1. The presentation
Nursing care
Ectopic Pregnancy

2. Our Team Work
ROSMINAH
RUSLY
RESKI

3. OUTLINE
 Background
 Anatomy physiology reproductive organs
 Definition
 Etiology
 Risk Factors
 Signs and Sympton
 Patofisiology
 Complication
 Supporting investigation
 Management / treatment
 Nursing Care

4. Background
 Ectopic pregnancy is an abnormal location of the implantation of a
fertilized egg cell, where the location of the products of conception
grow and develop are not on the endometrial cavity of the uterus.
 These abnormalities can cause many complications in pregnancy
one of which is the Ectopic Pregnancy Impaired
 By The Centers for Disease Control and Prevention in the United
States the incidence of ectopic pregnancy ranges from 1-2% of all
pregnancies and is a major cause of death Mothers common in the
first trimester of pregnancy.
 In Indonesia, particularly West Java at Dr dr. Hasan Sadikin period
in 2011 found 103 cases with the most common location on the
tube that is 82 cases

5. Anatomy physiology reproductive
organs inner female genitalia
 Ovarium
 fallopian tube
 Uterus
 Vagina

6. Definition
Ectopic pregnancy is a pregnancy
where implantation / nidasi / fruit
attachment pregnancy outside the
normal place, ie outside the uterine
cavity.
While known as ruptured ectopic
pregnancy is an ectopic pregnancy
who experienced abortion rupture in
the tube wall.

7. Etiology
 Most of the causes are not well known.
Each pregnancy is known to egg growth
ampulla tuba section, and on the way to
the uterus then obstacles when they
dituba fallopian nidasi.
 According Trijatmo Rachimhadhi in his
book describes some of the factors
associated with ectopic pregnancy causes
impaired :

8. Cont ...
Factor in the lumen of the tube.
Factors tuba lumen wall
Factors beyond the walls of the
tube lumen
Other factors

9. factors associated with ectopic
pregnancy causes impaired
 Mechanical factors
 Functional Factor
 Improving the acceptance of tubal mucosa
of the fertilized ovum.
 Other things like; KET history and the
history of previous induced abortion

10. location of ectopic pregnancy

11. Cont ...

12. Risk Factors
 a.Endosalpingitis.
 b. Diverticula.
 c. Tumor pressing on the tube.
 d. Previous surgery, such as tubal ligation or resection.
 e. Ovum transfer.
 f. Konginital defects of the reproductive tract.
 g. Ectopic endometrial implants in the fallopian mucosa.
 h. Sexually transmitted infection in the tubes.
 i. Intrauterine devices.
 j. Smoking.
 k. Hormonal contraception.
 (Williams & Wilkins, 2011).

13. Signs and Symtomps
pregnancy has not been disturbed
 a little pain in the lower abdomen that is not how
ignored. On vaginal examination, uterus enlarged and
flabby, even though the amount may not be according to
gestational age. Tuba containing products of conception
because they flabby hard palpable on bimanual
examination
 Interrupted tubal pregnancy symptoms are very
different from bleeding a lot to arrived in the abdominal
cavity until there are no obvious symptoms make
diagnosis difficult

14. Cont ..
Pain is the main complaint on
ruptured ectopic pregnancy. At tubal
rupture lower abdominal pain occurs
suddenly - arrived and strong
intensity accompanied by
hemorrhage that caused the mother
fainted and went into shock.
Beeding pervagina
Amenore

15. Ruptured Etopic Pregnancy
 gastrointestinal complaints
 Tenderness of the abdomen and pelvis.
 Amenore.
 Vaginal spotting or bleeding
 Changes uterus
 Blood pressure and pulse
 Hipovolemi
 Temperature
 Pelvic masses
 Pelvic Hematokel

16. Patofisiology
 In normal pregnancy, the process of fertilization
(meeting the egg by the sperm) occurs in the fallopian
then the fertilized egg cell is driven and implantation in
the uterine endometrial cavity.
 Ectopic pregnancy can be caused, among other factors
inside the tube and outside the tube, so that the result
of conception obstructed or can not enter the uterine
cavity, so that the fertilized egg grows and implants
(stuck) in some places the female reproductive organ
cells in the uterine cavity, among others in the fallopian
tubes (fallopian tubes) cervical canal (cervix), ovary
(ovarian), and the abdominal cavity. Most occur in the
fallopian tube (90%). (Mitayani, 2009).

17. Complication
 Ectopic pregnancy complications can occur
secondary to late diagnosis error, or management
of approach.
 Failure diagnosis quickly and accurately may result
in tubal or uterine rupture, depending on the
location of the pregnancy, and this can cause
massive bleeding, shock, DIC and death.
 Complications arising from the surgery include
bleeding, infection, damage to surrounding organs
(intestines, bladder, ureter, and large blood
vessels). In addition there are also complications
related to anesthesia action.

18. Supporting investigation
 Complete blood count
 HCG-B levels decreased
 Toucher vaginal
 Ultrasonografi
 Kuldosintesi
 Oksitosin Test
 Foto Rontgen
 Histerosalpingografi
 ECG

19. Management / treatment
Surgical :
 - 1. Tubektomi
 - 2. Laparatomi
 - 3. Laparoskopi
 - 4. Blood Tanfusi
Nursing :
1. Collaboration with the medical team in drug delivery
2. Implementation of chemotherapy
3. Create a calm and comfortable atmosphere to
reduce pain and anxiety.
4. Post-action counseling and self care during home

20. Nursing Care
1. Assessment
2. Phisical Assessment
3. Diagnosa
4. Intervention

21. Diagnosa
 1. Ineffective tissue perfusion gastrointestinal associated
 with defisit hemoglobin, as a result of more bleeding
 in the uterus.
 2. Deficit fluid volume associated with the rupture at the site of
 implantation, Bleeding
 3.Pain associated with a ruptured fallopian tube, intraperitoneal
 hemorrhage
 4.The weakness relates to the amount of blood that comes out
 when bleeding
 5. Grieving associated with fetal death
 6. Anxiety associated with the process will be done surgery
 7. Lack of knowledge related to lack of understanding or do not
 know the sources of information.

22. Cont ...
 POST OP :
 1. Acute pain associated with skin
 diskontinuitas tissue secondary to
 laparotomy
 2.The risk of wound infection associated with
 the operation and installation of equipment
 maintenance

23. For Intervention
Please Check your
Nanda’s Book
Ok ... Any Question
?????