Module 2 Activity 2

Unit 2. Care of High-risk and Sick Mother and Child

SPONTANEOUS ABORTION & ECTOPIC

PREGNANCY

GROUP LEADER

Ilagan, Irish Marie

GROUP MEMBERS:

Dasig, Lorraine Angela

Flores, Krystal Joy

Gerasmia, Kelly

Gerona, Jessa

Gomez, Allyza

Julaton, Dayron Kei Lanz

Julit, Sarah Jane

Mallo, Louise Carmela

Mallorca, Emysal Genefer

Masukat, Jarred Abraham

A. DESCRIPTION/ OVERVIEW OF THE DISEASE

The care of high-risk and sick mothers and children is a specialized field of healthcare that
focuses on managing the health needs of pregnant women and infants with elevated health risks.
This includes prenatal care for high-risk mothers, obstetric interventions, neonatal care for sick
infants, and postpartum support for mothers and babies.

Prenatal care involves close monitoring by healthcare professionals, specialized

screenings and diagnostic tests, and tailored management plans to mitigate potential risks and
ensure optimal outcomes for both the mother and the baby. Obstetric interventions may be
necessary in cases where complications arise during pregnancy or labor, such as cesarean
sections, induction of labor, or interventions to manage conditions like preeclampsia or gestational
diabetes.

Neonatal care for sick infants requires specialized care to address medical conditions that
may arise during the perinatal period or shortly after birth. This includes neonatal intensive care
for premature infants, treatment for birth injuries, management of congenital abnormalities, and
support for infants with medical complications. Neonatal care teams provide around-the-clock
monitoring, medical interventions, and supportive care to optimize outcomes for sick infants.

Postpartum support for mothers and babies is critical, ensuring proper healing, emotional
well-being, and successful breastfeeding. Postpartum care may involve continued medical
monitoring, specialized interventions, and support for feeding and developmental needs. A
multidisciplinary approach is often used to address the complex medical, emotional, and social
needs of these vulnerable populations. By providing specialized care and support, healthcare
providers aim to optimize outcomes and improve the health and well-being of both mothers and
babies.
B. SCHEMATIC DIAGRAM (CONCEPT MAP ) OF THE PATHOPHYSIOLOGY OF THE
DISEASE

Spontaneous abortion (SAB) may be diagnosed incidentally on ultrasound or may present

with amenorrhea, vaginal bleeding, and/or pelvic pain. A pregnancy test should performed on all
women of childbearing age who present with vaginal bleeding. Physical exam is important to
assess hemodynamic stability, abdominal tenderness or peritoneal signs, the degree of bleeding,
uterine size, and cervical dilation.
C. SIGNS AND SYMPTOMS

Spontaneous Abortion (Miscarriage):

Spontaneous abortion refers to the natural loss of a pregnancy before the 20th week of gestation.
Signs and symptoms include:

• Vaginal bleeding: This is often the first sign. It can vary from light spotting to heavy
bleeding, sometimes accompanied by clotting.
• Abdominal pain: Cramping or abdominal pain, which can range from mild to severe, may
occur, similar to menstrual cramps.
• Passage of tissue: You may pass clots or tissue from the vagina, which can sometimes
resemble the tissue of the fetus or the placenta.
• Decrease in pregnancy symptoms: If you were experiencing symptoms such as breast
tenderness, nausea, or fatigue, these symptoms may diminish or disappear suddenly.

Ectopic Pregnancy:

An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, commonly in the
fallopian tube. Signs and symptoms include:

• Abdominal or pelvic pain: This pain may be sharp, stabbing, or cramp-like. It may develop
gradually or suddenly and can be severe.
• Vaginal bleeding: Light vaginal bleeding may occur, often lighter than a menstrual period.
It may be accompanied by other symptoms like dizziness or weakness.
• Shoulder pain: In some cases, the ectopic pregnancy can cause referred pain to the
shoulder, especially if there is internal bleeding irritating the diaphragm.
• Rectal pressure: Some women experience pressure or discomfort in the rectum due to the
ectopic pregnancy pressing against nearby organs.
• Signs of shock: In severe cases where there's significant internal bleeding, symptoms like
fainting, dizziness, or a rapid heartbeat may occur, indicating shock.

D. LABORATORY & DIAGNOSTICS

Laboratory and diagnostic tests for spontaneous abortion and ectopic pregnancy include:

1. Quantitative beta-human chorionic gonadotropin (β-hCG) measurements: Serial β-hCG

levels are used to monitor pregnancy progression and to detect a decrease in levels, which
may indicate a failed pregnancy.
2. Ultrasound examinations: Transvaginal ultrasound is the main method used to evaluate
for spontaneous abortion and ectopic pregnancy. It can detect the presence of a fetus,
fetal cardiac activity, and the location of the pregnancy.
3. Pelvic examination: A dilated cervix may indicate an inevitable abortion.
 4. Serum progesterone levels: Low serum progesterone levels may be a marker of suitability
for expectant management of ectopic pregnancy.
5. Endometrial biopsy: In some cases, an endometrial biopsy may be performed to confirm
the presence or absence of a viable pregnancy.

Diagnosis of Ectopic Pregnancy

USG findings
An inhomogeneous or non cystic adnexal mass is the most common finding, about 50–60% of
cases. A small anechoic cystic structure is more likely to be an early sac rather than a ‘pseudosac’.
Positive pregnancy test with and a small anechoic cystic structure without adnexal mass has
probability of ectopic pregnancy is 0.02%.

Double decidual sign.

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Intradecidual sign.

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A small amount of anechoic fluid in the pouch of Douglas may be found physiologically in normal
pregnancy and may be seen with ectopic pregnancies. Which may signify tubal rupture, Most
commonly the echogenic fluid has been reported is due to blood leaking from the fimbrial end of
the fallopian tube but it may be tubal rupture. Culdocentesis was used in the past to diagnose
hemoperitoneum.

Cervical pregnancy
Cervical ectopic pregnancy is diagnosed by following usg criteria:
1. Empty Uterus
 2. a barrel-shaped cervix,
3. a gestational sac is seen below the level of the internal cervical Os,
4. ‘Sliding sign’ usually absent
5. On colour Doppler, Blood flow around the gestational sac
6. The ‘sliding sign’ distinguishes cervical ectopic pregnancies and miscarriages that are
within the cervical canal. It is present in cervical miscarriage but absent in cervical ectopic
gestation.

Clinical criteria for diagnosis of cervical pregnancy.

● Pregnancy with painless vaginal bleeding.
● Soft and expanded cervix with length is equal or more than fundus wasp like or hourglass
shape.
● Product of conception firmly attached to cervical canal.
● Closed internal os and partially opened external os.

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Cesarean scar pregnancy

Cesarean scar pregnancy is defined as implantation into the myometrial defect occurring at the
site of the previous uterine scar.

The diagnostic criteria described for cesarean scar implantation on transvaginal ultrasound
include:
● Empty uterine cavity and endocervical canal
● Gestational sac or the solid mass of trophoblast located anteriorly at the level of the
internal Os embedded at the site of the previous lower uterine segment cesarean section
scar
● The myometrial layer between the bladder and gestational sac is absent or thin.
● Evidence of prominent trophoblastic/placental circulation on Doppler examination.
https://cdnintech.com/media/chapter/80212/1512345123/media/F4.png

Interstitial pregnancy
When the implantation occurs in the proximal part of fallopian tube that lies within the muscular
layer of uterus. Ipsilateral salpingectomy is a risk factor for interstitial pregnancy.

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Cornual pregnancy
The implantation occurs in the rudimentary horn of uterus it may be communicating or non
communicating. It is a confusing terminology. Some authors prefer the cornual pregnancy when
implantation occurs in upper lateral part of uterine cavity of normal uterus.

Ovarian pregnancy
Findings suggestive of an ovarian ectopic pregnancy on transvaginal ultrasound with an empty
uterus are:
● A wide echogenic ring with an internal anechoic area on the ovary is seen commonly. A
yolk sac or embryo is rarely seen.
● It is not possible to separate the cystic structure or gestational sac from the ovary on gentle
palpation (negative sliding organ sign).
● Corpus luteum is identified separately from the suspected ovarian pregnancy.
Abdominal pregnancy
When the implantation occurs in intraperitoneal cavity excluding tubal, ovarian and
intraligamentous pregnancy. Usually the women have vague symptoms or no symptoms.
Abnormal foetal position may be palpated. Sonographic diagnosis may not be useful. MRI is very
much useful to confirm the diagnosis and to identify placental implantation because placenta may
be implanted over vital structures, such as major blood vessels and bowel.

Heterotopic pregnancy
When there are both intrauterine and extrauterine implantation it is called heterotropic gestation
it can be diagnosed with ultrasonography. A higher than expected level of serum beta-hCG in
relation to gestational age may be suspicious of heterotopic pregnancy but, the presence of a
complete or partial mole must be ruled out.

Miscarriage

Diagnosis
Your health care team might do a variety of tests:

● Blood tests. These can check the level of the pregnancy hormone, called human
chorionic gonadotropin (hCG), in your blood. This level is often repeated after 48
hours. A low or falling level of hCG could be a sign of pregnancy loss. If the pattern
of changes in your hCG level is irregular, your health care professional may
recommend more blood tests or an ultrasound. Your blood type also might be
checked. If your blood type is Rh negative, a medicine called Rh immunoglobulin
(RhoGAM) will likely be recommended unless you are less than six weeks pregnant.
● Pelvic exam. Your health care professional might check to see if the lower end of
your uterus, called the cervix, has begun to open. If it has, that makes a miscarriage
more likely.
● Ultrasound. During this imagining test, your health care professional checks for a
fetal heartbeat and figures out if the pregnancy is growing properly. If the result of
the test isn't clear, you might need to have another ultrasound in about a week.
● Tissue tests. If you've passed what looks like tissue, it can be sent to a lab to confirm
that a miscarriage has happened — and that your symptoms aren't tied to another
cause.
● Chromosomal tests. If you've had two or more previous miscarriages, your health
care professional may recommend blood tests for both you and your partner. The
tests can help find out if your or your partner's chromosome make-up might be linked
with increased risk for miscarriage.
E. NURSING MANAGEMENT

For Spontaneous Abortion:

1. Assess the level of bleeding that the patient is experiencing and monitor the patient for
signs of hypovolemia, including rapid heartbeat, low blood pressure, and cool, clammy
skin.
2. Provide emotional support and reassurance to the patient and the family.
3. Administer medications as ordered, including pain relief medications, oxytocic to help the
uterus contract, and antibiotics if needed.
4. Educate the patient on the need to avoid strenuous activity, heavy lifting, and sexual
intercourse until the bleeding has stopped, and follow-up appointments with the healthcare
provider.
5. Document the patient's vital signs, blood loss, and other pertinent information accurately
and completely, and report any significant changes in the patient's condition to the
healthcare provider.

For Ectopic Pregnancy:

6. Monitor the patient for signs of shock, including changes in skin color, rapid heartbeat,
and low blood pressure.
7. Administer medications as ordered, including methotrexate to dissolve the pregnancy or
surgery if the patient is at risk of hemorrhage or the embryo has grown too large.
8. Educate the patient and family members on the signs and symptoms of ectopic pregnancy,
including light vaginal bleeding and lower abdominal pain, and encourage them to seek
medical attention immediately if they occur.
9. Document the patient's vital signs, response to medications, and other pertinent
information accurately and completely, and report any significant changes in the patient's
condition to the healthcare provider.
10. Provide emotional support and counseling to the patient and family members and offer
resources for ongoing support and care.

F. MEDICAL MANAGEMENT

1. Spontaneous Abortion:

• Monitoring and Supportive Care: In many cases, a miscarriage occurs naturally without
medical intervention. Monitoring for signs of infection or excessive bleeding is essential.
Emotional support is crucial for the woman and her partner.

• Medical Management: If the miscarriage is incomplete, a healthcare provider may

recommend a dilation and curettage (D&C) procedure to remove any remaining tissue
from the uterus.
 • Pain Management: Pain relief medications may be prescribed to manage discomfort.

• Follow-up Care: Follow-up appointments are essential to monitor recovery and address
any concerns.

• Emotional Support: Counseling or support groups may be recommended to help cope with
the emotional impact of a miscarriage.

2. Ectopic Pregnancy:

• Methotrexate: In cases where the ectopic pregnancy is detected early and the fallopian
tube is not ruptured, methotrexate may be administered. This medication stops the growth
of the embryo.

• Surgery: If the ectopic pregnancy has progressed or the fallopian tube is at risk of rupture,
surgery may be necessary to remove the pregnancy and, if needed, repair or remove the
affected fallopian tube.

• Monitoring: Close monitoring is essential, especially for women who receive methotrexate,
to ensure the treatment is successful.

• Pain Management: Pain relief medications may be prescribed to manage pain associated
with the ectopic pregnancy.

• Follow-up Care: Regular follow-up appointments are important to monitor recovery and
address any complications.

• Emotional Support: Given the emotional impact of an ectopic pregnancy, counseling or

support groups may be recommended.

G. SURGICAL MANAGEMENT
- In situations of spontaneous abortion, if the products of conception are not ejected
naturally or with medicine, surgical therapy may include a technique known as
dilation and curettage (D&C), which involves dilating the cervix and scraping the
uterine lining to remove any leftover tissue. Ectopic pregnancy, on the other hand,
if not treated promptly or medically, may necessitate surgical intervention, most
commonly by laparoscopic surgery, in which small incisions are made in the
abdomen to find and remove the ectopic pregnancy while preserving the fallopian
tube if possible. Medical therapy with methotrexate, a medicine that inhibits
embryo growth and allows the body to reabsorb it, may be explored for tiny and
stable ectopic pregnancies.
H. COLLABORATIVE MANAGEMENT

Collaborative management for Spontaneous Abortion (Miscarriage) and Ectopic Pregnancy

involves a team of healthcare professionals working together to provide the best care and support
for patients. Here's a list of professionals who are part of this collaborative management:

1. Obstetrician-Gynecologist (OB-GYN): Specializes in women's reproductive health,

pregnancy, and childbirth. They play a central role in managing both spontaneous abortion
and ectopic pregnancy cases.

2. Perinatologist: A subspecialist in high-risk pregnancies who may be involved in complex

cases requiring advanced fetal monitoring or specialized interventions.

3. Radiologist: Interprets and analyzes imaging studies, such as ultrasounds, to help

diagnose and monitor the progression of spontaneous abortion or ectopic pregnancy.

4. Pathologist: Analyzes tissue samples from miscarriages to determine the cause and rule
out any underlying medical conditions.

5. Anesthesiologist: Manages pain relief and anesthesia during procedures related to

spontaneous abortion or ectopic pregnancy.

6. Nurse Practitioner or Midwife: Provides patient education, emotional support, and

assistance in managing symptoms and care plans.

7. Psychologist or Counselor: Offers emotional support and guidance to patients and their
families dealing with the emotional aspects of pregnancy loss.

8. Social Worker: Assists with financial, legal, and practical concerns that may arise during
the management of spontaneous abortion or ectopic pregnancy.

9. Pharmacist: Provides information on medications and their potential side effects or

interactions, as well as ensuring appropriate medication management.

11. Primary Care Physician: Coordinates care with the rest of the team and provides ongoing
care for the patient's general health.

12. Genetic Counselor: Offers guidance on the risk of genetic disorders in future pregnancies
and helps families make informed decisions about family planning.

13. Fertility Specialist: If needed, provides assistance for couples trying to conceive after
experiencing pregnancy loss or complications.
I. LIST AT LEAST 10 NURSING DIAGNOSES BASED ON PRIORITY

1. Impaired Gas Exchange related to altered oxygen supply secondary to decreased

hemoglobin concentration from blood loss
2. Acute Pain related to physical process of spontaneous abortion or ectopic pregnancy
3. Impaired Comfort related to physical changes associated with spontaneous abortion or
ectopic pregnancy
4. Fatigue related to dizziness and weakness, abdominal pain and vaginal bleeding
secondary to ectopic pregnancy
5. Anxiety related to the potential for death for oneself or a fetus secondary to ectopic
pregnancy
6. Fear related to the potential for death for oneself or a fetus secondary to ectopic pregnancy
7. Grieving related to loss of pregnancy
8. Risk for Post-Trauma Syndrome related to spontaneous abortion or ectopic pregnancy
9. Risk for Deficient Fluid Volume related to blood loss from spontaneous abortion or ectopic
pregnancy
10. Risk for Infection related to invasive procedures or tissue damage from spontaneous
abortion or ectopic pregnancy

J. CREATE AT LEAST THREE (3) NURSING CARE PLANS BASED ON PRIORITY

NCP #1
DIAGNOSIS GOAL INTERVENTION RATIONALE EVALUATION

Impaired Gas Short Term: Dependent 9. Short-term:

Exchange Interventions:
related to altered After 4 hours of Goal met as
oxygen supply nursing 1. 1. -to increase the evidenced by the
secondary to intervention, the Administ amount of patient
decreased patient will er oxygen available demonstrating
hemoglobin demonstrate supplem for gas improved gas
concentration improved gas ental exchange within
from blood loss exchange as oxygen 4 hours as
as evidenced by evidenced by as -to replace lost evidenced by
dyspnea, oxygen ordered. blood and oxygen
tachypnea, saturation levels 2. Exchang increase saturation levels
peripheral maintained at or e. hemoglobin maintained at or
cyanosis, above 95%, a 3. concentration, above 95%, a
oxygen pulse rate within 4. 2. improving pulse rate within
saturation of normal limits (60- Administ oxygen-carrying normal limits,
90%, blood 100 bpm), and er blood capacity. and verbalization
pressure of verbalization of products of decreased
90/60, pulse rate decreased as -to detect dyspnea.
of 120 bpm, and dyspnea. ordered changes in
patient oxygenation and Long-term:
verbalizing Long Term: hemodynamic
“Kabudlay status. Goal met as
maginhawa nga After 1 week, the evidenced by the
daw may dako patient will patient
nga bato na maintain optimal 5. maintaining
nakapatong sa gas exchange as 6. 3. -to maximize optimal gas
akon dughan.” evidenced by Monitor lung expansion exchange as
oxygen vital signs and improve gas evidenced by
saturation levels closely exchange. oxygen
consistently at or 7. saturation levels
above 98%, 8. consistently at or
normal -to promote lung above 98%,
respiratory rate Independent expansion and normal
(12-20 breaths Interventions: improve respiratory rate,
per minute), oxygenation. absence of
absence of 1. Position the cyanosis, and
cyanosis, and patient in semi- -to reduce blood pressure
blood pressure Fowler's or high oxygen demand within normal
within normal Fowler's position and promote range for the
range for the relaxation. patient’s age and
patient’s age and 2. Encourage condition.
condition. deep breathing
exercises

3. Provide
comfort
measures (e.g., -to promote lung
pain expansion and
management, mobilize
quiet secretions.
environment)

Collaborative
Interventions:

1. Work with -to promote

respiratory hemoglobin
therapists for synthesis and
nebulizer improve oxygen-
treatments or carrying
chest capacity.
physiotherapy as
ordered to help the
patient cope with
2. Collaborate the emotional
with the dietician stress of the
for a diet high in condition, which
protein and iron can affect
respiratory
function.
 3. Collaborate
with the social
worker or
psychologist for
emotional
support

NCP#2
DIAGNOSIS GOAL INTERVENTION RATIONALE EVALUATION

Acute Pain Short Term: Dependent 5. Short-term:

related to the Interventions:
physical process Within the next 8 Goal met as
of spontaneous hours, the patient 1. 1.Admini -to manage pain evidenced by the
abortion as will report a ster and provide patient reported
evidenced by decrease in pain prescribe comfort. a decrease in
vaginal bleeding, from 8 to 4 on the d pain from 8 to 4
abdominal pain pain scale, as analgesic -to detect on the pain scale
of 9/10 as evidenced by s changes in the within 24 hours.
reported by the verbalization and 2. patient’s
patient, lower non-verbal cues. 3. 2. condition that Long-term:
back ache, heart Monitor could indicate
rate of 110 bpm, Long Term: vital signs
worsening pain Goal met as
blood pressure of closely. or complications evidenced by the
90/60, After 1 week, the 4. patient reported
respiratory of 20 patient will report no pain or a
bpm, and patient no pain or a manageable
in guarding manageable level of pain (2 or
position. level of pain (2 or -to reduce below on the
below on the physical stress pain scale),
pain scale), as Independent and help stable vitals
evidenced by Interventions: alleviate pain. signs, and
verbalization and patient’s
non-verbal cues. 1. Position the -to help the verbatim of
patient patient cope with absence of pain.
comfortably the emotional
stress of the
situation, which
2. Provide can exacerbate
emotional the perception of
support and pain.
reassurance
.

-to ensure a
comprehensive
approach to pain
 Collaborative management.
Interventions:

1. Collaborate-to pelp the

with thepatient cope with
healthcare team the emotional
for painaspects of the
management situation, which
can affect the
2.Work with a perception of
social worker or pain.
psychologist for
emotional
support

NCP #3
DIAGNOSIS GOAL INTERVENTION RATIONALE EVALUATION

Impaired Short Term: Dependent 4. Short-term:

Comfort related Interventions:
to physical Within the next Goal met. The
changes 24 hours, the - manage pain patient reported
associated with patient will report 1. Administer and provide a decrease in
ectopic a decrease in prescribed comfort. pelvic pain from
analgesics:
pregnancy as pelvic pain from 9 to 5 on the pain
evidenced by 9 to 5 on the pain scale within 24
pelvic pain of scale, as -to manage hours, as
9/10 as reported evidenced by 2. Administer nausea and evidenced by
by the patient, verbalization and antiemetics vomiting. patient
vaginal bleeding, non-verbal cues. as ordered verbalizes,
rectal pressure, 3. “masarangan ko
dizziness, Long Term: na nag sakit
nausea, kaysa sang
vomiting, By discharge, the kagina nga daw
amenorrhea, and patient will report indi gd ko ya ka
breast no pain or a hulag.”.
tenderness. manageable Independent
level of Interventions: Long-term:
discomfort (2 or
below on the Goal met as
1. Position the -to reduce
pain scale), as evidenced by the
patient physical stress
evidenced by comfortably patient reported
verbalization and and help no pain or a
non-verbal cues. alleviate pain. manageable
level of pain (2 or
2. Provide -to help the below on the
emotional patient cope with pain scale),
support and the emotional stable vitals
reassurance stress of the signs, and
 situation, which patient’s
can exacerbate verbatim of
discomfort. absence of pain.

Collaborative .
Interventions:

1. Collaborate -to ensure a

with the comprehensive
healthcare team approach to pain
for pain management.
management

2.Work with a -to pelp the

social worker or patient cope with
psychologist for the emotional
emotional aspects of the
support situation, which
can affect the
perception of
pain.
 K. CREATE AT LEAST THREE (3) DRUG STUDY BASED ON THE MEDICATIONS TO BE
ADMINISTERED TO THE ABOVEMENTIONED DISEASE CONDITION.

DRUG NO. 1: METHOTREXATE

Name of Dosage Mechanism Indication Contraindicatio Special Side Effects & Nursing
Drug /Route of Action n Precaution Adverse Responsibilitie
/Frequency Effects s
Generic Dosage: 50 Methotrexat Methotrexat - - Patients - CNS: - Methotrexate
Name: mg/m^2 of e exerts its e is Contraindicated receiving arachnoiditis should be used
Methotrexat body surface therapeutic indicated for in patients with methotrexate within hours of only by health
e area. For effect by the known should be closely intrathecal use, care providers
spontaneous inhibiting the treatment of hypersensitivity monitored for subacute whose
abortion, the enzyme ectopic to the drug or its signs of toxicity, neurotoxicity knowledge and
Brand dosage may dihydrofolate pregnancy components. including bone possibly experience
Name: be adjusted reductase, and certain marrow beginning a few include the use
Trexall, based on thereby cases of - suppression, weeks later, of antimetabolite
Reditrex, clinical disrupting spontaneous Contraindicated hepatotoxicity, and demyelination, therapy
Rasuvo, judgment folate abortion, in patients with gastrointestinal malaise, fatigue, You sent
Otrexup, and metabolism where its severe liver adverse effects. dizziness, Drug may be
and Xatmep individual and anti- disease, severe aphasia, hemi- given daily or
patient ultimately proliferative renal - Methotrexate is paresis, fever. once weekly,
factors. leading to properties impairment, pre- known to have depending on
impaired are utilized existing blood teratogenic effects EENT: blurred the disease. To
Route: DNA to terminate disorders, and should be vision, pharyn- avoid
IM synthesis the immunodeficienc avoided during gitis. administration
Classificatio and cell abnormal y syndromes, or pregnancy or in errors, know
ns proliferation, pregnancy active infections. women of Gl: gingivitis, patient's dosing
Frequency: which is and prevent childbearing stomatitis, schedule.
You often utilized in further potential without diarrhea, GI
Therapeutic: only need 1 the complication appropriate ulceration, GI - Monitor
Antineoplasti dose. treatment of s. contraceptive bleeding, pulmonary
cs Sometimes ectopic measures. enteritis, function tests
people will pregnancy nausea, period- ically
Pharmacolo need a and - Concomitant use vomiting. and fluid intake
gic: Folate second dose spontaneous of methotrexate and output daily.
antagonists to fully treat abortion. with other GU: En- courage
the ectopic medications that nephropathy, fluid intake of 2
pregnancy. may interact or tubular necrosis, to 3 L daily.
increase the risk of renal failure,
toxicity, such as menstrual - Monitor uric
nonsteroidal anti- dysfunction, acid level.
inflammatory abor- tion,
drugs (NSAIDs) or cystitis. - Drug
trimethoprim- distributes
sulfamethoxazole, Hematologic: readily into
should be carefully leukopenia, pleural effusions
evaluated and thrombocytopeni and other third-
managed under a. space
medical compartments,
supervision. such as ascites,
Skin: urticaria, leading to
pruritus, prolonged
hyperpigmentati systemic level
on, and risk of
erythematous toxicity. Use
rashes, drug cautiously
ecchymoses, in these
rash, patients.
photosensitivity
reactions,
alopecia, acne,
psoriatic lesions
ag gravated by
exposure to sun.
 DRUG NO. 2: MIFEPRISTONE

Name of Dosage Mechanism Indication Contraindicatio Special Side Effects & Nursing
Drug /Route of Action n Precaution Adverse Responsibilitie
/Frequency Effects s
Generic Dosage: - - Medical - -Mifepristone - CNS: - Instruct patient
Name: 200 Antagonizes termination Contraindicated should only be dizziness, to notify health
Mifepristone milligrams endometrial of in: Presence of administered fainting, care
(mg) and intrauterine an intrauterine under the headache, professional
myometrial pregnancy device (IUD); supervision of a weakness. immediately if
Brand Route: effects of up to day 49 Confirmed or qualified she develops
Name:, PO or progesteron of suspected healthcare - GI: abdominal weakness,
Mifeprex Buccal e. Sensitizes pregnancy. ectopic provider who can pain, diarrhea, nausea,
and Korlym the pregnancy; ensure appropriate nausea, vomiting,
myometrium Undiagnosed counseling, vomiting. diarrhea, with or
Frequency: to adnexal mass; monitoring, and without
Mifepristone contraction- Chronic adrenal follow-up care. - GU: uterine abdominal pain
is usually inducing failure; bleeding, uterine or fever more
administered activity of Concurrent long- - Pregnancy is cramping, than 24 hr after
Classificatio once, prostaglandi term dated from the first ruptured ectopic taking
ns followed by ns. corticosteroid day of the last pregnancy, mifepristone;
a second Therapeutic therapy; menstrual period pelvic pain. may indicate life-
medication Effects: Bleeding threatening
Therapeutic: called Termination disorders or - Duration of sepsis.
Abortifacient misoprostol. of concurrent pregnancy may be
s pregnancy. anticoagulant determined from - Inform patient
therapy; menstrual history that vaginal
Pharmacolo Inherited and clinical bleeding and
gic: porphyrias. examination uterine cramping
Antiprogesta will probably
tional agents Use Cautiously - Assess the occur. Bleeding
in: Chronic pregnancy by or spotting
medical ultrasonographic occurs for an
conditions such scan if the average of 9–16
as duration of days, but may
cardiovascular, pregnancy is continue for
hypertensive, uncertain or if more than 30
hepatic, renal, or ectopic pregnancy days. Instruct
respiratory is suspected patient to report
disease (safety any severe or
and efficacy not - Remove any unusual
established); intrauterine device cramping,
Women >35 yrs (IUD) before bleeding, or
old or who treatment pelvic pain that
smoke ≥10 extends beyond
cigarettes/day. - Because most the expected
women will expel time periods.
the pregnancy
within 2-24 hr of
taking misoprostol,
discuss with the
patient an
appropriate
location for her to
be when she takes
the misoprostol,
taking into account
that expulsion
could begin within
2 hr of
administration-

- Mifepristone
should not be
used in patients
with certain
medical conditions
such as
uncontrolled
 hypertension,
adrenal failure, or
bleeding
disorders, as it
may exacerbate
these conditions or
lead to adverse
effects.

DRUG NO. 2: MISOPROSTOL

Name of Dosage Mechanism Indication Contraindicatio Special Side Effects & Nursing
Drug /Route of Action n Precaution Adverse Responsibilitie
/Frequency Effects s
Generic Dosage: 800 - Acts as a - Misoprostol - Misoprostol is - Bacterial - CNS: - Advise patient
Name: mcg prostaglandi is indicated contraindicated infections reported headache. GI: to avoid alcohol
Misoprostol n analogue, as a tablet to in cases of after use abdominal pain, and foods that
Route: decreasing reduce the confirmed or diarrhea, may cause an
Buccal gastric acid risk of suspected - Patients must constipation, increase in GI
Brand secretion NSAID ectopic seek medical dyspepsia, irritation.
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administered production duodenal fallopian tube, - Administration to menstrual spontaneous
a minimum of protective ulcers in leading to pregnant women disorders. abortion.
of 24 hours mucus high risk potentially life- can cause
and a (cytoprotecti patients. threatening abortion, - If used with
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ns 48 hours Causes is used off such as birth defects terminate
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mifepristone contractions. managemen - Uterine rupture inform patient
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antiulcer 1 Effects: miscarriages known when drug is bleeding and
agents, Prevention , and hypersensitivity administered to uterine cramping
cytoprotectiv of gastric prevention to misoprostol or pregnant women will probably
e agents, ulceration of any of its to induce labor; occur. Bleeding
and from postpartum components risk of uterine or spotting
abortifacient NSAIDs. hemorrhage. should not use rupture increases occurs for an
s With It is also the medication, with advancing average of 9–16
mifepristone used alone as they may gestational ages days, but may
Pharmacolo terminates or in experience and prior uterine continue for
gic: pregnancy combination allergic reactions surgery, including more than 30
prostaglandi of less than with ranging from cesarean delivery days. Instruct
ns 49 days. mifepristone mild skin patient to report
in other irritation to - Contraindicated any severe or
countries for severe in pregnant unusual
first anaphylaxis. women to reduce cramping,
trimester peptic ulcer risk bleeding, or
abortions. - Misoprostol from nonsteroidal pelvic pain that
should be used anti-inflammatory extends beyond
with caution or drugs (NSAIDs) the expected
avoided in time periods.
patients who are - Warn patients of
receiving long- risk for abortion, - Instruct patient
term and warn them not to report
corticosteroid to give drug to bothersome side
therapy, as it others effects, including
may increase severe or
the risk of prolonged
gastrointestinal headache,
adverse effects menstrual
such as irregularities, or
ulceration, GI problems
bleeding, or (nausea,
perforation. diarrhea,
vomiting,
constipation,
heartburn,
flatulence,
abdominal pain).
L. JOURNAL READINGS.
- Search for at least one (1) related journal ( 2019 to 2024 ). Use APA format for referencing.

Title: Determinants of ectopic pregnancy among pregnant women attending referral hospitals in
the southwestern part of Oromia regional state, Southwest Ethiopia: a multi-center case-control
study

OBJECTIVES:

Ectopic pregnancy is an abnormal condition in which implantation of the blastocyst occurs

outside the endometrium of the uterus. It is gynecological important, particularly in the developing
world, because of associated with enormous rate of high morbidity, during the first trimester of
pregnancy. A better understanding of its risk factors can help to prevent its prevalence. However,
the determinants of ectopic pregnancy are not well understood and few researches conducted in
our country were based on secondary data covering small scale area. This study aimed to identify
determinants of ectopic pregnancy among pregnant women attending referral hospitals in
Southwestern part of Oromia regional state, Southwest Ethiopia.

METHODOLOGY:

A hospital-based case-control study was conducted from June 1 to September 30, 2019,
in five referral hospitals located in the southwestern part of Oromia regional state. The final sample
size comprised 59 cases and 118 controls. Data entry was performed using Epidata version 3.1,
and analysis was carried out using SPSS version 23. Descriptive statistics were utilized to
examine the data. Explanatory variables with a p-value of < 0.25 in the bivariate analysis were
then included in multivariable logistic regression. Factors associated with the outcome were
identified at a 95% confidence interval (p < 0.05).

RESULTS:

Out of the 177 participants (comprising 59 cases and 118 controls), 174 individuals (58
cases and 116 controls) were included in the study. Factors such as having undergone two or
more induced abortions [Adjusted Odds Ratio (AOR) = 3.95; 95% Confidence Interval (CI): 1.22–
13.05], previous history of caesarean section [AOR = 3.4; 95% CI: 1.11–10.94], being single [AOR
= 4.04; 95% CI: 1.23–13.21], reporting prior recurrent sexually transmitted infections [AOR = 2.25;
95% CI: 1.00–5.51], and previous history of tubal surgery [AOR = 3.32; 95% CI: 1.09–10.13],
were associated with a higher likelihood of having an ectopic pregnancy, as indicated by their
respective Adjusted Odds Ratios and 95% Confidence Intervals.

CONCLUSION:

It was found that having a history of more than two induced abortions during previous
pregnancies, marital status (single), recurrent sexual transmitted infection, prior history of tubal
surgery and experiencing prior caesarean section were found to be determinants of ectopic
pregnancy. Hospitals should give emphasis on prevention and early detection of risks of ectopic
pregnancy and create awareness in order to reduce the burden of ectopic pregnancy.
REFERENCES:

Gerema, U., Alemayehu, T., Chane, G., Desta, D., & Diriba, A. (2021). Determinants of ectopic
pregnancy among pregnant women attending referral hospitals in southwestern part of Oromia
regional state, Southwest Ethiopia: a multi-center case control study. BMC Pregnancy and
Childbirth, 21(1). https://doi.org/10.1186/s12884-021-03618-7

PICOT FRAMEWORK

Population:

The population under investigation comprises pregnant women attending referral

hospitals in the southwestern part of Oromia regional state, Southwest Ethiopia. These women
are seeking medical care during their pregnancy, making them relevant subjects for studying the
determinants of ectopic pregnancy within this specific geographical region and healthcare setting.

Intervention:

The intervention or exposure in this study is the various factors potentially associated with
ectopic pregnancy among pregnant women. These factors could include previous medical history
such as previous induced abortions, prior cesarean sections, history of tubal surgery, as well as
demographic characteristics like marital status and behavioral factors such as reporting prior
recurrent sexually transmitted infections. Understanding these factors is crucial for identifying
potential risk factors for ectopic pregnancy.

Comparison:

The comparison group in this study consists of pregnant women attending the same
referral hospitals but without ectopic pregnancy. By comparing the characteristics and exposures
of women with ectopic pregnancy to those without, researchers can identify differences and
potential risk factors associated with the occurrence of ectopic pregnancy among pregnant
women in the study population.

Outcome:

The primary outcome of interest in this study is the occurrence of ectopic pregnancy
among pregnant women attending referral hospitals in the southwestern part of Oromia regional
state, Southwest Ethiopia. This outcome will be determined through medical diagnosis and
confirmation of ectopic pregnancy cases among the study participants during the study period.

Time:

The study was conducted over a specified timeframe, from June 1 to September 30, 2019.
This timeframe is important for understanding when the data collection occurred and provides
context for analyzing the determinants of ectopic pregnancy among pregnant women attending
referral hospitals in the southwestern part of Oromia regional state, Southwest Ethiopia, during
this period.
REFERENCES:

Ectopic Pregnancy - Obstetrical & Gynaecological Nursing. (2022). SlideShare; Slideshare.

https://www.slideshare.net/JaiceMaryJoy/ectopic-pregnancy-obstetrical-gynaecological-
nursing?fbclid=IwAR0h18f6GvXPrPiE8TsbRZppeULwz8dty50ns-WFa1CnzLp2m5McHZfogHw

Spontaneous abortion: Nursing - Osmosis Video Library. (2024). Osmosis.

https://www.osmosis.org/learn/Spontaneous_abortion:_Nursing?fbclid=IwAR04LhFNPV6Wwbp
pkSSNxGS1g86e1q-ytl_iyYtlw49ZzI26ivzM4SWnKjE

Ectopic pregnancy: Rare but potentially life-threatening-Ectopic pregnancy - Symptoms & causes
- Mayo Clinic. (2022). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/ectopic-
pregnancy/symptoms-causes/syc-
20372088?fbclid=IwAR17a_YVPoev9X_HCnjB4yn2_4XtWm9e9aujbmwmHZE1r1YDk2bwZJEv
mMc

Jazayeri, A. (2021, October 16). Surgical Management of Ectopic Pregnancy: Overview,

Preparation, Technique. Medscape.com; Medscape.
https://emedicine.medscape.com/article/267384-
overview?fbclid=IwAR0IyLALYrex9rBx4A1oJCGmhrftP0XJ8hoCDLxXLICnlVLepyWaX0uaGeA
&form=fpf

Gerema, U., Alemayehu, T., Chane, G., Desta, D., & Diriba, A. (2021). Determinants of ectopic
pregnancy among pregnant women attending referral hospitals in southwestern part of Oromia
regional state, Southwest Ethiopia: a multi-center case control study. BMC Pregnancy and
Childbirth, 21(1). https://doi.org/10.1186/s12884-021-03618-7

Panda, S., Das, A., Singh, K., Baruah, P., & Sharma, A. (2022). Diagnosis of ectopic pregnancy.
In IntechOpen eBooks. https://doi.org/10.5772/intechopen.101715

Miscarriage - Diagnosis and treatment - Mayo Clinic. (2023, September 8).

https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/diagnosis-
treatment/drc-20354304