LIST B PERSPECTIVE : Impact on individual patient or community
Ectopic pregnancy occurs when a fertilized egg implant at any site other than the normal uterine location. This is common in 1% of pregnancies. (kumar) Late diagnosis and treatment my lead to the death of the fetus.(1) The most common site for ectopic pregnancy is fallopian tube ( approximately 97.7%), with 80% usually occurring in the ampulla followed by isthmus (12%),fimbrae (5%), cornua (2%) and interstitia (2-3%).
Sites and frequencies of ectopic pregnancy. By Donna M. Peretin, RN. (A) Ampullary, 80%; (B) Isthmic, 12%; (C) Fimbrial, 5%; (D) Cornual/Interstitial, 2%; (E) Abdominal, 1.4%; (F) Ovarian, 0.2%; and (G) Cervical, 0.2%.
There are many risk factors that can lead to ectopic pregnancy, such as previous history of ectopic pregnancy, tubal damage, previous genital infections, multiple sexual partners and the usage of intrauterine device (IUD). Classic triad of ectopic pregnancy includes vaginal bleeding, amenorrhea and abdominal pain. If patient complains of any of this symptom during pregnancy, immediate investigations should be done. There are varieties of test that can be used to detect ectopic pregnancy. These include serum progesterone level,beta human chrionic gonadotrophin level ( beta- HCG) and transvaginal ultrasound. Trasvaginal ultrasound is the preferred test, as study have shown it to have a sensitivity and specificity of 90% and 99.8% respectively, with positive predictive value of 93% and negative value of 99.8%. (4)
Emotional Impact
Ectopic pregnancy diagnosis usually comes in as a surprise for the patient. It is emotionally traumatic as the patient often receives the news a few weeks after their pregnancy confirmed. This may lead to...
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...e is pregnant. However, she would be in dilemma thinking what would happen next? Will she be able to get pregnant this time? Or she might get an ectopic pregnancy again due to her previous history? This is because the risk of ectopic pregnancy increases if the patient had previous ectopic pregnancy. And in the case of Ms B, she had previous history of ectopic pregnancy in 2008 as well as 2010. Salpingectomy, removal of a fallopian tube, also increases the recurrence of ectopic pregnancy in the future. Therefore, this is one of the biggest worried for Ms B when she got pregnant recently. She was hoping that everything would be fine this time, but the results turned her down again. Morever, several studies have shown that the risk of ectopic pregnancy increases with maternal age. Ms B is 39 this year and her chances of getting pregnant are getting lower year by year.
Gaufberg, S. V. (2011, May 19). Emergent Management of Abruptio Placentae. Retrieved May 06, 2013, from Medscape Reference: http://emedicine.medscape.com/article/795514-overview#a1
Estimate frequency of multiple conceptions, Gestational Diabetes Mellitus, Pregnancy Induced Hypertension, Pre-eclempsia, preterm delivery and different modes of delivery in these pregnancies.
Deering, S.H. (2004). Abruptio placentae. Department of obstetrics and gynecology: Madigan army medical center, 2, 3.
Obstetric Ultrasound -- a Comprehensive Guide to Ultrasound Scans in Pregnancy. Mar. 2006. Web. 13 Apr. 2011. .
Getahun, Darios, Yinka Oyelese, Hamisu M. Salihu, and Cande V. Ananth. "Previous Cesarean Delivery and Risks of Placenta Previa and Placental Abruption." Obstetrics & Gynecology 107.4 (2006): 771-78. Print.
Step 1: patient education. The information that is given to the patients should be accurate, thorough, and easy to understand. We need to discuss the options with Gwen and Nicole. Apparently, they have the choice of termination or continuation of the pregnancy. If they choose to continue the pregnancy, they have the option of keeping the baby or putting it up for adoption once it’s born. In order to make an informed decision of whether to keep the baby or not, the couple need to have a comprehensive understanding of the medical conditions that the baby may have if it’s born, the responsibilities that they will face to take care of the baby, and the possible impacts of those responsibilities on their relationship and family life. The doctors and nurses have the responsibilities to deliver the information, help the couple to understand the situation, and answer any questions that they have. As nurses, we need to be unbiased and non-judgmental. Support the couples’ decision anyway we can. Ideally, information should be delivered
As for the concern with genetic abnormalities a process called Amniocentesis can be performed before the sixteenth week into pregnancy. It is suggested that this screening be done sooner in the pregnancy. Amniocentesis is a fetal screening process in with they take fluid from your amniotic sac and derive cells from the fluid and make a culture out of the cells. You should consider this as the doctors can then examine the culture to indicate genetic or chromosomal abnormalities. I will forewarn you that it does contain the risk of causing a miscarriage however. Do to the fact that you are conceiving at this age it is recommended that you have some sort of screening done and in fact its quite the norm for women approaching towards their forties to have it done. There is a procedure that can be done later on in the pregnancy but it has a higher miscarriage risk. If you and your doctor come to the conclusion that this is not the route you want to go there is a blood test that can be done on both of you to detect neural tube defects like Spina Bifida and certain chromosomal abnormalities. This process is called alpha-fetoprotein. If you want to eliminate any extra miscarriage risk added from amniocentesis then you should opt to talk to your care physician about the latter of the two
..., it is necessary to describe them in detail to the patient and to give a prognosis, as far as available medical knowledge will allow, regarding the outcome of pregnancy and postnatal development. To assist the patient in making a decision on the disposition of the pregnancy, prognostication should include medically documented risk figures. Ethically, pregnancy termination should not be recommended made to the patient and her family and significant others. This option should be discussed, but the ultimate decision of whether to continue the pregnancy should be left to the patient and her family and significant others. Furthermore, I think, it is better to refer her to the teratogen or genetic counselor to help her by providing the patient with as much information as possible and encourage her to make her own decision regarding whether to continue the pregnancy.
medicines to cause a miscarriage or by surgery, where the pregnancy is out of the uterus. The
There are many risks that come along with having an abortion that the patient learns about before having the operation ("Abortion"). Cancer is one of the risks. Women with a history if one abortion face 2.3 times higher risk of getting cervical cancer and when the woman has had two or more abortions, the risk rises to 4.92 times. These increased cancer rates for post-abortion may be linked to the disruption of the hormonal changes or stress on the immune system ("Abortion"). Another risk is uterine perforation, in which two to three percent of all abortion patients suffer from, though most go undiagnosed. Damage to the uterus can lead to different problems later in life with pregnancies that can cause fetal malformation, prenatal death, and excessive bleeding during labor ("Abortion").
For centuries there has been a medical epidemic that has plagued expecting mothers around the world. Considered for so long to be simply a woman’s issue, men remained unconcerned and distant—if they even knew as often they were never told. Most everyone has heard whispers of it, but until recent years the medical and psychological communities did not recognize the lasting implications of this occurrence. Now as couples break historical norms and become more egalitarian-based, this issue is one that not only affects women, but their partners also.
McCrae, R.K. (December 4, 2010). “Thrombocytopenia in Pregnancy.” ASH Education Program Book: doi: 10.1182/asheducation-2010.1.397 vol. 2010 no. 1 397-402
eclampsia in a pregnant woman can put her and her unborn child at risk. A risk
Each year in the United States there are six million child births. Of the six million births in the United States 12,000 are said to be due to ectopic pregnancies. One in fifty women are likely to have an ectopic pregnancy (Diagnostics, Pregnancy). An ectopic pregnancy is a complication within the first trimester of pregnancy and normally symptoms begin to occur between the five to fourteen week periods (Diagnostics). Ectopic means “in an abnormal position” (Ectopic). An ectopic pregnancy is when the ovum is fertilized and begins to develop somewhere other than the uterus.
"Transactions of the Washington Obstetrical and Gynecological Society."Google Books. N.p., n.d. Web. 20 May 2014.