Management And Treatment Of Ectopic Pregnancy - Case Study Example

 Management And Treatment Of Ectopic Pregnancy Introduction: Ectopic pregnancy is a gestational problem that is classified as a pathological problem that is seen in the initial term of pregnancy. According to Monga and Dobbs, “Ectopic pregnancy is defined as implantation of a conceptus outside the normal uterine cavity.” In the United Kingdom, 11,000 pregnant women present with ectopic pregnancy annually and 11 out of every 100,000 women die due to this problem. In the United States, one pregnant female out of every 150 females presents with an ectopic pregnancy. Though it has been analyzed that occurrence of this problem has reduced significantly, but it is still considered to be the major cause of death of pregnant women during the first three months of gestation (Robbins et al 2005; Sher et al 2005; Monga et al 2011). Ectopic pregnancy is an important gynecological disorder which has many underlying causes and it is a condition that can be diagnosed by different techniques. This pathology can be treated and therefore early diagnosis is important to prevent the fatalities that result due to this condition. Etiology: Ectopic pregnancy is led to by many causes. Invasion of the pelvis by infective microorganisms which include Chlamydia results in infection of the pelvis and this Pelvic Inflammatory Disease is classified as an underlying cause of ectopic pregnancy in approximately 40 percent of the cases. A pregnant woman who has a history of ectopic pregnancies has a higher risk of developing the same disorder again. Appendicitis, leiomyomas as well as endometriosis may result in the sticking together of the fallopian tubes. This also increases the susceptibility of ectopic pregnancy. Intrauterine devices that are used for contraception also result in a raised chance of developing ectopic pregnancies. An important characteristic that has been identified is that ectopic pregnancy may develop in a female who does not present with any prior history of risk factors and has normal tubal structures (Robbins et al 2005; Monga et al 2005). It has also been seen that women who resort to in vitro fertilization techniques for conceiving also have an increased risk of developing ectopic pregnancies. The improper development of the fallopian tubes by birth is also associated with ectopic pregnancy as it obstructs the movement of the fertilized ovum towards the uterine lining (Sher et al 2005). Site of Ectopic Pregnancy: The normal site for the attachment of the embryo is the endometrium of the uterus. An ectopic pregnancy ensues due to deviation of the embryo from its normal place of attachment and the attachment occurs in abnormal locations. These locations include the fallopian tubes where 95 percent of the ectopic pregnancies occur. Seventy four percent of the tubal pregnancies are found in the ampulla. Three percent of the ectopic pregnancies may occur in the ovary whereas one percent may be present in the cavity of the peritoneum. The remaining one percent may be seen in the cervix or on the scar tissue that may have formed following a caesarean section (Monga et al 2011; Smeltzer et al 2009). Signs and Symptoms: The patient may present with alteration in the normal menstrual cycle and complain of the postponement of the period from the normal date by approximately 2 weeks. She may complain of the passage of a small amount of blood after the time period of these two weeks. These symptoms explain of the presence of ectopic pregnancy. The patient may experience pain in the abdomen relative to the sight of implantation. The pain may be mild initially but may progress to become severe with time. This may be accompanied by abnormal bleeding which varies from the normal menstrual cycle. The patient may be lethargic and complain of fainting episodes. The patient may also complain of blood discharge from the vagina which would be dark red in color suggestive of the fact that the blood is not fresh. The patient may present with pain in the iliac fossa. In patients who may have presence of blood in the abdomen, may present with radiating pain in the shoulder. This is associated with the activation of the phrenic nerve of the diaphragm (Sher et al 2005; Monga et al 2011; Smeltzer et al 2009). The attachment of the embryo in the fallopian tubes results in increased pressure within the tubes with the growth of the embryo. This makes it essential that ectopic pregnancies should be diagnosed at an early stage to prevent complications. This is owing to the fact that undiagnosed cases beyond 6 weeks may lead to a fatal sequence of events. This results owing to the bursting of the tube. Following this, the embryo enters into the abdomen and the female experiences excruciating pain along with vomiting and weakness. This is accompanied by shortness of breath. The hemorrhage puts the patient in a state of hypovolemic shock. The pulse becomes fast, the blood pressure drops below normal and the patient sweats extensively and becomes pale. This condition is an emergency and needs to be diagnosed immediately (Monga et al 2011; Robbins et al 2005; Sher et al 2005; Smeltzer et al 2009). Diagnosis: The diagnosis of ectopic pregnancy is done by using various methods. The patients are first analyzed for their vitals which include the blood pressure, temperature and the pulse rate. This is followed by testing the blood group so that if an emergency procedure is required, the blood is available beforehand. This is accompanied by the testing of the levels of the hormone HCG. In a normal pregnant female, the HCG keeps on increasing and reaches its highest level after ten weeks. Furthermore, in a normal pregnant woman, the HCG level increases to twice its level after every 2 days. This is not the case in an ectopic pregnancy and the hormone does not follow this normal pattern. The readings of the hormone progesterone are also crucial. In a normal pregnancy the progesterone reading is above 25 ng/mL. But in abnormal cases the levels may be low. A transvaginal ultrasound scan (TVS) is also used for detecting an ectopic pregnancy. After 4.5 weeks of implantation of the embryo, the presence of the sac can be seen through the ultrasound. The HCG level at this stage is normally 1500 mIU/mL. The heart sounds of the fetus can be detected by 5 weeks and the HCG level at this stage is 3000 mIU/mL. Thus, if there is no proper correspondence between the HCG levels and the TVS, an ectopic pregnancy can be diagnosed. The ultrasound accompanied with levels of HCG and progesterone as well as the clinical presentation of the patient should be used to reach to a definitive conclusion of ectopic pregnancy. If all measures fail to reach to a definitive diagnosis, laparoscopy is performed (Monga et al 2011; Smeltzer et al 2009). Management and Treatment: The condition can be treated either medically or surgically. This is determined by the condition of the patient. Medical therapy revolves around the administration of methotrexate mainly through the intramuscular route which works by disrupting the growth of the embryo and preventing the formation of DNA in the cells of the embryo. This results in the detachment of the embryo. This option is not suitable for women with liver and kidney pathologies. It is also not advised for females who have reduced immune status as well as are nursing their child. Furthermore, the vitals of the patient must also be stable. It is the most appropriate treatment option for women who want to retain their fertility as well as in cases where the ectopic pregnancy overlies the vasculature or the bowel (Monga et al 2011; Sher et al 2005; Smeltzer et al 2009). The surgical approach for the condition is either laparoscopy or laparotomy. Laparoscopy is preferred owing to the reduced quantity of blood lost and due to the lesser time taken for the operation. The patient recovers quickly after laparoscopy as well. Laparotomy is mainly performed in those cases that are in a very unstable condition or the laparoscopic procedure cannot be performed due to lack of resources. Salpingectomy or salpingotomy are done through these surgeries. In salpingectomy, the fallopian tube is extracted. On the other hand, in salpingotomy the tube is opened and matter of conception is removed. In patients who have an intact second fallopian tube, salpingectomy is performed as it reduces the chances of another ectopic pregnancy (Monga et al 2011). References Top of Form Kumar, V., Abbas, A. K., Fausto, N., Robbins, S. L., & Cotran, R. S. (2005). Robbins and Cotran pathologic basis of disease. Philadelphia: Elsevier Saunders. Top of Form Monga, Ash, & Dobbs, Stephen P. (2011). Gynaecology by Ten Teachers. Gardners Books. Top of Form Sher, G., Davis, V. M., & Stoess, J. (2005). In vitro fertilization: The A.R.T. of making babies. New York: Checkmark Books. Bottom of Form Bottom of Form Bottom of Form Top of Form Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2009).. Brunner & Suddarth's textbook of medical-surgical nursing. Philadelphia: Lippincott Williams & Wilkins. Bottom of Form Read More