The Issue of an Ectopic Pregnancy - Case Study Example

Case Study In most developed countries, pregnant women normally have appointments with their obstetrician on a monthly basis to ensure an uncomplicated pregnancy (The Medical News 1-2). For most of these appointments, tests are done including ultrasound and the expectant mother is given a prescription of vitamins to maintain her health and that of the unborn baby (The Medical News 1-2). However, such practice is being undermined by research studies that show women who visit their obstetrician rarely or lesser times than other women who religiously makes the visit to obstetricians. Said studies or researches gives an idea that both sets of women are on an even footing to having or developing pre-eclampsia, post-partum anemia, low birth weights and death of mother and baby (The Medical News 1-2). This is relative to a report by the World Health Organization (WHO), and other related studies suggests that women will have an overall good rate of pregnancy with fewer visits to their respective obstetricians ( The Medical News 1-2). While the preceding paragraphs may introduce scientific reasoning on why few visits are currently encourage with specialist or obstetricians during pregnancy, Ruth must understand that her case is quite critical because of previous pregnancy mishaps in the form of miscarriages, ectopic pregnancy and having a stillborn. An initial assessment of her case or situation can somehow be enlightened by visiting her obstetrician who will inquire about her previous pregnancies, previous major surgery, medical condition, immunization and genetic history (Family Health Guide 2007). Tests will also be done on her urine and bloods in the event that she will need blood transfusion during the birthing process and whether she is Rh-positive or negative (Family Health Guide 2007). The obstetrician will also give her instructions during the initial appraisal or evaluation of her pregnancy. Paramount to this will be an advice that in case she experiences abdominal pain, unusual cramps, bleeding, vaginal discharge and a fever of over 38 degrees Celsius (sign of infection) to contact him or her immediate and proceed directly to a hospital emergency room. Because the risk of miscarriage is highest in the first trimester (12 weeks or first 3 months) of pregnancy (Family Health Guide 2007). In her current state, Ruth is described as Gravida (G)5, Para (P)1. This means that has had a total of five pregnancies excluding her current one which resulted to one live birth. Gravida is the sum total number of pregnancies a woman had whether she was able to carry them all to full term or not; Para indicates the number of feasible births (Encylco, Online Encyclopedia 1). Ruth’s past medical history indicates that she is a high risk for carrying a baby into full term as indicated by a couple of miscarriages, ectopic pregnancy and a stillborn. To better understand such conditions, the above mentioned terms are explained as follows: a. Ectopic Pregnancy Ectopic pregnancy is also known as cervical pregnancy, abdominal pregnancy or tubal pregnancy (Chen 1-5). This condition happens when the fertilized egg or fetus develops outside the uterus. The common location for such is in one of the fallopian tubes. In very rare cases, the fertilized egg can even develop or occur in the stomach cavity, ovary or cervix area (Chen 1-5). Cases of ectopic pregnancies occur because of a physical blockage in the tubes that slows down the fertilized egg’s movement toward the uterus (Chen 1-5), while some cases may be attributable to defects within the fallopian tubes, ruptured appendix complications or scarring due to a past pelvic operation (Chen 1-5). It is impossible for ectopic pregnancies to be carried to full term since the cells need to be removed in order to save the mother’s life. Most women who had ectopic pregnancies may be able to have normal pregnancy later, while some women do not become pregnant again (Chen 1-5). Ectopic pregnancy normally leads to bleeding and shock that may lead to death if the ruptured tube was not detected immediately. Although such cases are infrequent (Chen 1-5). To reduce having another ectopic pregnancy Ruth must be advised to (Chen 1-5): 1. Avoid having multiple sex partners and risk getting STD or sexually transmitted disease an PID of pelvic inflammatory disease. 2. Get or have an early diagnosis and treatment for STDs. 3. Get or have an early diagnosis and treatment for PID. The latter two can only be done effectively if Ruth visits her obstetrician regularly as scheduled. b. Miscarriage Is generally termed as spontaneous abortion where loss of fetus happens before the 20th week of pregnancy (Vorvick 1-3). Causes of miscarriages may be attributed to hormone problems, infection, problems with the mother’s reproductive organs, problems with the body’s immune system and systemic diseases like diabetes which the mother already has before she became pregnant (Vorvick 1-3). The rate of incidents for miscarriage is high in women who are: older than 35 years old; and who had previous miscarriages (Vorvick 1-3). Once miscarriage occurs, the placenta which exits the body must be examined to make sure that no pregnancy tissue remained inside the uterus (Vorvick 1-3). In the event that the pregnancy tissue did not exit the body normally, a surgery in the form of D and C is performed or a medicine is given to eliminate the remaining tissue inside the uterus (Vorvick 1-3). After being treated, the woman resumes normal menstrual cycle after a few weeks. Further bleeding must be closely monitored to detect any infection that may require immediate medical attention (Vorvick 1-3). Most miscarriages are caused by systemic diseases like diabetes, which can be avoided if the disease was identified and properly treated before a pregnancy developed (Vorvick 1-3). Thus, a comprehensive prenatal care is recommended to prevent a miscarriage (Vorvick 1-3). c. Stillbirth A stillbirth happens when a fetus which was expected to be carried to full term and birth dies during the late stages of pregnancy (Smith 1). Fetal death in stillbirths may be due to: birth defects, illnesses, infections, injuries, hemorrhage, cardiac arrests and placenta detachment which is due to poor placenta function (Smith 1). Since Ruth has had quite traumatic experiences in her other past pregnancies, it is best that she does the following to attain a better chance of being able to give birth in a healthy condition, which will likewise ensure the good health of the baby (The Pregnancy Zone 1-2.): 1. Eat a balance diet that is divided into smaller meals. 2. Avoid spicy, fried and fatty foods. 3. Reduce Vitamin A intake since Vitamin A causes jaundice and liver damage. 4. Avoid fizzy drinks and citrus juices. 5. Consult the doctor about new products to be used while pregnant. 6. Quit smoking to prevent asthma. In addition to all the foregoing, it is essential that Ruth considers the best maternity care for her current pregnancy. Maternity care given in a hospital or medical setting provides informed choices about pregnancy and giving birth. Models of care chosen for pregnancy have an effect on the alternatives and options available on the onset of pregnancy and childbirth (Bellybelly 1-5). The mother, Ruth and her child must be the chief focus of the maternity care that is provided professionally. Generally, a midwife is the suitable primary caregiver during the whole term of pregnancy and birth (Bellybelly 1-5). In most cases, midwives work collaboratively with other medical professional like doctors and nurses especially during situations where the birthing requires complicated procedures or has potential risks to both mother and child (Bellybelly 1-5). Before or prior to engaging in any various forms of maternity care model, Ruth must be made to understand that, her former pregnancies where two were miscarriages, one was ectopic and another - a full term stillborn, may have an impending effect on her current pregnancy. Her carer or physician (obstetrician) whom she is currently seeing for antenatal visits must explain that the first trimester (12 weeks of pregnancy) is a period where the baby is most vulnerable to damage from drugs taken by the mother or infections, like German measles affecting the mother (Family Health Guide 2007). It is also at this stage where she will be experiencing many symptoms of pregnancy which are attributable to the changed hormonal levels in the body. High levels of hormones such as progesterone and estrogen are accountable for the emotional swings of the first months, where sleepiness and frequent urination may also occur (Family Health Guide 2007). There are a lot of ways wherein a laboring or pregnant woman like Ruth, along with the professionals providing care for her pregnancy can both work with or interfere in the natural processes. In planning for the birth of her baby, Ruth must understand the roles of professional carers together with her own to support spontaneous birth which is uncomplicated (Family Health Guide 2007). Ruth may consider the following types of maternity care for her current pregnancy: 1. Midwife Primary Care The primary care or first level care from a certified midwife will let her build an affiliation and confidence with her chosen midwife. This fundamental form of care involves social, physical and psychosocial compensations (Bellybelly n.d.). Ruth must be informed firsthand that the scope of a midwife’s work permits the midwife to work on her own accord, knowledge and training as long as the mother and baby under her personal care are doing well. However, in situations where illness or complications has been detected, the midwife needs to work closely with medical and nursing givers to ensure the wellbeing of her charge (Bellybelly 1-5). Being a first level carer, the midwife’s responsibility comprises the ability to effect a normal maternity care which is from early pregnancy till birth and early parenting. In majority of primary care settings, the midwife must be available to advice and monitor Ruth’s progress. This includes attending the labor if such service has been pre-arranged and is within the scope of the primary carer’s practice (Bellybelly 1-5). In the event that the midwife is not available to give care when needed, an appropriate substitute must be available to cover for the absence of the original midwife (Bellybelly 1-5). 2. Specialist Care Specialist care is given or provid3ed by a specialist obstetrician who is a doctor expert or skilled in providing treatment for complications that occurs during pregnancy and birth (Bellybelly 1-5). If Ruth is experiencing a complicated pregnancy, or if she has a serious medical condition detached from her pregnancy, she must seriously consider to be under the care of a specialist given the fact that shed had previous pregnancies that did not have a good outcome (Bellybelly 1-5). Under the specialist care, Ruth will be given continuity of care for the whole duration of her pregnancy, should she decide to enter into a private care arrangement that gives access to private or public hospital when birthing time comes (Bellybelly 1-5). Antenatal care is normally given in a doctor’s private room or clinic (Bellybelly 1-5). In some cases, even if Ruth is under the specialist care, during labor, the midwives at the hospital will be the ones to monitor her progress and will eventually call the obstetrician when birth is about to happen (Bellybelly 1-5). Care after birth will likewise be given by the hospital midwives and her obstetrician will be notified should complications arise (Bellybelly 1-5). If Ruth prefers to be under the care of the specialist, she will have to consider seeking the services of a midwife to work closely with her and in collaboration with her obstetrician and the other hospital staff (Bellybelly 1-5). 3. Shared Care Professional carers share maternity care in many ways. The shared care model involves midwives with general practitioners, or midwives and specialist obstetricians who will work together to provide the appropriate care Ruth needs in her pregnancy (Bellybelly 1-5). In this type of care model, the doctor (general practitioner or special obstetrician) will be the leading provider of care (Bellybelly 1-5). If Ruth will be receiving a shared care type of maternity care model, she must be made aware of the possibility of division and lack of connection of a single or prominent carer because the shared care model adheres to having different and several midwives and doctors to attend to her for the entire length of her pregnancy (Bellybelly 1-5). Although some arrangements may depend on the setting and in the manner in which the shared care is employed (Bellybelly 1-5). Other models of shared care make every effort to provide a single midwife from the beginning of the pregnancy until labor or birth; however, due to may external factors that may affect the arrangement, this is always not the case (Bellybelly 1-5). Hence, Ruth must thoroughly inquire how the shared care model works favorable in the setting she is currently contemplating (Bellybelly 1-5). Psychologically, Ruth must be able to feel the support and love of her family and friends during her entire pregnancy. The doctor must counsel her partner not to be away often as the pregnancy progresses because she needs moral support and the reassurance that she is not alone should something unexpected happens. It will also make her feel secure that her love ones are close enough to lend a hand if ever she needs one. References Bellybelly. (n.d.). Who Cares? Choosing a Model of Maternity. 27 July 2009 Chen, Peter. February 5, 2008. Ectopic Pregnancy. 28 July 2009 Encyclo, Online Encyclopedia. (n.d.). Gravida-para. 27 July 2009 Family Health Guide. 2007. The Nine Months of Pregnancy. MediMedia Asia Pte Ltd under license from Media Information (Netherlands) BV. D40213 Dusseldorf, Germany. Smith, Melanie. August 17, 2007. Stillbirth. 27 July 2009 The Medical News. 2005. The Facts on Prenatal Care. 28 July 2009 The Pregnancy Zone. (n.d.). Facts for Pregnancy Week 12. 28 July 2009 Vorvick, Linda. February 19, 2009. Miscarriage. 27 July 2009 Read More