Running Head: ECTOPIC PREGNANCY

NURS 252-ONC: Complications in Ectopic Pregnancy

Danna Gonzalez
Humber College

ECTOPIC PREGNANCY

2
Introduction

Ectopic pregnancy (EP) is a condition that occurs when a fertilized egg is implanted
outside of the uterus. In most cases, the fertilized ovum implants in the fallopian tube causing the
wall of the tube to stretch as the zygote begins to develop into a blastocyst (Lewis et al, 2014,
p.1547). Ectopic pregnancies are difficult to diagnose because the signs and symptoms are often
similar to an individual experiencing common effects of early intrauterine pregnancy: abdominal
or pelvic pain, irregular vaginal bleeding, amenorrhea, morning sickness, breast tenderness, and
syncope (Horne et al, 2012, p. 1278). When the fallopian tube becomes too distended and
ruptures, blood leaks into the abdominal cavity, putting the individual at risk for hemorrhage and
hypovolemic shock in addition to the intense pain that they may already be feeling (Lewis et al,
2014, p. 1547). Because factors that increase the risk of ectopic pregnancies include individuals
with a history of smoking, pelvic inflammatory disease, a previous ectopic pregnancy, use of an
intrauterine device, and unsuccessful birth control, it is important that sexually active females are
made aware of this possible complication when they find out that they are pregnant (Lewis, et al,
2014, p.1547).
Nursing Diagnoses
In the case of the 15 year-old teenager who was admitted into the post-surgical unit after
experiencing complications in ending her ectopic pregnancy, the chosen priority pathway
identified begins with the risk for future unplanned ectopic pregnancies. When a female
individual decides to terminate an ectopic pregnancy, surgical interventions include either the
removal of the trophoblast by salpingotomy or the removal of an entire fallopian tube by
salpingectomy (DHooghe & Tomassetti, 2014, p. 1444).

ECTOPIC PREGNANCY

Even though the case study does not provide information on which surgery may have
been performed during the termination of the clients ectopic pregnancy, both of the surgical
interventions present risks for another EP in the future. For instance, DHooghe and Tomassetti
(2014) noted a study comparing the two surgical procedures, and found that the growth of
trophoblasts were more likely to occur after a salpingotomy procedure was implemented
compared to a salpingectomy (p. 1444). This means that the female client in the case study is at
risk for a future pregnancy simply because she had to terminate her most recent one.
Clinical Manifestation/ Complication
The priority clinical manifestation identified in the pathway was the recent complication
to the termination of ectopic pregnancy the client had. Because there was no information
provided relating to what type of complication the teenager experienced, it is important to
consider that of all the other possible risk factors in her history, the risk for a future EP will exist
essentially because of her most recent termination. From a study conducted by Lawani and
colleagues (2013) in Nigeria, it was found that only 4.3% of the 4610 gynaecological admissions
involved ectopic pregnancies despite having no history of a previous EP (p. 516). The percentage
of incidence may be small, but because 95% of those ectopic pregnancies became ruptured,
mothers were often at life-threatening risk for large amounts of blood loss (Lawani et al, 2013, p.
516). This not only puts the teenage client at risk for hypovolemic shock, but also having to go
through the ordeal again in the future.
The case study also mentioned that the client was scheduled to meet with a counsellor in
regards to pregnancy prevention methods, but it is unknown whether or not she was already on
any form of contraceptives. Although forms of birth control help prevent unplanned pregnancies,

ECTOPIC PREGNANCY

those that fail often result in ectopic pregnancies (Li et al, 2014, p. 2). This means that the client
will generally be at a higher risk for another EP despite her use of contraceptives.
Interventions
Procedures to implement include immediate interventions that involve ensuring the client
does not experience any complications during her stay at the post-surgical unit, which can
prevent her from being discharged the next day. For starters, assessing the clients vital signs, and
input and output values to monitor for any signs of complications. When a client has lost too
much blood from a ruptured fallopian tube or ovary, she may experience haemorrhage or shock
because of the drop in blood pressure and volume (Lawani et al, 2013, p. 517). Along with a
possible blood transfusion, the client may need iron supplementation to aid in delivering oxygen
to her tissues, and to prevent her from becoming anaemic (Lawani et al, 2013, p. 516).
Depending on the clients input and output, and hydration status which are being closely
monitored the client may have to be encouraged to drink fluids to compensate for the blood
loss (Lewis et al, 2014, p. 1547).
Assessment and documentation of a clients historical data often begins when a client
first comes in contact with a healthcare provider for admittance. The nurse should also double
check the history records to determine whether or not the client smokes cigarettes, and how
many packs a day she smokes. Cigarette smoking not only poses as a risk for a future ectopic
pregnancy, but it also puts the client at risk for post-operative complications (like hypoxemia)
due to mucous secretions that may be required to cough out in order to clear the airway (Potter &
Perry, 2014, p. 1333). Intrauterine devices and the failure to properly use oral contraceptives
increase the risk of future ectopic pregnancies, which may be important for the nurse or
counsellor to discuss with the client (Li et al, 2014, p. 13). The client must also be made aware of

ECTOPIC PREGNANCY

the past medical histories she may have had that increased her risk for an ectopic pregnancy. One
of the most common risks is pelvic inflammatory disease due to a tubal infection from
chlamydia, a sexually transmitted disease (Kirk & Bourne, 2011, p.207). With successful
treatment, teaching, monitoring, and caring for the client, the risk for another ectopic pregnancy
will hopefully be reduced.
Conclusion
Ectopic pregnancy occurs within a small percentage of the population, but it is still life
threatening nonetheless. Although teen pregnancy rates have been gradually decreasing
throughout the years with the use of contraceptives, it is the failure or type of contraceptives that
put women at risk for ectopic pregnancy (Ahern & Bramlett, 2016, p. 25). Because most ectopic
pregnancies result in ruptured fallopian tubes, surgical intervention and fluid replacement is
always necessary to prevent shock (Lawani et al, 2013, p.516). According to the teenage client in
the post-surgical unit, it was imperative to assess and monitor treatments that may have been
ordered for her. In addition to the blood transfusion and intravenous fluid replacements the client
may have needed, it was also important to note her medical history and whether or not she used
contraceptives, which can increase her chances for future ectopic pregnancies (Li et al, 2014, p.
13). The interventions identified may have been specific to individuals who experienced
complications in ectopic pregnancy, but it is important to note that individual women who are
suffering from this type of pregnancy will not all be receiving the same treatment; each care plan
will always be built based on the needs of each client.

ECTOPIC PREGNANCY

6
Reference:

Ahern, N. R., Bramlett, T. (2016). Update on teen pregnancy. Journal of Psychosocial Nursing,
54(2), 25-28.
DHooghe, T. & Tomassetti, C. (2014). Surgery for ectopic pregnancy: making the right choice.
The Lancet, 383, 1444-1445.
Horne, A. W., Barnhart, K., Bourne, T., Messinis, I. Ectopic pregnancy. Clinical Chemistry,
59(9), 1278- 1285.
Kirk, E., Bourne, T. (2011). Ectopic pregnancy. Obstetrics, Gynecology and Reproductive
Medicine. 21(7), 207-211.
Lawani, O. L., Anozie, O. B., Ezeonu, P. O. (2013). Ectopic a pregnancy: a life-threatening
gynaecological emergency. International Journal of Womens Health, 5, 515-520.
Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., Bucher, L., Camera, I.M. (2014). MedicalSurgical Nursing in Canada: Assessment and Management of Clinical Problems (3rd
Ed.). Toronto, ON: Elsevier Canada.
Li, C., Zhao, W., Meng, C., Ping, H., Qin, G., Cao, S., Xi, X., Zhu, Q., Li, X., Zhang, J. (2014).
Contraceptive use and the risk of ectopic pregnancy: a multi-center case-control
study. PLoS ONE, 9(12), e115031. Doi: 10.1371/journal.pone.0115031.
Potter, P. A., Perry, A. G. (2014). Canadian Fundamentals of Nursing (5th ed.). Toronto, ON:
Elsevier Canada.