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Presented by: Jade Baynham, Rachel Fowler, Elisa Ghent, Tiffany Jazwinski, and Naima Shire.
In a normal pregnancy, an ovum is released by ovaries and becomes fertilized with sperm (Mummert & Gnugnoli, 2022).
The fertilized ovum moves within the fallopian tubes to then attach to the lining of the uterus (Mummert & Gnugnoli, 2022).
The uterus is the only organ that is able to sustain a pregnancy (Keenan-Lindsay et al., 2022)
Ectopic pregnancy occurs when a fertilized ovum implants outside the uterine cavity (Keenan-Lindsay et al., 2022)
Most ectopic pregnancies occur in the uterine fallopian tube, with most occurring in the ampullar section. Other sites include cervix, ovary and abdomen (Keenan-Linsay et al., 2022)
Hinkle, Cheever & Brunner, 2018).
Uncommon Sites
*Ectopic pregnancies result from an interruption in migration of the embryo through the fallopian tube. There is a 95% chance of an embryo being in the fallopian tube within the ampullar portion, a 0.5% chance in the ovary, a 1.5% chance in the abdominal cavity, and a 0.3% chance in the cervix
(Perry et al., 2022).
*Maternal age and ethnicity remain consistent for how frequent ectopic pregnancies occur
*The risk of ectopic pregnancies increases in women who use assisted reproductive therapy, who had tubal sterilization or reversal surgeries, surgical intervention for ectopic pregnancies, pelvic surgery, pelvic inflammatory disease, advanced age, smoking, and infertility
*10% to 25% of women who experienced an ectopic pregnancy will have another
(Perry et al., 2022).
*Ectopic pregnancies are constantly increasing with improved diagnostic testing as they are found early
*Point of care ultrasounds are used to detect intra-abdominal hemorrhages. Women with a moderate to a large amount of free fluid in the abdominal-pelvic area are 3 to 9 times more at risk for emergency ectopic pregnancies, while ultrasounds help to detect early to prevent emergency surgeries
(Stone et al., 2021).
*1.3% to 2% of all pregnancies result in an ectopic pregnancy
*1:7000 to 1:30,000 ectopic pregnancies occur from spontaneously conceived pregnancies
*9% of pregnancy deaths are related to ectopic pregnancies and is the leading cause of infertility (Karavani et al., 2021 & Perry et al., 2022).
Diagnosing an ectopic pregnancy can be challenging due to the signs and symptoms caused by other pelvic and abdominal illnesses such as:
(Lewis et al., 2019)
(Hendriks et al., 2020 & Lewis et al., 2019)
Serum progesterone and beta human chorionic gonadotropin (β-hCG)
β-hCG levels are measured twice, 48 hours apart, to determine how they change over time. During early pregnancy, the level of this hormone doubles every two days
Initial β-hCG level of less than 1,500 mIU per mL in normal pregnacy
A decrease in β-hCG of at least 21% in 48 hours implies a failed intrauterine pregnancy, whereas a smaller decrease should raise concerns regarding ectopic pregnancy
(Hendriks et al., 2020)
(Malachi, 2022).
(Stanica et al., 2021 & Hu, Paramboor et al., 2021).
(Perry, 2022).
(Keenan-Lindsay et al., 2022)
(Bump2baby, 2021)
(Zuin et al., 2021)
(Bump2baby., 2021)
Internal bleeding and hemorrhage
Rupture
Hypovolemic shock
Recurrent ectopic pregnancies
Death
Infertility and sterility
Expectant Management
Client stability, size of mass, and future pregnancies are factors to consider before choosing a type of treatment. Expectant management is watchful waiting with no treatment in hopes the ectopic pregnancy resolves on its own. This type of treatment is only optional for clients who are asymptomatic, with no mass found on diagnostic imaging, blood work is normal, and the client is stable
(Rubio et al., 2020)
Medical management includes:
Post treatment lifestyle restrictions.
Education:
*Inform the patient to avoid taking analgesic stronger than acetaminophen to prevent masking tubal symptoms.
*Recommend the patient stop taking folic acid and alcoholic beverage consumption due to increased risk of adverse effects to methotrexate and ectopic rupture
*Avoid sun exposure to prevent increased photosensitivity
*Avoid gas forming foods
*Report vaginal bleeding, or abdominal pain
*Recommend the patient avoid intercourse and inserting tampons or douches into the vaginal canal
(Keenan-Lindsay et al., 2022).
Surgical candidates include:
Types of surgeries
1.Salpingectomy; removal of the entire fallopian tube. 2.Salpingostomy; removal of fetal products from the fallopian tube. It is considered in women who want to pursue a pregnancy in the future.
(Keenan-Lindsay et al., 2022)
Pregnancy loss is a critical and traumatic event for women and men. Mourning and grieving can be painful after ectopic pregnancies. Negatively processing emotions and lack of support can cause anxiety, depression, and post-traumatic stress disorder.
Use distraction techniques to allow negative feelings to pass such as walking, exercise, listening to music, and forming new hobbies. Follow up with the family physician or gynecologist if feelings of anxiety or depression continue.
Discuss with the client and spouse the importance of rest after surgery and allowing the body to heal. Feelings can be overwhelming as the body returns to a nonpregnant state. The client may experience feelings of shock, disbelief, fear, upset, emptiness, relief, anger, sadness, guilt, jealousy, anxiety or worry. The relationship between the client and spouse may be affected.
Encourage the client and spouse to spend time with family and friends. Be open about negative feelings and encourage communication. Seek support services such as over the phone helplines, community support groups, and social services.
(Iwanowicz-Palus et al., 2021 & The Ectopic Pregnancy Trust., 2022)
Before the diagnosis
(Silvestri, L. A., & Silvestri, A. E., 2020)
(Prezi., 2022)
(Lewis et al., 2019)
(Prezi, 2022)
(Prezi, 2022)
(Keenan-Lindsay et al., 2022, Lewis et al, 2019 & Silvestri et al., 2020).
Video Link:
(Medical Centric., 2021).
https://www.youtube.com/watch?v=EBuqZr4Afw4
American International Medical University. (2017, June 25). Ectopic pregnancy: Diagnosis, complications and managment. American International Medical University.
https://www.aimu.us/2017/06/25/ectopic-pregnancy-diagnosis-complications-and-managment/
Bump2baby (2021). Ectopic Pregnancy? Know about the Symptoms | Signs | Treatment | Complications. Retrieved from https://bump2babyscans.co.uk/ectopic-pregnancy-know-about-the-symptoms
signs-treatment-complications/
Healthwise. (2021, June 16). Ectopic Pregnancy. https://www.healthlinkbc.ca/health-topics/ectopic-pregnancy
Hendriks, Rosenberg, R., & Prine, L. (2020). Ectopic Pregnancy: Diagnosis and Management. American Family Physician, 101(10), 599–606.
Hinkle, J. L., Cheever, K. H., & Brunner, L. S. (2018). Brunner & Suddarth's textbook of Medical-Surgical Nursing. (14th Edition). Wolters Kluwer.
Hu, Paramboor, M. S., & Guo, T. (2021). Diagnosis and management of intramural ectopic pregnancy. Clinical and Experimental Obstetrics & Gynecology, 48(4), 974–979. https://doi.org/10.3108
3/j.ceog4804154
Iwanowicz-Palus, G., Mroz, M., Bien, A., & Krzysztof, J. (2021). Social support and subjective assessment of psychophysical condition, health, and satisfaction with quality of life among women
after pregnancy loss. BMC Pregnancy Childbirth, 21(750) https://doi-org.roxy.nipissingu.ca/10.1186/s12884-021-04093-w
Karavani, Gutman-Ido, E., Herzberg, S., Chill, H. H., Cohen, A., & Dior, U. P. (2021). Recurrent Tubal Ectopic Pregnancy Management and the Risk of a Third Ectopic Pregnancy. Journal of
Minimally Invasive Gynecology, 28(8), 1497–1502.e1. https://doi.org/10.1016/j.jmig.2020.12.005
Keenan-Lindsay, L., Sams, C., O’Connor, C., Perry, S., Hockenberry, M., Low, D. (2022). Maternal Child Nursing Care in Canada: Pregnancy at Risk: Gestational Conditions
(3rd edition ). Elsevier Inc.
Kumari, S., Prasad, D., Sinha, A., & Parween, S. (2018). Retrospective study of ectopic pregnancy in tertiary care centre. IAIM, 5(1), 95-9. https://iaimjournal.com/wpcontent/uploads/2018/01/
iaim_2018_0501_13.pdf
Lewis, S. L., Buckner, L., Heitkemper, M. M., Harding, M. M., Barry, M. A., Lok, J., Tyerman, J. & Goldsworthy, S. (2019). Medical-surgical nursing in
Canada: Female Reproductive Problems.(4th edition). Elsevier Inc.
Medical Centric. (2021). Ectopic Pregnancy, Causes, Signs and Symptoms, Diagnosis and Treatment. [Video] YouTube. Retrieved June 22, 2022, from
https://www.youtube.com/watch?v=EBuqZr4Afw4.
Mummert, T., & Gnugnoli, D. M. (2022). Ectopic pregnancy. In StatPearls. StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/30969682/.b.
Ramanathan, S., Raghu, V., Ladumor, S. B., Nagadi, A. N., Palaniappan, Y., Dogra, V., & Schieda, N. (2018). Magnetic resonance imaging of common, uncommon, and rare
implantation sites in ectopic pregnancy. Abdominal Radiology, 43(12), 3425-3435. https://doi.org/10.1007/s00261-018-1604-2
Rubio, X. B., Kresak, J., Zona, M., Beal, S. G., & Ross, J. A. (2020). Educational Case: Ectopic Pregnancy. Academic pathology, 7, 2374289520911184.
https://doi.org/10.1177/2374289520911184
Silvestri, L. A., & Silvestri, A. E. (2020). Saunders comprehensive review for the NCLEX-RN examination. (8th edition.). St. Louis, Elsevier.
Stanica, Neacsu, A., Sima, R. M., & Ioan, R. G. (2021). Diagnosis and management of ectopic pregnancy. Practica Medicală (2006), 16(1), 73–78. https://
doi.org/10.37897/RJMP.2021.1.13
Stone, B. S., Muruganandan, K. M., Tonelli, M. M., Dugas, J. N., Verriet, I. E., & Pare, J. R. (2021). Impact of point-of-care ultrasound on treatment time
for ectopic pregnancy. American Journal of Emergency Medicine, 49, 226–232. https://doi-org.roxy.nipissingu.ca/10.1016/j.ajem.2021.05.071
The Ectopic Pregnancy Trust. (2022). Supporting you. https://ectopic.org.uk/Zuin, Zuliani, G., Rigatelli, G., & Roncon, L. (2021). Cullen’s sign associated
with ectopic pregnancy. QJM : Monthly Journal of the Association of Physicians, 114(6), 423–423. https://doi.org/10.\1093/qjmed/hcab040