Discharge And Home Healthcare Guidelines

Provide a list of prescribed medications, if any, that includes the name, dosage, route, and side effects and the signs and symptoms of potential complications, including hypotensive episodes. Explain the need for careful monitoring and follow-up of the bleeding. Encourage the patient to keep a "menstrual calendar" and record daily bleeding patterns. Teach the patient to have appropriate laboratory follow-up of the complete blood count if indicated.

Ectopic Pregnancy

DRG Category: 378

Mean LOS: 2.6 days

Description: MEDICAL AND SURGICAL: Ectopic

Pregnancy ectopic pregnancy is an implantation of the blastocyst (a solid mass of cells, formed by rapid mitotic division of the zygote, that eventually form the embryo) in a site other than the endometrial lining of the uterus. In more than 95% of ectopic pregnancies, this implantation occurs somewhere in the fallopian tubes, hence the term "tubal pregnancy." The ampullary portion of the tube is the most common site (80%), followed by the isthmic portion (12%) and the fimbria (5%). The fallopian tube lacks a submucosal layer, which allows the ovum to burrow through the epithelium. Fertilization occurs and the zygote lies within the muscular wall of the tube, drawing its blood supply from maternal vessels. Other sites of potential implantation are the cervix, ovary, abdomen, and interstitial tissue of the uterus.

After the blastocyst implants in the tube, it begins to grow and can cause bleeding into the abdominal cavity. Eventually, the ovum becomes too large, and the tube can rupture, thus causing further bleeding that can lead to shock and maternal death. Ectopic pregnancies occur in approximately 2 in 100 pregnancies and non-European Americans have a 1.4 times increased risk over European Americans. The frequency of ectopic pregnancy has increased fourfold since 1970, owing to the increase in sexually transmitted infections, better diagnostic techiques, increased use of artificial reproductive technology, and the increased use of tubal surgeries to treat infertility. Ectopic pregnancy accounts for 10% of all pregnancy-related deaths and reduces a woman's chance of future pregnancy because of tubal damage; approximately one-third of women who experience an ectopic pregnancy subsequently give birth to a live infant. Hemorrhage, peritonitis and infertility are the main complications.

The major cause of ectopic pregnancy is tubal damage, which can result from pelvic inflammatory disease, previous pelvic or tubal surgery, or endometriosis. Other causes may be hormonal factors that impede ovum transport and mechanically stop the forward movement of the egg in the tube, congenital anomalies of the tube, and a blighted ovum. Pelvic infections and sexually transmitted diseases (STDs), specifically chlamydia and gonorrhea, are often involved. Other risk factors include: smoking, diethylbestrol exposure, T-shaped uterus, certain intrauterine devices (IUDs), and a ruptured appendix.

Ectopic pregnancy is most often seen in non-European American women over the age of 35. Aging may result in progressive loss of myoelectrical activity responsible for moving the egg through the fallopian tube. Also, it often occurs in teens who have engaged in high-risk sexual practices that have resulted in frequent pelvic infections. African American teenagers and teenagers of other minority races have a mortality rate almost 5 times higher than that of white teenagers.

HISTORY. Elicit a history about the onset of menses, gynecologic disorders, pattern of sexual practices and birth control, and past pregnancies. Patients with an ectopic pregnancy often have some

Pregnancy Guide

Pregnancy Guide

A Beginner's Guide to Healthy Pregnancy. If you suspect, or know, that you are pregnant, we ho pe you have already visited your doctor. Presuming that you have confirmed your suspicions and that this is your first child, or that you wish to take better care of yourself d uring pregnancy than you did during your other pregnancies; you have come to the right place.

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