, Mertihan Kurdoglu, Cagdas Ozgokce & Numan Cim

Department of Radiology, Women and Child Hospital, Van, Turkey

Fulya Adali

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All authors were involved in patient's care. RY, AK and FA analyzed and interpreted the patient data regarding the clinical and radiological findings of the patient and prepared the manuscript. EA, MK and CO edit and coordinated the manuscript. All authors read and approved the final manuscript.

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Yildizhan, R., Kolusari, A., Adali, F. et al. Primary abdominal ectopic pregnancy: a case report. Cases Journal 2 , 8485 (2009). https://doi.org/10.4076/1757-1626-2-8485

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Received : 12 January 2009

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Published : 07 August 2009

DOI : https://doi.org/10.4076/1757-1626-2-8485

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A Live 13 Weeks Ruptured Ectopic Pregnancy: A Case Report

1 Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU

Reham Abdulgader

2 Obstetrics and Gynecology, King Abdulaziz University Hospital, Jeddah, SAU

Ossamah Abdulqader

Ectopic pregnancy is a pregnancy that occurs outside the uterus, most commonly in the fallopian tube. It is usually suspected if a pregnant woman experiences any of these symptoms during the first trimester: vaginal bleeding, lower abdominal pain, and amenorrhea. An elevated BhCG level above the discriminatory zone (2000 mIU/ml) with an empty uterus on a transvaginal ultrasound is essential for confirming ectopic pregnancy diagnosis. Such pregnancy can be managed medically with methotrexate or surgically via laparoscopy or laparotomy depending on the hemodynamic stability of the patient and the size of the ectopic mass. In this case study, we report on a 38-year-old woman, G3P2+0 who presented to King Abdulaziz University Hospital’s emergency department with a history of amenorrhea for three months. She was unsure of her last menstrual period and her main complaint was generalized abdominal pain. Upon examination, she was clinically unstable and her abdomen was tender on palpation and diffusely distended. Her BhCG level measured 113000 IU/ml and a bedside pelvic ultrasound showed an empty uterine cavity, as well as a live 13 weeks fetus (measured by CRL). The fetus was seen floating in the abdominal cavity and surrounded by a moderate amount of free fluid, suggestive of ruptured tubal ectopic pregnancy. The patient’s final diagnosis was live ruptured 13 weeks tubal ectopic pregnancy which was managed successfully through an emergency laparotomy with a salpingectomy.

Introduction

Ectopic pregnancy is a pregnancy in which the developing blastocyst implants outside the endometrial cavity [ 1 ]. Extrauterine pregnancy is estimated to account for 1.3% to 2.4% of all pregnancies [ 2 ]. 90% of ectopic pregnancies occur in the fallopian tubes, and the remaining implant on the cervix, the ovary, the myometrium, and other sites [ 3 ]. Ectopic pregnancy may present as abdominal or pelvic pain, amenorrhea with or without vaginal bleeding in the first trimester. The minimum diagnostic requirement for an ectopic pregnancy is a transvaginal ultrasound and serological confirmation of pregnancy [ 4 ]. This article involves an unusual case of a live ruptured 13 weeks ectopic pregnancy which was seen, diagnosed, and managed at King Abdulaziz University Hospital in Jeddah, Saudi Arabia.

Case presentation

A 38-year-old Filipino patient, G3P2+0 presented to the emergency department on the 18th of October 2019 complaining of acute onset of lower abdominal pain associated with a history of amenorrhea for three months. She was unsure of the date of her last menstrual period and had no previous antenatal follow-up. She was medically free and her past obstetric history included a normal uncomplicated vaginal delivery, followed by a cesarean section which was performed four years back. She had no allergies and was not taking any medication or contraception. Upon presentation, she complained of generalized lower abdominal pain which was of a sudden onset, continuous, not radiating, and not relieved by oral analgesia. The pain was associated with nausea and symptoms of anemia such as dizziness and shortness of breath, but there was no history of loss of consciousness, gastrointestinal or urinary tract symptoms. There was no history of fever or symptoms suggestive of pelvic inflammatory disease. 

Upon clinical examination, the patient looked pale and distressed. Her blood pressure was 90/42 mmHg, with a pulse rate of 110 beats per minute. Her abdomen was generally distended and tender on both superficial and deep palpation, with signs suggestive of peritonitis. The digital vaginal examination was positive for cervical motion tenderness and her BhCG Level measured 113000 IU/ml. The examination was complemented by a bedside pelvic ultrasound, which showed an empty uterine cavity as well as a live fetus floating in a moderate amount of free fluid in the pouch of Douglas (Figure ​ (Figure1). 1 ). Her hemoglobin count measured 3.2 g/L, and her total white cell count was 7.5 g/L. Blood grouping and cross-matching of four blood units were immediately sent. 

Arrows indicate: (a) uterus; (b) endometrial line; (c) fetus.

The possibility of a ruptured ectopic pregnancy was explained to the patient, and she consented to an emergency laparotomy with possible salpingectomy. During the laparotomy, a total of 4 liters of intra-abdominal blood was suctioned while blood transfusion was ongoing. A live 13-week fetus was found and removed from the pelvic cavity, and the remains of the ectopic pregnancy (gestational sac and placenta) were found along a ruptured right fallopian tube. The right tube was successfully resected, and the specimen was sent to histopathology. Both the right and left ovaries looked normal. Peritoneal lavage was completed, and a large pelvic drain was inserted. The histopathology report revealed chorionic villi within the lumen of the right tube, which was consistent with tubal ectopic pregnancy (Figure ​ (Figure2 2 ).

Arrows indicate: (a) placenta; (b) fetus; (c) right fallopian tube.

Intra-operatively, the patient received a total of five units of packed red blood cells plus three units of fresh frozen plasma. She was transferred to the Surgical Intensive Care Unit where she was observed for two days. During her ICU stay, she remained hemodynamically stable. Her oxygen saturation was maintained with a 6L O2 face mask. Her chest was clear with bilateral equal air entry. Her abdomen was soft and lax, and the surgical wound was covered with a dressing. The pelvic drain contained hemoserous fluid measuring around 450cc and urine output was adequate. Repeated hemoglobin level post-transfusion was 10 g/L, and her white blood cell count was 15 g/L. Electrolytes were balanced and double antibiotic coverage was initiated along with and anti-stress medications. On post-op day 3, the patient was transferred back to the Gyne ward. She was discharged home in a stable condition five days after surgery.

Ectopic pregnancy is a well-known first-trimester pregnancy complication. It is a potentially life-threatening condition and is still regarded as a major cause of maternal mortality, as it is responsible for 9% to 13% of all pregnancy-related deaths [ 2 ].

The vast majority of ectopic pregnancies implant at different locations in the fallopian tube, most commonly in the ampulla (70%), followed by the isthmus (12%), fimbria (11.1%), and interstitium (2.4%) [ 5 ].

Many risk factors are correlated with ectopic pregnancy such as previous ectopic pregnancy, tubal damage or adhesions from pelvic infection or prior abdomino-pelvic surgery, history of infertility, in vitro fertilization treatment, increased maternal age and smoking. However, half of the women with ectopic pregnancies have no identifiable risk factors [ 6 ].

Tubal pregnancy often becomes symptomatic in the first trimester due to the lack of submucosal layer within the fallopian tube wall which enables ovum implantation within the muscular wall, allowing the rapidly proliferating trophoblasts to erode the muscularis layer. This usually causes tubal rapture at 7.2 weeks ± 2.2, leading to hemorrhage and shock. However, cases of advanced gestational age with different presentations have been reported in the literature. Such events are rare as it is unusual for the fallopian tube to dilate to the point of accommodating a second- or third-trimester fetus [ 5 ].

Ectopic pregnancy remains a challenging diagnosis in an emergency department setting. Therefore, biochemical investigation (BhCG) and skilled sonographic evaluation of the pelvis in a patient with a suspected ectopic pregnancy play a vital role in accelerating the management of patients [ 7 ].

Deciding on the best treatment option depends on various factors including the patient’s hemodynamic stability, BhCG level, the size of the gestational sac, and patients’ desire for future fertility. Un-ruptured single ectopic pregnancies can be successfully treated with systemic methotrexate [ 2 ]. In our case, an emergency laparotomy and a right salpingectomy were performed due to the ruptured ectopic mass, unstable hemodynamic status of the patient, and the accumulation of a large amount of intra-abdominal blood noted on the ultrasound image.

Conclusions

Although it is unusual for an ectopic pregnancy to persist beyond the first trimester, it can occasionally occur. Thus, in all cases of surgical abdominal emergencies during pregnancy, it is paramount to rule out ruptured ectopic pregnancy as it is life-threatening to the mother when the proper diagnosis and management are delayed.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

Human Ethics

Consent was obtained by all participants in this study. Unit of Biomedical Ethics Research committee issued approval not applicable. The above titled research has been examined.

Ectopic Pregnancy Case Study Hesi

Ectopic pregnancy case study hesi – Embark on a journey through the complexities of ectopic pregnancy with our HESI case study. From causes and symptoms to management and nursing care, we unravel the intricacies of this critical condition.

In this comprehensive exploration, we delve into the diagnostic procedures that unravel the mystery of ectopic pregnancy, uncovering the various treatment options and their implications.

Ectopic Pregnancy Case Study

Ectopic pregnancy is a serious condition that occurs when a fertilized egg implants outside the uterus. This can be a life-threatening condition for the mother, and it can also lead to infertility.

Causes of Ectopic Pregnancy

The exact cause of ectopic pregnancy is unknown, but there are a number of risk factors that can increase the likelihood of developing this condition. These risk factors include:

Pelvic inflammatory disease (PID)

• Previous ectopic pregnancy
• Use of an intrauterine device (IUD)
• Use of fertility drugs
• Age (women over 35 are at an increased risk)

Symptoms of Ectopic Pregnancy, Ectopic pregnancy case study hesi

The symptoms of ectopic pregnancy can vary, but they often include:

• Abdominal pain
• Vaginal bleeding
• Irregular menstrual periods
• Nausea and vomiting

Diagnosis of Ectopic Pregnancy

Ectopic pregnancy can be diagnosed with a variety of tests, including:

• Pelvic exam
• Blood tests
• Laparoscopy

Management of Ectopic Pregnancy

Ectopic pregnancy, a life-threatening condition, requires prompt diagnosis and management to prevent maternal morbidity and mortality. Treatment options for ectopic pregnancy include medical management and surgical intervention, each with its advantages and disadvantages.

Medical Management

Medical management, primarily using methotrexate, is a non-invasive approach that terminates the pregnancy and resolves the ectopic implantation. It is effective in unruptured ectopic pregnancies with low beta-hCG levels and minimal embryonic growth.

Advantages:

• Non-invasive
• Preserves fertility

Disadvantages:

• May require multiple doses
• Can fail, leading to surgical intervention

Surgical Management

Surgical management involves removing the ectopic pregnancy through laparoscopy or laparotomy. It is the preferred approach for ruptured ectopic pregnancies, pregnancies with advanced embryonic growth, or those resistant to medical management.

Step-by-Step Surgical Management of Ectopic Pregnancy:

• Laparoscopic Approach:
• Three or four small incisions are made in the abdomen.
• A laparoscope, a thin lighted instrument, is inserted through one incision.
• Surgical instruments are inserted through the other incisions to remove the ectopic pregnancy.
• Laparotomy Approach:
• A single larger incision is made in the lower abdomen.
• The ectopic pregnancy is removed directly.
• Definitive treatment
• Can be performed in an emergency setting
• Can affect future fertility

Nursing Care for Ectopic Pregnancy: Ectopic Pregnancy Case Study Hesi

Nurses play a vital role in providing comprehensive care to patients with ectopic pregnancy, ensuring their well-being and recovery.

The nursing care process for ectopic pregnancy involves:

A thorough assessment is crucial to gather essential information about the patient’s condition. This includes:

• History taking: Medical and gynecological history, including symptoms, risk factors, and previous pregnancies.
• Physical examination: Abdominal and pelvic exams to detect pain, tenderness, and any masses or abnormalities.
• Diagnostic tests: Blood tests (hCG, progesterone), ultrasound, and laparoscopy may be ordered to confirm the diagnosis and assess the severity of the condition.

Complications of Ectopic Pregnancy

Ectopic pregnancy, a life-threatening condition, can lead to severe complications if not treated promptly. Understanding these complications and their management is crucial for healthcare professionals.

The primary complications associated with ectopic pregnancy include:

• Tubal rupture
• Internal bleeding

Tubal Rupture

Tubal rupture occurs when the fallopian tube bursts due to the expanding ectopic pregnancy. This is a medical emergency that requires immediate surgical intervention.

Risk factors for tubal rupture include:

• Tubal surgery
• Use of intrauterine devices (IUDs)

Symptoms of tubal rupture include:

• Sudden, severe abdominal pain
• Shoulder pain (Kehr’s sign)
• Lightheadedness or dizziness

Management of tubal rupture involves:

• Emergency surgery to remove the ruptured fallopian tube
• Blood transfusion to replace lost blood
• Pain medication
• Antibiotics to prevent infection

Prevention of Ectopic Pregnancy

Ectopic pregnancy is a preventable condition. Understanding the risk factors and implementing evidence-based recommendations can significantly reduce the incidence of ectopic pregnancies.

Modifiable Risk Factors

• Pelvic inflammatory disease (PID): PID is a major risk factor for ectopic pregnancy. It is caused by sexually transmitted infections (STIs) such as chlamydia and gonorrhea, which can damage the fallopian tubes.
• Smoking: Smoking increases the risk of ectopic pregnancy by up to two times. It damages the cilia that line the fallopian tubes, impairing their ability to transport the fertilized egg to the uterus.
• Hormonal contraception: Progestin-only contraceptives, such as Depo-Provera and Norplant, slightly increase the risk of ectopic pregnancy. This is because they can alter the hormonal environment in the fallopian tubes, making it more conducive to ectopic implantation.
• Assisted reproductive technologies (ART): ART procedures, such as in vitro fertilization (IVF), increase the risk of ectopic pregnancy by up to 5%. This is because ART can bypass the natural selection process, allowing fertilized eggs with abnormal characteristics to implant outside the uterus.
• Previous ectopic pregnancy: Women who have had an ectopic pregnancy are at a significantly increased risk of having another one.

Non-Modifiable Risk Factors

• Age: The risk of ectopic pregnancy increases with age, especially after 35 years.
• History of pelvic surgery: Pelvic surgery, such as a hysterectomy or tubal ligation, can increase the risk of ectopic pregnancy by damaging the fallopian tubes.
• Endometriosis: Endometriosis is a condition in which endometrial tissue grows outside the uterus. This can increase the risk of ectopic pregnancy by creating an environment that is conducive to implantation outside the uterus.
• Genetic factors: Some women may have a genetic predisposition to ectopic pregnancy.

Evidence-Based Recommendations for Prevention

• Avoid risk factors: Avoiding modifiable risk factors, such as smoking, STIs, and hormonal contraception, can significantly reduce the risk of ectopic pregnancy.
• Prompt treatment of STIs: Early detection and treatment of STIs can prevent PID and reduce the risk of ectopic pregnancy.
• Appropriate use of ART: ART procedures should be used judiciously and only when necessary. Women undergoing ART should be aware of the increased risk of ectopic pregnancy.
• Public health initiatives: Public health initiatives aimed at reducing smoking rates, promoting safe sex practices, and increasing access to reproductive healthcare can contribute to reducing the incidence of ectopic pregnancy.

Role of Public Health Initiatives

Public health initiatives play a crucial role in reducing the incidence of ectopic pregnancy. These initiatives can include:

• Education and awareness campaigns to inform women about the risk factors and symptoms of ectopic pregnancy.
• Implementation of screening programs to identify women at high risk of ectopic pregnancy.
• Promotion of early detection and treatment of STIs.
• Advocacy for policies that support access to reproductive healthcare, including contraception and ART.

By implementing these evidence-based recommendations and supporting public health initiatives, we can significantly reduce the incidence of ectopic pregnancy and improve the reproductive health of women.

FAQ Resource

What is the most common cause of ectopic pregnancy?

What are the early symptoms of ectopic pregnancy?

Vaginal bleeding, abdominal pain, and shoulder pain

What is the primary diagnostic tool for ectopic pregnancy?

Transvaginal ultrasound

What is the most common treatment for ectopic pregnancy?

Surgery to remove the embryo

Ectopic Pregnancy Hesi Case Study

Ectopic pregnancy hesi case study: An in-depth exploration of a critical obstetric condition, providing comprehensive insights into its diagnosis, management, and nursing care.

Ectopic pregnancy, a life-threatening condition, occurs when a fertilized egg implants outside the uterus. This case study delves into the complexities of this condition, examining its epidemiology, clinical presentation, diagnostic evaluation, management options, and the crucial role of nurses in patient care.

Definition and Epidemiology: Ectopic Pregnancy Hesi Case Study

An ectopic pregnancy is a condition in which a fertilized egg implants outside the uterine cavity. This most commonly occurs in the fallopian tube (95% of cases), but can also occur in other locations such as the ovary, cervix, or abdominal cavity.

Ectopic pregnancy is a life-threatening condition that requires prompt diagnosis and treatment. The prevalence of ectopic pregnancy is approximately 1-2% of all pregnancies, and it is the leading cause of pregnancy-related deaths in the first trimester.

Risk factors for ectopic pregnancy include: previous ectopic pregnancy, pelvic inflammatory disease, endometriosis, assisted reproductive technologies, and smoking.

Clinical Presentation, Ectopic pregnancy hesi case study

The most common symptoms of ectopic pregnancy are abdominal pain and vaginal bleeding. The pain is typically unilateral and may be sharp or stabbing in nature. The vaginal bleeding is often light and irregular.

Other symptoms of ectopic pregnancy may include: nausea, vomiting, diarrhea, constipation, and shoulder pain. These symptoms may be similar to those of other conditions, such as miscarriage or pelvic inflammatory disease, so it is important to seek medical attention if you are experiencing any of these symptoms.

Early diagnosis and management of ectopic pregnancy is essential to prevent life-threatening complications, such as rupture of the fallopian tube and internal bleeding.

Diagnostic Evaluation

The diagnosis of ectopic pregnancy is based on a combination of physical examination, transvaginal ultrasound, and serum hCG levels.

• Physical examination: The physical examination may reveal abdominal tenderness and a palpable adnexal mass.
• Transvaginal ultrasound: Transvaginal ultrasound is the most sensitive and specific test for diagnosing ectopic pregnancy. It can visualize the gestational sac and embryo outside the uterine cavity.
• Serum hCG levels: Serum hCG levels are typically elevated in ectopic pregnancy, but they may be lower than expected for the gestational age. Serial hCG levels can be used to monitor the progression of the pregnancy.

Management Options

The treatment of ectopic pregnancy depends on the patient’s symptoms, the location of the pregnancy, and the size of the gestational sac.

• Medical management: Medical management with methotrexate is an option for patients with small, unruptured ectopic pregnancies. Methotrexate is a medication that stops the growth of the embryo and allows the body to reabsorb the pregnancy.
• Surgical management: Surgical management is the treatment of choice for patients with ruptured ectopic pregnancies or large, symptomatic ectopic pregnancies. Surgical management can be performed laparoscopically or laparotomically.

Nursing Care

Nurses play a vital role in the care of patients with ectopic pregnancy.

• Assessment and monitoring: Nurses assess patients for signs and symptoms of ectopic pregnancy, such as abdominal pain, vaginal bleeding, and shoulder pain. They also monitor patients’ vital signs and perform physical examinations.
• Patient education and support: Nurses provide patients with information about ectopic pregnancy, its symptoms, and its treatment options. They also provide emotional support to patients and their families.
• Discharge planning: Nurses help patients plan for their discharge from the hospital. They provide patients with instructions on how to care for themselves at home and when to follow up with their healthcare provider.

FAQ Resource

What is the most common risk factor for ectopic pregnancy?

Pelvic inflammatory disease (PID)

What is the primary diagnostic tool for ectopic pregnancy?

Transvaginal ultrasound

What is the first-line treatment for ectopic pregnancy?

Methotrexate

What is the role of nurses in managing ectopic pregnancy?

Assessment, monitoring, patient education, support, and discharge planning