Ectopic pregnancy is a life-threatening aspect of pregnancy
that a woman goes through. Mostly occurs in more than hundred pregnancies and
led to approximately ten percent of those pregnancies end in death. It
commonly occurs as the result of tubular obstruction or blockage that prevents
normal passage of the fertilized ovum. Ectopic pregnancy is one of the
highest cases that play a role in woman’s fertility. Over the years, there
has been a tremendous technical advance in the medical field. The rapid
increases of ectopic pregnancy came about because of the many childbearing
women that undergo scarring of the fallopian tubes from surgeries,
inflammation, and pelvic infections. Those women who also receive many
reproductive techniques are prone to having an ectopic pregnancy.

Keywords:  ectopic, tubal, life-threatening, pregnancy

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Ectopic Pregnancy

According to (M. Selner & R. Nall, 2015), fertilization goes through
the process to help the egg travel throughout the uterus. The fertilized egg enters
the uterus to begin the development phase for the baby. In order for the woman
to be at risk for having an ectopic pregnancy, the woman egg never reaches the
uterus to be able to fully develop. Instead, the egg connects to the fallopian
tubes and other female reproductive organs. Therefore, the only way the
fertilized egg can survive is growing inside of the uterus.

Causes & Symptoms

There always been an unknown reason of what causes tubal
pregnancy; there have been many conditions that lead up to women
experiencing ectopic pregnancy (M. Selner & R. Nall, 2015). Although the
conditions may not seem as invasive, having any type of inflammatory female
organs or genetic abnormalities can mean life or death situation (M. Selner & R. Nall, 2015). There are quite a
few signs and symptoms that can have an impact on the female bodies such as
pelvic and abdominal pain and vaginal bleeding (McKinney, 2013, 2009, 2005, 2000). Some of these
symptoms can be the reason why it affects the fallopian tubes (McKinney, 2013, 2009, 2005, 2000). Research by (MedlinePlus, 2010) claimed that the
route in which the eggs travels is thru your tubes and attaches to your uterus.
However, if something is put in place to cause the egg to be slowed through the
tubes, it can lead to a terminated pregnancy. In which it stills may be from
having either endometriosis or scarring of other female organs (MedlinePlus, 2010). Research by (Osguthorpe, 1987) states that vascular
engorgement and edema occur because of the physiologies demands of the
growing embryo. Although the tube wall thickens, there is little decidua
response or muscular enlargement as is seen in a normal uterine pregnancy. As
the zygote tunnels thru the tube and it results in being progressively
distended, the danger of tubal rupture increases. Rupture generally occurs almost
a two months after implantation (Osguthorpe, 1987).

Risk Factors1

            Your
lifestyle can have a major impact on your body because of what you taking in.
In a manner where there is a case of sexually transmitted diseases or pelvic
inflammatory disease involved. Many other factors are the history of previous
tubal pregnancies, older than age 35 and other reproductive techniques (McKinney, 2013, 2009, 2005, 2000). According to (M. Selner & R. Nall, 2015) and (MedlinePlus, 2010) other risk factors
may include having the intrauterine device; multiple abortions; surgeries to
untie tubes to become pregnant; multiple sexual relations; and smoking
cessation. The classic triad of symptoms abdominal pain, amenorrhea, and
abnormal vaginal bleeding is not always present, and ectopic pregnancies
frequently are misdiagnosed (Osguthorpe, 1987). Women who experience an ectopic
gestation may report a delay or variation in their menstrual periods; however,
individuals with irregular periods may not be aware of any abnormality (Osguthorpe, 1987). Most patients
have light bleeding resulting in a dark red color. Profuse or bright red
bleeding is not common. The bleeding comes from uterine lining that is
due to degeneration and sloughing of the uterine decidua, since the fertilized
ovum is unable to support the endometrium hormonally (Osguthorpe,
1987).
HCG is usually lower in ectopic pregnancies than in uterine pregnancies
of the same gestational period (Osguthorpe, 1987).

Diagnosis & Treatment.

Being able to determine the best commentary is not that
simple as if receiving a physical examination. However, the doctor may perform
a few other known exams to diagnose a woman suspected of having an ectopic
pregnancy (M. Selner & R. Nall, 2015). The combined use of
a transvaginal ultrasound examination and determination of the beta-HCG level
usually results in early detection (McKinney, 2013, 2009, 2005, 2000). HCG is a hormone produced
normally when someone has become pregnant. An abnormal pregnancy suspected, only
if the blood levels are low (MedlinePlus, 2010). Another way to diagnose a woman with ectopic
pregnancy is performing a pelvic exam. The pelvic area may show some signs of
tenderness. A woman with a pelvic inflammatory disease is can be another way
used to shows in deranged pregnancy (Osguthorpe, 1987). Therefore, an unruptured ectopic
pregnancy is difficult to locate. Uterine enlargement, which can occur with intrauterine
pregnancies, may be evident. The last exam performed is a laparoscopy. Laparoscopy
is performed when symptoms and diagnostic tests do not provide a definitive
diagnosis. Laparoscopy is a prompt, effective means of diagnosis and eliminates
prolonged observation and unnecessary laparotomy solely for diagnostic purposes.
Laparoscopy also allows for the diagnosis of other conditions, if it is
ruled out (Osguthorpe, 1987). If severe symptoms start occurring,
such as unbearable pain or excessive bleeding, you have to undergo an emergency
surgery.

This type of
pregnancy put you at a monumental risk for the baby not able to fully develop. Therefore,
the mother might have to go thru a miscarriage or abortion to terminate the
pregnancy to save the mother life. Treatment options vary depending on the location of the ectopic
pregnancy and its development. If the ectopic pregnancy has not ruptured,
treatment may include surgery or medications that will have to end the
pregnancy itself. Medical management is most successful if the tube is intact,
the pregnancy is early, the size of the pregnancy is less than 3.5 cm, and the
fetus is not living (McKinney, 2013, 2009, 2005, 2000).

According to the
American Academy of Family Physicians, one common medication for this is
methotrexate (Rheumatrex). Methotrexate is an immunosuppressive drug that treats
and interferes with the growth of certain cells of the body. This drug can
cause severe birth defects that are given in early pregnancy. You will have
blood tests done because it treats certain blood cancers. When the blood tests
come back positive, you may have certain symptoms such heavy cramps and
bleeding and tissue passing (M. Selner & R. Nall, 2015).

If the woman has to
undergo surgery, the baby will be expelled and reconstruction of any
other internal damages. This procedure performed is laparotomy. If the surgery
is ineffectual, it will repeat with even larger laceration (M. Selner & R. Nall,
2015).
You will need emergency medical help, if the laceration breaks open.
Rupture can lead to bleeding and shock. Treatment for shock may include blood
transfusion; fluids inside vein; oxygen; warmth; and raising the legs (MedlinePlus, 2010). The doctor will
then have to remove the fallopian tubes (Osguthorpe, 1987).

Home care treatment
is another big concept once you leave the hospital. The main part to check for
will include different conditions that will lead to infections. Having
light bleeding or small blood clots are normal after surgery (M. Selner & R. Nall, 2015). Always be aware to
contact the health care provider when experiencing abnormal vaginal bleeding
and lower abdominal and pelvic pain.

Prevention & Outlook.

 Trying to avoid
the risks or causes is not always the option. Managing your lifestyle needs can
vary because of the factors that play a part in ectopic pregnancy  (M. Selner
& R. Nall, 2015). Most forms usually happen outside of
the tubes. Making sure you are getting checked regularly for certain infections
or diseases can somehow prevent you from being a candidate of a tubal pregnancy
 (MedlinePlus, 2010). 

Some women are
still able to have a healthy baby, even after they have an ectopic pregnancy.
On the other hand, many may not try again to get pregnant because it still puts
you at having another ectopic pregnancy. All of the factors that played an
important role before will increase even more with another pregnancy (M. Selner & R. Nall,
2015).
The long-term outlook after an ectopic pregnancy depends on your condition.  According to the American Pregnancy
Association, if both fallopian tubes are still intact, there may be a chance of
having pregnancy to term. Any preexisting conditions that may have affected you
before can affect you later on (MedlinePlus, 2010).

Conclusion.

 Nurses are important to
the healthcare team in the identification and management; however,
they also have a role in prevention and education (Osguthorpe, 1987). Knowledge of risk factors helps the
nurse counsel individuals who may be at increased risk for ectopic pregnancy. Nursing
should focus on preventing or identifying hypovolemic shock, controlling pain,
and providing psychological support for the those who have undergone
ectopic pregnancy (McKinney, 2013, 2009, 2005, 2000). Encouragement of
early prenatal care also can help decrease mortality. Nurses take into
consideration of being nonjudgmental to the fact that it is a difficult
situation to go thru. Showing your support early on and throughout the process
will help the mother. Ectopic pregnancies can lead to death. Ectopic
pregnancies result in pregnancy loss and not ever having children
again.