Extrauterine pregnancies are extremely rare, occurring in only 1% of pregnancies, with 98% of those located intratubal. They result in a perinatal mortality rate between 40% and 95% due to massive hemorrhage. The most common management of this condition is removal of the fetus with a hysterectomy. Nurses have a pivotal role as advocates for patents.
A 25-year-old female patient presented to a tertiary facility with a diagnosis of an abdominal pregnancy. The patient was admitted at 24 weeks, gravida 2, para 1, and all prenatal labs were within normal limits. The ectopic pregnancy was confirmed by magnetic resonance imaging and exploratory laparoscopic surgery. Although termination of the pregnancy was recommended, the patient elected to continue the pregnancy. The nurses supported her decision and gave her daily encouragement. The patient remained hospitalized and on bed rest for 8 weeks before giving birth.
The patient's plan of care included collaboration between multidisciplinary teams from many specialties and clinical experts within the hospital. Because the location of the placenta and how pregnancy was affecting other adjacent organs was unknown, there was concern regarding the development of the fetus and when delivery should occur. Potential risks included the possibility that the placenta might grow into the peritoneum, bowel, bladder, or omentum, possible fetal growth restriction, rupture of membranes, or bleeding. As a result, all abdominal complaints were taken under serious consideration.
Nurses used an evidence-based approach to manage the patient's physical and emotional concerns. Fear and stress can cause vasoconstriction and reduce cardiac output. Holistic care was provided by utilizing complementary therapies to help to reduce anxiety and discomfort,which included chaplain services, arts/crafts, healing touch, and pet, music, and hydro therapy. Surgery to deliver the infant revealed the pregnancy in the cornual horn. There has been no documentation of a pregnancy exceeding 12 weeks in this location. The patient gave birth to a 32-week viable boy, weighing 1,400 grams, and we were able to preserve her uterus for future pregnancies.
Collaboration is very important for high-morbidity risk cases for optimal patient outcomes. Perinatal nurses must be prepared for the potential intrapartum catastrophe with proactive and anticipatory nursing, critical assessment skills, and psychosocial care to ensure a positive pregnancy and birth for the mother and fetus.