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Title: Gestational Time Bomb, a Case Study of Abdominal Pregnancy – a Rare Birth
- Explain proactive, anticipatory interventions necessary to care for a patient with a abdominal pregnancy
- List the multidisciplinary team members that are necessary for the safe delivery of a patient with a abdominal pregnancy
- Discuss some complementary therapies that can help to reduce the stress and anxiety of prolong antepartum hospitalization
Extrauterine pregnancies are extremely rare, occurring in only 1% of pregnancies, with 98% of those located intratubal and a perinatal mortality rate between 40-95% due to massive hemorrhage. The overwhelming management of this condition is removal of the fetus with a hysterectomy.
Nurses have a pivotal role in being a patient’s advocate and respecting a patient’s wishes. 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, G2 P1 , all her 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 while she jeopardized her life for her unborn child. The patient remained hospitalized and on bed rest for 8 weeks before delivering.
Case:
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 with the development of the fetus and when delivery should occur. Potential risks included fear the placenta may grow into the peritoneum, bowel, bladder, or omentem, and possible fetal growth restriction, indication of rupture of membranes, or bleeding. As a result, all abdominal complaints were taken under serious consideration.
Nurses gave 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 help to reduce anxiety and discomfort, this included chaplain services, arts/crafts, Healing Touch, ,and pet, music , and hydro therapy Surgery to deliver the infant revealed the pregnancy was found in the cornual horn. There has been no documentation of a pregnancy exceeding 12 weeks in this location. The patient delivered a 32 week viable boy, weighing 1400 grams and were able to preserved her uterus for future pregnancies.
Conclusion:
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 with critical assessment skills and psycho-social care for the best positive pregnancy and delivery for the mother and fetus.
Keywords: Abdominal pregnancy, intrapartum emergency, and ectopic pregnancy
