[Shenanigans]

NOt sure if this is the right place to put this subject, but I have an asignment where I have to do a report on an acute illness - I've chosen the rupture of an ectopic pregnancy. The lecturers said we can make up the patients.

So, has anyone here seen a rupture? I've got all the patho and the "hows" sorted, I'm just looking for personal stories, also, the "patient" wanted the baby, so what kind of grief process do these women experience post a rupture? Or would ER nurses not really see that as that could come later?

On a side note, for my last placement/electives I'm going to the Accident and Emergency (ER). Yay.

[txpixiedust]

Hi Shenanigans,

I'm in Postpartum, not L&D or ER, so I don't have any ectopic loss stories to share. However, I took a 4 hour Perinatal Loss class as part of my internship, and learned that women with a loss at any stage of pregnancy can grieve equally - meaning for some their grief can be just as deep as that of a mother who delivers a stillborn baby, etc.

I suggest looking for posts here, articles in the MCN (Maternal Child Nursing Journal) at your school, or on the internet with the topic Perinatal Loss. I think you'll find a lot of what you're looking for.

Good Luck & God Bless!
txpixiedust

[flightnurse2b]

i have taken care of one patient with a ruptured ectopic pregnancy. very scary. i remember her well, she was a beautiful girl. she was in her early 20's, not too far along at all, 3rd baby, did not know she was pregnant, + for chlamydia, smoker. presented to ER with severe lower back pain, scanty vaginal bleeding, menstrual like cramps, vertigo and hypotension. she was lying on the stretcher, screamed out that her back hurt, coded and was intubated. we all thought triple A, bp did not come up after levo/dopamine. did ultrasound, taken to the OR, ecoptic mass had ruptured. her husband was there with their other children. he and i would chat when he was outside smoking.. she spent 4 months in the icu, got septic, coded again, and died. it was horrific. my heart broke for that family.

[RN-Cardiac]

Not sure if this is what you're looking for,..I'm in ER,.most of the ruptured ectopics I've seen (not many actually) didn't even know they were pregnant. It doesn't take long to rupture a tube. They usually come in with severe abd pain,..sometimes back pain,.hypotensive, tachycardic, vag bleeding seems to vary with the position of the ectopic. These pts get typed and screened ASAP and go to the OR.

[LilgirlRN]

I actually took care of a woman who had had an abortion earlier in the week, came in with bleeding and terrible pain. They had taken an embryo from her uterus when she had an abortion but evidently didn't see the other one growing in her left tube.

She worked as a waitress. When she had the abortion they told her some bleeding and pain were normal. She was at work that night and just started gushing blood and had very intense pain in her pelvis as well as under her left scapula.

They took her to surgery right away, her bp was in the 80's, her HR in the 130's. She was truly bleeding to death internally. She made it through the surgery and I went to ICU to see her the next day. She had no idea who I was, so I had to explain to her that I had taken care of her in the ER the night before. She thanked me as b eing instrumental in saving her life. I didn't think she was going to make it, but so glad she did.

[KatieBell]

I have taken care of one ruptured extopic, and like the others, she really did not spend a significant amount of timein the Emergency Dept, just enough time to figure out what was going on and send her to the OR. In those m oments, she and family were simply terrified.
WIth just a typical ectopic, the patient stays in the ER longer (but not much longer) and I have seen all sorts of reactions, from fear to sadness, to wierdly, relief.
But with the rupture, you really don't have the patient in the ER for very long (at least she shouldn't be there.) so you don't get an opportunity to do much about the grieving process....more likely to be worried about BP and other vitals than the grieving process...

[ERRNTraveler]

I had a 16 year old girl come in via EMS after passing out at a restaurant during her prom-night dinner- came in wearing a prom dress and everything. Pastor's daughter, swore she was a virgin..... Urine preg came back positive, Ultrasound showed ruptured ectopic. The boyfriend disappeared very quickly after we found this out! Parent's were horrified..... Sent her to OR right away, and she was fine. Hopefully she went on birth control after that!

[Shenanigans]

Thanks for the help everyone, this is exactly the sort of stuff I was after.

Happy Easter everyone!

[clc-rn-emt]

I had a friend who was 38, had a tubal ligation 12 years earlier. She had been feeling fatigued, run down, thougth as if she had food poisoning, this had been going on for about 1 week. One day while at the family business sitting in a chair not feeling well, her husband and her were talking and few was dozing in and out, and at one point her husband had a hard time waking her up slapping her trying to get her to wake up, she did but was very pale and lethargic, but responsive. So he took her to the ed. While at the ed, they did labs and iv fluids, monitoring her. At one point they asked for a urine sample for a pregnancy test, she asked "why, I've had a tubal ligation", they said they still needed to check. The pregnancy test came back postive at which time they did a pelvic ultrasound I believe and determined she had quite a bit of blood in her pelvis from a ruptured eptopic pregnancy, and had surgery that day for this.
The funny thing was she had mild to no abdominal pain, no vaginal bleeding, her peroid was about 2 weeks late but she did not think anything about it thinking maybe premenopause. She is doing well, but it lets you know not everyone presents the the emergency room with classic symptoms, and that goes for any serious illness, such as AAA, MI, or CVA.

Hope this helps, good luck on your paper.

[kmoonshine]

I have not had an actual "rupture", but I once had a girl who came in around 9pm at night with abd. pain, and she had a pos. preg test at home. We sent her to US and she had an ectopic (I think it was pretty large, because suddenly everyone was running around like mad, type/cross, prepare for emergency surgery). The girl didn't want to go to surgery until her boyfriend came home in the morning. We had a difficult time explaining to her that she probably wouldn't last that long unless she had the surgery NOW. For awhile, she was actually refusing the surgery and was stating she was going home. And it broke my heart when she asked "what will happen to the baby?".

For my patients who are diagnosed as having a miscarriage or ectopic, I try to refer to the fetus/embryo as "your baby". Because they don't imagine holding a fetus, they imagine holding a baby. Saying that "the embryo implants in the fallopian tube and as the embryo grows..." sounds so cold to me. I think that saying "baby" helps to solidify what is actually happening and allows the patient to start the grieving process and ask questions about what is happening and what to expect, rather than the patient going to surgery, going home, and wondering "what just happened to me".