ECTOPIC_PREGNANCY_disorders of reproductive organs_1_(3)[1].ppt

ECTOPIC_PREGNANCY_disorders of female reproductive organs

1. MEDICAL SURGICAL
NURSING II
DISODERS OF THE FEMALE
REPRODUCTIVE SYSTEM

2. ECTOPIC PREGNANCY
PRESENTED TO 2023 COHORT
5
TH
SEPTEMBER, 2024
BY KAREN NSANDU GIVA

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4. BROAD OBJECTIVE
 LEARNERS SHOULD GAIN
KNOWLEDGE, SKILLS AND ATTITUDE
ON ECTOPIC PREGNANCY
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5. SPECIFIC OBJECTIVES
BY THE END OF THE LESSON, LEARNERS SHOULD BE ABLE
TO:
1. DEFINE ECTOPIC PREGNANCY
2. EXPLAIN RISK FACTORS
3. DESCRIBE PATHOPHYSIOLOGY
4. LIST SYMPTOMS
5. DESCRIBE MANAGEMENT USING NURSING PROCESS
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6. DEFINITION
•Ectopic pregnancy occurs when a fertilized
ovum ( a blastocyst) becomes implanted on
any tissue other than the uterine lining.
•A pregnancy in which the fertilised egg
implants outside the uterus.
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7. CT..
•NOTE: ECTOPIC PREGNANCY IS THE
LEADING CAUSE OF PREGNANCY RELATED
DEATHS IN THE FIRST TRIMESTER
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8. INCIDENCE
•The incidence is approximately 20 per
1000 pregnancies (1%~2%)
•More than 90% of EP are tubal
pregnancy
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10. CONT..
Sites For Ectopic Pregnancy include:
 Cervix
 Ovary
 Infundibular
 Tubal ( Ampulla)
 Abdominal tissue
 Tubal ( Isthmus)
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11. SITES OF ECTOPIC PREGNANCY
1. TUBAL PREGNANCY
•In this condition pregnancy occurs in the fallopian
tube.
•Reasons - chronic PID, tubal plastic operations,
ovulation induction and IUD use.
•Early diagnosis & therapy reduce maternal
deaths.
• Incidence varies from 1 in 300 to 1 in 150
deliveries
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12. SITES FOR ECTOPIC PREGNANCY
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13. ETIOLOGY
•Infections
•Congenital factors
•Salpingitis isthmica nodosa of the tube- is a
condition of nodular thickening of the proximal
fallopian tube
•Failed contraception - A possible explanation is
that progesterone modifies tubal function,
reduces contractility and thus slows the rate of
ovum or blastocyst transport.
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14. CT…
•Previous tubal surgery
•Assisted reproductive technology
•Previous ectopic
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15. TYPES OF ECTOPIC PREGNANCY
There are basically three types of ectopic pregnancy
1.ACUTE ECTOPIC PREGNACY
•An acute ectopic is fortunately less common (about
30%) & it is associated with cases of tubal rupture
with massive intraperitoneal haemorrhage.
•Mode of onset – acute abdominal pain (100%)
amenorrhea (75%)
•vaginal bleeding (70%).
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16. CT..
2. Unruptured tubal ectopic pregnancy
• patient has history of abnormal bleeding and/or
abdominal pain.
• they may also complain of delayed period or
spotting with features suggestive of pregnancy.
•Complain of sided flank pain
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17. TYPES
•On bimanual examination: uterus is usually soft
showing evidence of early pregnancy.
•A tender mass may be felt through one fornix
separated from the uterus.
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18. TYPES CT..
3. Chronic or old ectopic
•onset is gradual. Pt had previous attacks of acute pain from
which she had recovered or she had chronic features from
the beginning.
•Chronic or old ectopic symptoms • amenorrhoea • pain •
irregular vaginal bleeding • vasomotor symptoms(hot flashes)
• other symptoms: • features of bladder irritation like dysuria
• frequency or even retention of urine • rise of temperature
due to infection
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19. RISK FACTORS
•Salpingitis
•Peri-tubal adhesions ( after pelvic infection,
appendicitis)
• Structural abnormalities of the fallopian tubes
•Previous ectopic pregnancy
• previous tubal surgery
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20. RISK FACTORS CT…
•Multiple previous induced abortions
particularly if followed by infection
• Tumours distorting the tube
•Intra uterine devices
• Use of progestin only contraceptives.
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21. PATHOPHYSIOLOGY
•As most ectopic pregnancy initially implant in
a fallopian tube, the blastocyst burrows into
the epithelium of the tubal wall, tapping
blood vessels by the same process as normal
implantation into the uterine endometrium
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22. CONT..
The environment is different because
There is a decreased resistance to the invading
trophoblast tissue by the fallopian tube.
 Decreased muscle mass lining the fallopian tubes
 Blood pressure in the tubal arteries is higher than
in the uterine arteries
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23. CONT

Limited decidua reaction hence less human
chorionic gonadotropin (HCG) and signs
of pregnancy are limited
- Depending on gestational age , the
pregnancy ends in rupture or spontaneous
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24. EARLY SYMPTOMS
•Vaginal Bleeding
• Cervical Motion Tenderness
• Palpable Pelvic Mass
• Haemorrhagic Shock Occurs After
Rupture
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25. MANAGEMENT
•Emergency that requires prompt
intervention to prevent life-threatening
complications such as haemorrhage and
shock.
•Here's a general outline of the
management approach:
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26. MANAGEMENT CT..
Initial assessment and stabilization:
•Check the patient's vital signs including blood
pressure, heart rate, respiratory rate, and oxygen
saturation.
•Assess the patient's level of consciousness.
•Initiate appropriate monitoring, including
continuous cardiac monitoring and pulse oximetry.
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27. CT..
•Fluid resuscitation:
•Start intravenous (IV) access with large-bore catheters.
•Administer crystalloid fluids rapidly to restore intravascular
volume and stabilize blood pressure.
•Blood transfusion:
•If the patient is actively bleeding and hemodynamically
unstable, transfuse blood products as necessary (packed
red blood cells, fresh frozen plasma, platelets) to correct
coagulopathy and maintain tissue perfusion.
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28. CT..
•Pain management:
•Provide adequate pain relief using analgesics
such as opioids (e.g., Morphine) as needed only
when the BP is stabilised .
•Ultrasound examination:
•Perform a bedside ultrasound to confirm the
diagnosis of ectopic pregnancy, assess for the
presence of intra-abdominal bleeding, and
determine the extent of hemoperitoneum.
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29. CT..
SURGICAL INTERVENTION:
•Emergency laparotomy or laparoscopy is
typically required for definitive management.
•Do emergency pre-op care
•Stabilise the patient before taking her to OT
•Make sure she or family understand that they
are going to take out the F. tube
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30. CT
•Intraoperatively, the surgeon will identify and
control the source of bleeding, evacuate the
hemoperitoneum, and remove the ectopic
pregnancy (salpingectomy or salpingostomy).
MEDICAL MANAGEMENT (ADJUNCTIVE):
•where pt is stable, medical management with
methotrexate- it may be considered for select patients
with unruptured ectopic pregnancies and stable
hemodynamics.
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31. CT
•This drug stops cells from growing, which ends
the pregnancy.
•The pregnancy then is absorbed by the body
over 4–6 weeks. This does not require the
removal of the fallopian tube.
•This option is not appropriate for ruptured
ectopic pregnancies or hemodynamically
unstable patients.
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32. CT..
•POSTOPERATIVE CARE:
•After surgery, closely monitor the patient's vital
signs, haemoglobin levels, and signs of ongoing
bleeding.
•Provide appropriate pain management and
supportive care.
•Counsel the patient regarding follow-up care,
including monitoring for signs of complications
and the need for contraception.
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33. CT..
Psychological support:
•Ectopic pregnancy and its management can be emotionally
distressing for patients.
•Offer psychological support and counselling as needed.
•Follow-up:
•Arrange for close follow-up with the patient to monitor
recovery, assess for any complications, and provide long-term
management if necessary.
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34. CT
•Consider the patient’s nutritional needs
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35. QUESTIONS
THE END
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