OBSTETRIC EMERGENCIES

FIRST – TRIMESTER PREGNANCY

EMERGENCIES

BY
WAGIYO,Skp.,M.Kep
 ECTOPIC PREGNANCY
I. Definition
1. Ectopic pregnancy occur when the
fertilized ovum implantation
enywhere other then in the
endometrium of the uterine cavity.
2. Such as in the fallopian tube, the
ovary, the cervix or the abdominal
cavity and begins to grow and
possibly rupture
3. Rupture usuallty occurs after the twelfth
week of pregnancy. Ninety – five percent
of all ectopic pregnancy involve of the
falopian tubes.
4. Ectopic pregnancy is one of the major
causes of the maternal death because
involves the rupture of a highly
vascularized area.
5. Death is usually the result of the
hemorrhage.
6. Women with rupture ectopic pregnancies
are often see in the emergencie
department.
 PREDISPOSING FACTORS
 Tubel infections
 Adesions from previous surgery
 Tubal ligations
 Possibly the presence of the intrauterine
devices.
 The most common site for tubal
implatations is the ampulla, followed by
the isthmus.
 Ektopic pregnency is condition that may
Confuse the best diagnostician.
BEING THE GREET IMITATOR IT MAY
BE MISTAKEN.

 For a ruptured ovarian cyst.

 Appenducitis.
 Pelvic imflamatori disease (PID).
 Incomplete abortion.
 Pelvic pain and vaginal bleeding.
 Kehr’s sign –radiating shoulder pain that
occur when the diapragm is irritated from
blood loos in the peritoneum.
 ECTOPIC PREGNANCIES
MANIFESTATION
 Acute (or ruptured).with
intraperitoneal
hemorrhage
 Acute pain ,and shoch
,and chronic(or
unruptured),with less
pain
 No shock in either case
 vaginal bleeding may
be abseent.
 ACTIVITIES NURSE
1. The nurse should place her in
trendelenbrug `s position .
2. Inflat the pneumatic anthishock
garment ,start two large –bore
intraveneus (IV) lines and ringers laktat
solution.
3. Consider a tranfusion of negatif blood
for severe cases that do not respond to
the administration of cristalloids.
 Draw blood for a complete blood cell
count (CBC).
 Determinition of sedimentation rate
and typing and croos-matching for
possible tranfusion.
 In many largers institutions, it is now
possible to determine pregnancy at
early gestation with a blood sample
for radioimmunoassay.
 Radiorereceptorassay, but for those
institution withuot facilities to perfome
this test, the urine is still used for
pregnancytesting.
 It should be remembered, howewer, that
negativ urine test for human corionic
gonadotropin (hCG) is not enterely
reliable in rulling in out a ecopic
pregnancy since not all ectopic pregnancy
are estabillished enough to provide
suficience level of hCG to give positive
result.
 History taking is again of utmost importantce for
diferential diagnosis of septik shock
 PID, or ectopic pregnancy, sudden onset of pain,
sexual activity, missed or abnormal menstrual
periods, and history of tubal infection or surgery,
are especially indicative of ectopic pregnancy.
 A normal sedimentation rate and absence of a
fever shold rule out PID.
 Pelvic radiographs are not helpful, but the pelvic
ultrasonographic study and specific for ectopic
pregnancy.
 In this authors experence, women with ectopic
pregnancys often state that they feel as if they
need to help a bowel movement.
 Fifteen percent of patient with ectopic
pregnancy, are simpthomatic before the
first mised periods.
 In these cases the patient will not have
mised a menstrual period and most likely
doesnot know that she is pregnant.
 The patient need now preparation for
ultrasonography, which gives a picture of
pelvic structure, other than hidration so that
the full blader can be used as a point
reverence for the radiologies.
Although still perfomed in many areas of
the Unit State Couldosentesis (needle
aspiration of the doglas col-de sac through
the vagina) is not recommended since the
procedure is not infillible.
Aspiration of blood from the col-desac is
diagnostic, for intra peritonial bleding, but
absence of blood does not rule uot ectopic
pregnancy
The use laparoscopy as a save and efective
diagnostic toolis the usually cols of action
 Is a tubal pregnancy is pound salphingektomy is
perfomed , laparoscopy infoulves giving a general
anastation and making small incicion (a proximaly
1to 2 inches wide) at umbilicus trough which a
slender tube containing a telescope lens is spases
in to the peritonial cavity.
 This lens permints the ginecologis to examined the
ovaries, falopian tubes and the outside of the
uterus without subjecting to the trauma of the
explaratory laparotomy and prolonged hospital
stay.
 The patient can usually be discharge as soon as
she recoveresfrom anasthation. IF not condition
recuiring surgery is fond.
 If the patient is in shock, the nurse shuld
stabilished the condition with fluid or
blood replacement as indication administer
of oxygen.
 If blood loss is suficience to cause
respiratory difficulties, and transfer the
patient the operating room if indicated.
 The nurse must also recognize the patient
and family for emotional suport.
 The patient may have fearly not only for
her live but for her foture feel boring
ability