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7a Ectopic Pregnancy 异位妊娠, inhibit DNA synthesis - folic acid antagonist,…
7a Ectopic Pregnancy 异位妊娠
def: occurs when the fertilized ovum (zygote) is implanted
outside the uterine cavity
. -e.g. fallopian tube, ovary, abdomen, cervix
occurs before 13 weeks of gestation
risk factors
peritubal adhesion 肛周相连
previous ectopic pregnancy
chronic salpingitis 慢性输卵管炎
congenital defects of the fallopian tube 输卵管缺陷
previous tubal surgery 输卵管手术
multiple previous induced abortion人工流产
(IUD) Intra Uterine device
pelvic inflammatory disease
fertility drugs
smoking
pathophysiology
after the union of ovum and sperm, zygote begins to divide and grow
due to several factors, the zygote cannot travel through the length of the tube to the uterus
fertilization usually occurs at the distal third of the fallopian tube
implantation takes place at that area instead of the uterus
clinical manifestations
ectopic pregnancy
pain while urinating/ bowel movement
amnorrhea闭经
slight vaginal bleeding (spotting)
stabbing pain at the lower abdomen
ruptured ectopic pregnancy
shoulder & neck pain
vaginal bleeding
cramping pain over the pelvic region, lower back
hypovolemic shock & haemorrhage: pallor, rapid pulse, hypotension (decreased blood pressure), sweating, subnormal temperature (hypothermia), restlessness
diagnostic evaluations
transvaginal / abdominal ultrasound
FBC (full blood count: Hb, total white blood count, platelets)
blood for hCG (human chorionic gonadotrophin)
GXM (group & cross match): blood transfusion
urine for hCG (pregnancy test)
Nursing Diagnosis
BLEEDING related to rupture of the fallopian tube
ANXIETY related to effect of surgery on fertility
FLUID VOLUME DEFICIT related to bleeding from a ruptured ectopic pregnancy
GRIEVING related to pregnancy loss
LOWER ABDOMINAL PAIN related to inflammation / ruptured of the fallopian tube
managment
medical
Surgery - Salpingostomy (incision in tube)输卵管造口术, Salpingectomy (removal of tube)输卵管切除术
Treatment for shock - fluid replacement, blood transfusion, provide warmth, oxygen
Medical therapy -
Methotrexate
: inhibit the cell division in the embryo, allows it to be absorbed
surgical
Salpingostomy, Salpingectomy
Complications
recurrent of ectopic pregnancy
hypovolemic shock
ruptured ectopic pregnancy
immediate nursing interventions
monitor vital signs every 15 minutes & temperature 4 hourly - increase pulse rate & drop in blood pressure indicate hypovolemic shock and infection
administer IV Normal saline if pt is NBM - replace blood and fluid loss
monitor the intake & output - monitor renal function and hydration status
monitor pad chart - note the colour and amount of blood loss
observe for s/s of hypovolemic shock - prevent pt compromised
administer o2 if necessary - increase the amount of o2 saturation
provide emotional support - allay fear and anxiety
pain management - promote comfort and relieve pain
blood transfusion if excessive bleeding - replace blood loss
prepare for surgery if there is excessive bleeding due to ruptured fallopian tube - prevent pt compromised
inhibit DNA synthesis - folic acid antagonist
Methotrexate: drug for rheumatoid arthritis类风湿关节炎