Minimizing Outcome of Ectopic Pregnancy - Essay Example

Ectopic Pregnancy Name Institution Date Introduction A normal pregnancy results when an egg is fertilized and later attaches itself to the wall of the uterus. However, in the case of ectopic pregnancy, the fertilized egg implants itself somewhere different rather than on the uterine wall. In most cases, ectopic pregnancy occurs in the fallopian tubes, that is, the tubes that carry the fertilized egg to the uterus for implantation. In other cases, ectopic pregnancy can occur in the cervix, the ovary or even in the abdominal cavity. An ectopic pregnancy cannot survive since the growing egg can lead to damage in the maternal tissues resulting into a life threatening condition (Farquhar, 2005). The condition therefore requires early diagnosis and treatment to ensure that the mother’s health is preserved and also other future pregnancies. This essay looks at the some of the available options or strategies that the paramedics can implement to ensure that there is minimal adverse outcome of ectopic pregnancy. Definition of related terminologies Ectopic pregnancy: this is a form of pregnancy where the fertilized egg attaches itself outside the uterus in most cases in the fallopian tubes. Fallopian tubes: these are also known as the uterine tubes. They are long thin tubes that connect the ovaries and the uterus. They are the sites for fertilization between the male and the female eggs. Uterus: this is also known as the womb. It is a hollow organ found in the female reproductive system which acts as the site where development of the embryo takes place and also full growth of the fetus. Symptoms of ectopic pregnancy During the early stages, ectopic pregnancy may not show any abnormal signs. It just shows the signs of a normal pregnancy such as missed menstrual periods, breast tenderness and nausea and vomiting. This might continue for about fourteen weeks after which abnormal signs start to appear. These include vaginal bleeding which may not be too heavy, nausea and vomiting that is accompanied by pain, Pain in the lower abdomen, abdominal cramps which are sometimes very sharp, pain on the shoulder or neck and dizziness. In undiagnosed cases where the fallopian tube may rapture, severe bleeding and pain may be experienced which may end up leading to fainting (Farquhar, 2005). Epidemiology of ectopic pregnancy The incidence of ectopic pregnancies has been on increase in various parts of the world over the last three decades. This is according to the last national data released by Center for Disease Control in the mid twentieth century. During this time, it was estimated that 20 per 1000 pregnancies were ectopic. All women of child-bearing age are at risk of ectopic pregnancy with estimates that 2% of all women suffer ectopic pregnancy. The rate is however highly experienced more in developing countries compared to developed ones. For example, in 1966, the rate of ectopic pregnancies in England was 3.45 per 1,000 live births while in 1996; the rate had gone up to 15.5 per 1,000 live births. In Australia, there was however a slight decrease between 1990 and 1998. In 1990, the rate was 17.4 per 1000 births while in 1998; it was 16.2 per 1000 live births. This decrease is associated to improvement in diagnosis and management of ectopic pregnancy cases (Piasarska & Carson, 1999). . Risk factors for ectopic pregnancy A woman’s risk for experiencing ectopic pregnancy is increased by various behaviors and diseases in her life time. Some of these are factors related to the woman’s reproductive health while others may be independent. These include: History of sexually transmitted infection: previous infection with Chlamydia and gonorrhea are likely to increases a woman’s chances of developing ectopic pregnancy. This is because the sexually transmitted infections cause infection of the pelvis, scarring and they also distort the normal anatomy of the reproductive system. This increases the likelihood of developing ectopic pregnancy (Piasarska & Carson, 1999). Past occurrence of pelvic inflammatory disease: this is a condition of inflammation of uterus, ovaries or the fallopian tubes. This condition results in scarring and distortion of the pelvic cavity, thus increasing the likelihood of developing ectopic pregnancy. Women with a past history of pelvic inflammatory disease are 3.4 times likely to develop ectopic pregnancy compared to those who have never suffered the condition (Piasarska & Carson, 1999). Previous ectopic pregnancy: women who had experienced ectopic pregnancy previously are most likely to have another incidence of ectopic pregnancy. Those who have had more than one incidence are more likely than those who have had one previously. Smoking: cigarette smoking is associated with 35% of the risk of developing ectopic pregnancy. This risk increases with the number of cigarettes smoked per day. Those who smoke more than 20 cigarettes each day are four times at higher risk than those who smoke 10 cigarettes per day, compared to those who have never smoked (Bouyer, et al., 2003). Intrauterine contraceptive device: when a woman conceives while using intra uterine contraceptive device, the pregnancy is most likely to be ectopic. Women who had also used IUCD previously are also likely to develop ectopic pregnancy. Other risk factors for developing ectopic pregnancy include previous miscarriage, induced abortion, age where the risk increases with age, sterilization and previous tubal surgery (Bouyer, et al., 2003). Complications of ectopic pregnancy Late diagnosis and treatment of ectopic pregnancy lead to adverse effects which may be life threatening to the victim. Late treatment also increases to likelihood of another ectopic pregnancy in the future. Some of the complications associated with this condition include; Ruptured ectopic pregnancy: this is splitting of the fallopian tubes due to the growth of the ectopic pregnancy. This results to excessive internal bleeding and sudden drop in the blood pressure resulting to hypovolemic shock. This can in some cases lead to death associated with bleeding (Stabile, 1996). Short-term infertility: about 65% of women who experience ectopic pregnancy take more that 18 months to be able to have another successful pregnancy. However, this is sometimes dependent on the type of treatment and management offered to the patients (Stabile, 1996). Another ectopic pregnancy: later diagnosis and treatment of ectopic pregnancy increases the chances of fallopian tubes rapture and this increases the likelihood of occurrence of another ectopic pregnancy (Stabile, 1996). Ectopic pregnancy also has emotional impacts to those affected. This is because it is associated with feelings of grief and bereavement. The patients may also be overwhelmed by sadness and distress. Diagnosis of ectopic pregnancy Ectopic pregnancy cannot be easily diagnosed from the symptoms it exhibits alone. This is because the symptoms can be similar to those of a normal pregnancy. However, after the symptoms have been noted, various tests should be carried out to confirm the condition and prevent further adverse complications. Some of the tests that may help in early and accurate diagnosis of ectopic pregnancy include; Blood tests: after symptoms of ectopic pregnancy have been experienced, blood tests may be conducted to check on the level of hormone Human Chorionic Gonadotropin (hCG). This hormone is produced by the tissues in the placenta and its levels are usually lower than those of the normal pregnancy if it is an ectopic pregnancy. In a normal pregnancy, the level of hCG doubles every 72 hours to a level higher than 100,000 IU per L. It reaches the peak between the 8th and 10th week from where it starts to decline. For an ectopic pregnancy, the levels of hCG is usually as low as 50,000 IU per L and does not rise (Stabile, 1996). Vaginal Ultrasound: a transvaginal ultrasound scan can also be carried out to diagnose ectopic pregnancy. This is a scan that makes use of high frequency sound waves which produces an image of the patient’s reproductive system. During the ultrasound scan, a small blunt-ended instrument used during surgery is inserted into the woman’s vagina which captures the image of the uterus and other areas surrounding. This is able to show the exact area where the pregnancy is located (Timor-Tritsch et al. 1989). Laparoscopy: this is a surgical procedure where a small cut is made in the belly from which a lighted thin tube is inserted to enable viewing of the female reproductive organs. In ectopic pregnancy, it is done to enable the doctor to view the fallopian tubes and the womb. Laparoscopy is performed under general anesthesia. In most cases, it is done after all the other methods have failed to give the desired results (Schollmeyer et al. 2013). Clinical examination of ectopic pregnancy Transvaginal ultrasound and checking the level of hCG are the most recommended methods of diagnosing ectopic pregnancy. Physicians should start by taking the history of the patient before proceeding to physical examination. During physical examination, the physician should be able to determine the risk level of the patient by looking at things such as cervical motion, pain, and fetal heart tones. Transvaginal ultrasound should then follow together with hCG tests which should be repeated after 48 hours. After confirmation of the tests, management should start immediately to prevent further complications (Lipscomb, Stovall & Ling, 2000). Management of ectopic pregnancy Pre-hospital management of ectopic pregnancy is very crucial but is only limited to the ABCs. These include managing breathing which may be done by providing oxygen, providing adequate fluids to the patient and also finding the IV access routes. Other pre-hospital management activities may include observing whether the patient is in shock or whether she looks ill. Then transport to the medical facility should be arranged immediately (Goodwin, et al. 2010). Once the patient is in the hands of physicians, hospital management should start. Historically, surgery was the only available means of treating ectopic pregnancy. However, with the advancement in medical technology, other options have been found that are helpful in management of ectopic pregnancy. These include the single dose outpatient management which was an advancement of the long term hospitalization where the patient was being put on multiple doses which would sometimes result in adverse side effects (Kopani, Rrugia & Manoku, 2010). Currently there are a number of ways that can be followed in hospital management of ectopic pregnancy. These include surgical and drug treatment methods. Surgical methods There are two surgical methods that can be used to treat ectopic pregnancy. These include Laparoscopy: this method involves removing the fertilized egg from the woman’s fallopian tube. Laparoscope is a telescope device that is inserted through a small cut at the belly button. After it is inserted, carbon dioxide gas is blown inside the abdomen to make it easier to identify the internal organs. Another small cut is made in the lower abdomen which will be used to insert the smaller instruments that are used in the process. These small instruments are used to manipulate and also to remove the ectopic pregnancy. The surgical process may aim at removing the fallopian tube or opening the tubes and then removing the ectopic pregnancy (Schollmeyer et al. 2013). However, the doctor reaches to the decision of conducting laparoscopy after assessing the patient’s symptoms, after medical examination and also after considering the test results. It is recommended where the patient is found to have internal bleeding or where there is high likelihood of internal bleeding. Laparotomy: This is an open operation which is performed if the ectopic pregnancy is in the advanced stages or if the bleeding is too much and the patient is hemodynamically unstable. It is also recommended if situations where laparoscopy is difficult to perform. In some cases, the surgeon may require to perform the open surgery so that he can be able to see more of what is happening in the body of the patient (Schollmeyer et al. 2013). Drug therapy Methotrexate drug: This is a drug given through intramuscular injection in the buttock or in the leg. The drug works by dissolving the pregnancy. This is given where the patient is not in pain or the pain is minimal. It is also given after the doctor ascertains that there is no internal bleeding, or there is minimal risk of internal bleeding. The injection may take some time before it works and sometimes it may not be successful. The drug is also used at the very early stages when the ectopic pregnancy is very small. With this option, the doctor must ensure that the pregnancy has fully ended to avoid the risk of it remaining and causing internal bleeding Kopani, Rrugia & Manoku, 2010). Wait and see option This is where after examining the ectopic pregnancy, the doctor may tell patient to give it some more time. This is where there is observed likelihood that the ectopic pregnancy may end up in miscarriage. This may happen to patients who are experiencing very little pain, the ultrasound examination shows that there is no definite ectopic pregnancy and also where the levels of pregnancy hormones are going down. After a short while, such pregnancy may end up in miscarriage. This should be followed by blood tests for follow-up to ensure that the ectopic pregnancy has completely ended and there is no remaining tissue that may cause internal bleeding (Lipscomb, Stovall & Ling, 2000). Pre-hospital versus hospital management of ectopic pregnancy Due to high risks for complications associated with ectopic pregnancy, the emergency medical staffs do not have much to do during the pre-hospital management. However, the most important things that can be done include preparation for shock management even if there are no fully developed signs and symptoms, administration of oxygen, ensuring that the patient is kept warm, provision of the IV fluids and urgent transport arrangement to the nearest obstetric facility (Navarro, 2009). This should not take long before the patient is taken to the obstetric facility where the doctor can make a decision for surgery, drug treatment or wait and see depending on his observation of the patient’s symptoms. Recommendations on best practices in management of ectopic pregnancy The best pre-hospital practices when handling cases of ectopic pregnancy should start with early diagnosis. This is very important in preventing adverse outcomes of the condition such as rapture of the fallopian tube and also ensures successful hospital management of ectopic pregnancy. Diagnosis should also apply to all women who are at risk of ectopic pregnancy. These include all women in the reproductive age with complains such as abnormal vaginal bleeding which may be or may not be accompanied by pain and women who had previously experienced ectopic pregnancy since it may reoccur (Goodwin, et al. 2010). Where diagnosis is positive, an immediate decision on management should be made. The method of management will depend on the level of risk for the rapture of the fallopian tube. Where there is risk for rapture, the hemodynamic stability is then considered. Surgical management particularly laparoscopy is the recommended best practice. This method is highly recommended especially due to protection of future fertility. The failure rate for this method is very minimal and if it happens, it can further be managed by methotrexate drug. For future pregnancy after ectopic, it is dependent on the type of management that has been used and exposure of the woman to the risk factors. Too much damage to the fallopian tube may affect the ability to carry another pregnancy in the future. Exposure of the woman to risk factors such as smoking may have an effect in the future pregnancies (Fernandez et al. 2013). Conclusion Ectopic pregnancy should no longer be a life threatening condition. This is due to the advancement in the options that are available for its management. However, the most important thing is early diagnosis and immediate start of the management procedures. This would prevent the adverse outcomes and also the complications of ectopic pregnancy such as fallopian tube rapture which puts the woman at risk of failed future fertility and also recurrence of ectopic pregnancy. It is however important for women of reproductive age to be aware of the risk factors for ectopic pregnancy to help reduce the incidences of the condition. Early and full treatment of sexually transmitted infections is also very important since they are a risk factor to ectopic pregnancy. After treatment of pelvic inflammatory disease, it is important for the doctors to assess the extent of disease damage to the reproductive system and manage it properly to ensure that it does not leave the woman at risk of ectopic pregnancy. List of references Fernandez , H. et al. (2013). Fertility after ectopic pregnancy: the DEMETER randomized trial. Human Reproduction, 28:1247. Farquhar, C. (2005). Ectopic pregnancy. Lancet; 366:583. Lipscomb, G. Stovall, T. & Ling, F. (2000). Nonsurgical treatment of ectopic pregnancy. New England Journal of Medicine;343:1325–9 Timor-Tritsch I, et al. (1989). The use of trans-vaginal ultrasonography in the diagnosis of ectopic pregnancy. American Journal of ObstetGynecology;161:157–61. Schollmeyer, T. et al. (2013). Practical manual for Laparoscopic & Hysteroscopic Gynecological surgery. London: JP medical publishers ltd. Goodwin, T., et al. (2010). Management of Common Problems in Obstetrics and Gynecology. New York: John Wiley & Sons. Stabile, I. (1996). Ectopic Pregnancy: diagnosis and management. Cambridge University Press. Piasarska, M. & Carson, S. (1999). Incidence and risk factors for ectopic pregnancy. Clinical Obstetrics and Gynecology; 42:2. Kopani, F., Rrugia, A. & Manoku, N. (2010). Ectopic pregnancy comparison of different treatments. Journal of Prenatal Medicine, 4(2): 30–34. Bouyer, J. et al., (2003). Risk Factors for Ectopic Pregnancy: A Comprehensive Analysis Based on a Large Case-Control, Population-based Study in France. American Journal of Epidemiology, 157 (3): 185-194. Navarro, K. (2009). Prehospital management of obstetric complications. Retrieved from https://www.dshs.state.tx.us/ Read More