Problems of Ectopic Pregnancy - Essay Example

Most healthy women of reproductive age ovulates one egg every month (Goldman 2006). This egg (ovum) usually follows a path down the fallopian tube where it will settle down and awaits fertilization thru introduction of a sperm cell. Normally, the fertilized ovum also known as zygote will make its way down the fallopian tube and enters the uterus in 3-5 days. This zygote will securely implant itself in the wall of the uterus and grow into an embryo ('Ectopic Pregnancy'). However, when the fertilized ovum implants outside the uterus and develop there, this is when ectopic pregnancy comes in (Ural 2004). The word ectopic is defined as "in an abnormal place or position" ('Ectopic Pregnancy'). Ectopic pregnancy occurs in various places such as cervix, ovaries, peritoneal cavity, or interstitial tissue but more than 96% of all ectopic cases occur in the fallopian tubes (McCulloch 2007 and Togas 2006). This tube is in-charged of carrying fertilized ovum from the ovary down to the uterus ('Ectopic Pregnancy'). However, when the fertilized ovum implants and grows inside the fallopian tube, this will weaken the wall and eventually rupture the tube (McCulloch 2007). A ruptured ectopic pregnancy is a true medical emergency. It is the leading cause for 10 to 15 percent of all maternal deaths (Tenore 2000). In 2001, the Confidential Enquiry into Maternal Deaths (CEMD) 2001 reported that there are 5 women who die every single year from ectopic pregnancy. The report also revealed that one of the main reasons of maternal death was due to substandard care and the failure to detect early ectopic pregnancy. Indeed, it is important to be aware of the predisposing risk factors as well as investigate early signs and symptoms of ectopic pregnancy to prevent further mortality rates ('The Ectopic Pregnancy Trust'). There are a lot of predisposing risk factors associated with ectopic pregnancy and this include current or previous pelvic infection, primary infertility, history of ectopic pregnancy, prior tubal surgery, endometriosis, a history of abdominal or pelvic surgery, acute appendicitis, in-utero exposure to DES, vaginal douching, smoking, progestin pills, and use of an intrauterine device (IUD) (Tenore 2000 and Tay et al. 2000). In addition, assisted reproductive technology may compromise tubal structure and function which increases the risk of ectopic pregnancy. These include ovulatory induction medications, and in-vitro fertilization, or gamete intrafallopian transfer (McCulloch 2007). Here is a case study describing the experience of having an ectopic pregnancy. A 33year old female had been trying to conceive for four years, became pregnant with the help of fertility treatment (do not have details). At five weeks into her pregnancy she began to have one-sided pain and slight spotting. She was seen by her own consultant, follow-up tests were given, pregnancy test which was positive, a beta-Hcg test and a scan which showed her uterus to be empty. Later the same afternoon this lady was taken to the operating theatre and anaesthetised with cricoid pressure because she had eaten. A laparoscopy was carried out which show that she had ruptured tube. She lost her baby and one of fallopian tubes, which reduced her conceiving again by approximately 50% because she only has one fallopian tube now. This lady life was saved, but she was in grief for her lost child. She stays in the care of the hospital for two days, before going home under the care of the consultant. Her care has not been carried out by the NHS. This was her wishes. According to biopsychoscocial model, the patient's perception of ectopic pregnancy arises from a combination of her biological, emotional state, and concomitant social determinants. This model explains the phenomenon of signs and symptoms associated with ectopic pregnancy shifting to the patient's underlying psychological or social concerns (Geri et al. 2000 and Lakhan 2006). In the case study above, the patient was described to receive fertility treatment which is one of the predisposing factors of ectopic pregnancy. The presence of any risk factor accompanied by any signs and symptoms are the biomedical aspect of the patient, where it should alert the nurse to the possibility of ectopic implantation. In the first trimester, clinical signs and symptoms of ectopic pregnancy include abdominal pain or vaginal bleeding (Potter 2005), but these are not specific symptoms only for ectopic pregnancy. Signs and symptoms vary with the stage of pregnancy, ranging from minimal discomfort to severe abdominal pain. It is essential that diagnosis should be accurate and timely to preserve future fertility and reduce maternal morbidity (Lawlor et al. 1993 and McCulloch 2007). After observing the biomedical signs and symptoms associated with ectopic pregnancy it is crucial to confirm an early diagnosis. First, the doctor must determine that the patient is pregnant and that the location of the embryo is outside the uterus. Several laboratory tests of the patient's blood provide information for diagnosis. The most useful laboratory test in the early stages is the measurement of the human chorionic gonadotropin (hCG) level in the patient's blood serum. In normal pregnancy, the level of this hormone doubles about every 2 days during the first 10 weeks. On the other hand, in an ectopic pregnancy the rate of the increase is much slower and the low hCG for the stage of the pregnancy. This reveals a strong indication that the pregnancy is abnormal. The level is usually tested several times over a period of days to determine whether or not it is increasing at a normal rate ('Ectopic Pregnancy'). After detecting the hCG levels, diagnostic test could be followed by an ultrasound scan. The scan detects whether or not the pregnancy is ectopic. The doctor should be able to see whether or not there is a fetus developing in the uterus after 5 weeks of gestation ('Ectopic Pregnancy'). Another diagnostic test is laparoscopy, this will enable the doctor to see the patient's reproductive organs and examine an ectopic pregnancy. In this technique, a hollow tube with a light on one end is inserted through a small incision in the abdomen and internal organs can be observed. When a laparoscopy is done to visualize the ectopic pregnancy, the scope can be fitted with surgical tools to remove the ectopic mass. This affected fallopian tube can be repaired or removed as necessary ('Ectopic Pregnancy'). After laparoscopy and the detection of ruptured tube, the patients shall undergo a surgical incision into the abdomen, or laparotomy. This is performed to stop the immediate loss of blood and to remove the embryo. Every effort is made to preserve and repair the injured fallopian tube. However, if the fallopian tube has already ruptured, repair is extremely difficult and the tube is usually removed ('Ectopic Pregnancy'). Since the patient has taken meals, cricoid pressure is used to temporarily occlude the upper end of the esophagus. This maneuver is often used to decrease the chance of stomach contents being aspirated into the lungs during emergency anesthetic induction. This procedure becomes the standard care during rapid sequence induction or emergency cases (Landsman 2004). Establishing a clear diagnosis of ectopic pregnancy can significantly impact future patient care because a history of a tubal pregnancy has negative implications for future fertility and may prompt unnecessary use of artificial reproductive techniques (McCulloch). The earlier an ectopic pregnancy is diagnosed and treated, the better the outcome. The chances of having a successful pregnancy are lower after an ectopic pregnancy, but depend on the extent of permanent fallopian tube damage. If the tube has been spared, chances are as high as 60% but after the removal of one tube only 40% chances of successful pregnancy ('Ectopic Pregnancy'). It is not only important to note the biomedical aspect of ectopic pregnancy but also to consider the psychosocial aspect that women experience in ectopic pregnancy. Some patients experience grief and feelings of guilt, anger, frustration, or failure. Feelings of loss are similar to those of patients who suffer a miscarriage. Women who experience ectopic pregnancy may be at increased risk for depression or anxiety and may need referral for psychiatric treatment and/or bereavement counseling. These women need support, empathy, and time to express their feelings and to validate their experiences. They may have questions related to the prognosis of future pregnancies and the answer must be clear, honest, and consistent. The nurse can help direct the prospective parents toward reliable sources of information and supportive counseling (McCulloch 2007). Nurses practicing in private obstetric or public health clinics, emergency departments, and surgical suites often encounter patients with ectopic pregnancies. It is important that nurses should have a comprehensive and thorough knowledge regarding ectopic pregnancy and its treatment as this can augment nurses' participation in primary and secondary interventions. Accurate and prompt interventions can be potentially life saving. Nurses can be instrumental in helping to minimize the incidence of ectopic pregnancy through early diagnosis and aggressive patient education (McCulloch 2007). Overall, nurses play a critical role in the biopsychosocial aspect of the patient, prevention and early detection of ectopic pregnancies. Astute nursing assessment skills, the ability to recognize critical symptoms, familiarity with current diagnostic measures can enhance the accuracy of differential diagnoses as well as dealing with psychological emotion and social concerns of the patient. Timely diagnosis can allow for more conservative treatment, preserve fertility, reduce anxiety, and prevent untoward social interaction among families (McCulloch 2007). Nurse involvement in preventive programs, clinical research, counseling and advocacy for policy change may help reduce ectopic pregnancy mortality rates and could lead to better prevention of this increasingly common problem (Berstein 1995). Thus, nurses play a critical role in the healthcare setting by being involved in early detection, assessment, support, research and counseling addressing the biopsychosocial aspects of ectopic pregnancy. References Berstein, J 1995, 'Ectopic pregnancy: a nursing approach to excess risk among minority women', J Obstet Gynecol Neonatal Nursing, vol. 24, no. 9, pp. 803-10. 'Ectopic Pregnancy' 2007, viewed 20 January 2007, http://health.enotes.com/medicine-encyclopedia/ectopic-pregnancy/print Geri, D et al. 'Chronic Pelvic Pain in the Adolescent', The Female Patient, viewed 31 January 2007, http://www.obgyn.net/femalepatient/default.asppage=cpp-adol_tfp Goldman, K 2006, 'The Basics of Ovulation', viewed 31 January 2007, http://infertility.about.com/od/ovulation/a/ovbasics.htm Hein, C and Owen, H 2005, 'The effective application of cricoid pressure', Journal of Emergency Primary Health Care, vol. 3, issue 1-2. Lakhan, S 2006, 'The Biopsychosocial Model of Health and Illness', viewed 31 January 2007, http://cnx.org/content/m13589/latest/ Landsman, I 2004, 'Cricoid Pressure: Indications and Complications', Pediatric Anesthesia, vol. 14, pp. 43-47. 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