In recent years, the occurrence of ectopic pregnancy (implantation and development of fertilized eggs occur outside the uterus cavity) has increased. It often causes vaginal bleeding, menopause, and abdominal pain. This commonly reported clinical acute abdomen condition accounts for 1–2% of pregnancies and 2.7% of pregnancy-associated deaths. Ectopic pregnancy rupture and bleeding are widely reported in gynaecology and obstetrics and significantly associated with mortality in females during the first trimester. Notably, more than 95% of ectopic pregnancies occur in the fallopian tube, the other 2.5% emerge in the uterine horns, and few may occur in the abdominal cavity, ovaries, or cervix. Since these parts are not helpful to placental implantation and embryo development, the likelihood of rupture and heavy bleeding is high.

For the treatment of ectopic pregnancy, laparoscopic surgery is an ideal approach and has been widely used. Its intraoperative vision is clear that aids doctors to discover the lesion and eliminate it promptly.

Furthermore, this operation is carried out in a completely closed pelvic cavity. It reduces tissue damage by gauze and gloves, exposure of organs to air, and abdominal and pelvic adhesion incidence. Continuous improvement in laparoscopy, including equipment's, proficiency of surgeons and technical levels, has enabled the adequate management of women with ectopic pregnancy rupture, bleeding, or even shock during the surgery through active anti-shock. But, the laparoscopic operation is still an invasive surgery and can lead to complications like incisional hernia, bleeding, infection, and subcutaneous emphysema. It not only raises a person's pain but may also impact wound healing and lead to surgical failure.

The perioperative period refers to the time between surgical treatment and completion of therapy associated with the surgery. With the constant growth of laparoscopic technology, the perioperative nursing approach carried out in conjunction with laparoscopic operation has advanced from the conventional single nursing model to a novel type having robust comprehensiveness. To minimize the complication rate and promote recovery of the patients, this nursing model is beneficial.

RATIONALE BEHIND RESEARCH

Previous studies lack in investigating the effects of comprehensive nursing intervention compared to basic nursing intervention in women having ectopic pregnancy haemorrhage during the perioperative period. Thus, this trial was performed.

OBJECTIVE

This study was conducted to compare the outcomes of comprehensive and basic nursing intervention in patients with ectopic pregnancy haemorrhage during the perioperative period for providing a relevant basis for clinical care and faster recovery. 

Study outcomes

• The outcomes included the disappearance time of abdominal pain, the time to get out of bed, length of hospital stay, changes in stress levels, postoperative visual analogue scale (VAS) scores, psychological status (Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) scores), fallopian tube recanalization rate, and complication rate.

Baseline: There were no vital differences reported at baseline.

Study outcomes

• A significant reduction was observed in the length of hospital stay, time to get out of bed, and the disappearance of pain in the abdomen in the comprehensive nursing arm compared with the basic nursing arm.
• An increase in the blood sugar levels, aldosterone, cortisol, C-reactive protein, and interleukin-6 were observed in both the groups following the operation, but no vital differences were found between the groups.
• Following the surgery, the percentage of patients with VAS (7–10) was remarkably reduced in the comprehensive nursing intervention group (6.10%, n=5) compared to patients in the basic nursing intervention (15.85%, n=13) group. (Figure 2). 

• Patients in the comprehensive nursing group had a reduced complication rate, decreased HA MD and HAMA scores, and a higher fallopian tube recanalization rate than the basic nursing group.
  
  

Ectopic pregnancy is associated with rupture of blood vessels at pregnancy, leading to immense bleeding. It might be life-threatening if proper rescue is not done timely. Therefore, early diagnosis and treatment are essential for patients presenting abdominal pain, vaginal bleeding, and menopause. Laparoscopic surgery significantly improves patient prognosis and reduces the mortality rate, thus an ideal surgical method for treating ectopic pregnancy. Postoperative nursing intervention is also significant, along with correct medical measures for facilitating patient recovery and improving quality of life. Research has indicated that active nursing measures can promote successful surgery of individuals having ruptured bleeding in an ectopic pregnancy with clinical efficacy.

The comprehensive perioperative nursing intervention was introduced to utilize multidisciplinary knowledge for coping with the client's health issues. However, after a century of development, integrated management was devised, which forms the thinking mode of integrating the nursing process. It is a dynamically changing decision-making and feedback process. Additionally, it includes assisting the client in deciding to take suitable nursing measures through assessment and suitable adjustment of plans, cases, implementation, and feedback to fulfil their health requirements.  Today, the comprehensive nursing intervention has been extensively utilized in numerous clinical fields, including pancreatectomy and has attained specific results. 

Mathlouthi et al. conducted a study to evaluate the outcomes of comprehensive care during laparoscopic surgical therapy of ectopic pregnancy. The findings indicated that all the recruited subjects (n=160) attained the expected curative effect. In addition, no complications and infections were witnessed post-surgery. In another study by Ganesh et al., an appropriate nursing intervention was found to lower the rate of complications. These study findings reported that laparoscopic surgery significantly improves various preoperative preparations while strengthening intraoperative nursing cooperation and management. To achieve the expected curative effect, it is also essential to evaluate other aspects of nursing, active treatment of complications, patient's post-surgery state, and discharge provisions.

In this trial, the comprehensive perioperative care plan, including perioperative psychological intervention, infection prevention, and thermal insulation nursing intervention, health education and discharge guidance, was strengthened based on the basic perioperative nursing plan. The comprehensive nursing intervention significantly reduced the length of hospitalization, complication rate, disappearance time of abdominal pain, and time to get out of bed while increasing the fallopian tube recanalization rate compared with the necessary nursing intervention.

Following the operation, the percentage of patients receiving comprehensive nursing intervention with a VAS score of 7–10 was reduced vs patients receiving the basic nursing intervention. Also, the HAMD and HAMA scores of the comprehensive nursing intervention were considerably reduced compared with the basic nursing intervention. Psychological intervention and health education are valuable to minimize false cognition, improve an individual's ability to master adequate knowledge, and better cooperate with the nursing staff. It also enhances a person's compliance and acceptance of nursing and treatment. Targeted psychological counselling may also aid to alleviate the poor mental state of individuals having an ectopic pregnancy. Moreover, it can also help them in actively receiving treatment and also establishing a positive attitude.

Thus, comprehensive perioperative nursing intervention can effectively improve treatment, minimize complications, diminish the pain level to some extent, and also helps in prompt recovery of the patient.