nursingmanagementofthepatientwithan.docVIP

NURSING MANAGEMENT OF THE PATIENT WITH AN ECTOPIC PREGNANCY By T. Norris: RN, RM, RPN, RCHN, Assessor. Abstract This article reviews the care of a patient who presents with an ectopic pregnancy and the nursing management that is necessary to attend to her. Ectopic pregnancies are obstetric and surgical emergencies and can cause death if the patient is not adequately treated. By applying general basic nursing principles, nurses can recognize this emergency and be prepared for it. Introduction Ectopic pregnancies are on the increase primarily because of the rise in pelvic inflammatory disease. It leads to pregnancy related death in the first trimester of pregnancy and can lead to infertility. Definition An ectopic pregnancy occurs when the fertilized ovum fails to reach the uterus and becomes implanted elsewhere. It is also known as an extra uterine pregnancy (1). This means that the fertilized ovum can be implanted in the uterine tubes, the ovary, the abdomen or the cervix (2). Any factor that slows the passage of the ovum along the tube to the uterus can result in an ectopic pregnancy (3). Pathophysiology The ovum only implants when the zona pellucida [the thick transparent membrane surrounding the ovum (1)] is shed partially or completely. If the ovum dies, it is either reabsorbed, forms a tubal mole, or is aborted into the abdominal cavity. If the ovum survives, the trophoblast [a layer of ectodermal tissue that serves to attach the ovum to the wall of the uterus and supply nourishment to the embryo (1)] enlarges and erodes into the tissues of the uterine tube. The endometrium thickens, the uterus enlarges, the muscles of the tubes thicken and the ovarian and uterine arteries become tortuous (3). The tube stretches as the ovum develops and enlarges and as a result there are repeated bleeding episodes. Eventually the uterine tube can stretch no further and the tube ruptures (3). Sites of implantation include the fimbriate (3) or infundibu