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Abstract: The patient presented with abdominal pain and vaginal bleeding, elevated blood HCG, and a mass of tissue in the right adnexal region on ultrasound, which was considered ectopic pregnancy. She recovered well and was discharged 5 days after surgery.
Basic information】Female, 29 years old
Type of disease】Ectopic pregnancy
Hospital】General Hospital of Heilongjiang Agricultural Reclamation Bureau
Date of Consultation】04/2022
Treatment plan] Right tubectomy + intravenous injection (cefonicid sodium for injection)
Treatment period】5 days of hospitalization and 1 month of outpatient review
Treatment effect] Vital signs were stable and she was discharged from the hospital.
I. Initial consultation
On Sunday, we suddenly received a call from the emergency department. A pregnant patient came in with more than 40 days of menopause, abdominal pain with vaginal bleeding, without any examination, and told the emergency doctor to do an ultrasound first to see what the situation was. The diagnosis of ectopic pregnancy was considered based on the current examination. The patient was told that she needed to be hospitalized and that the ectopic pregnancy might rupture and cause hemorrhagic shock at any time during the process.
II. Treatment process
After the patient was admitted to the hospital, the relevant laboratory tests such as routine blood, urine routine, biochemistry, coagulation, infectious disease, ECG and HCG were completed. After the patient was admitted to the hospital, the lower abdominal pain gradually increased, and emergency bedside ultrasound was given, and liquid dark areas were seen in the abdomen and pelvis, and the left iliac fossa was about 1.7 cm deep, with more liquid dark areas than before, and persistent active bleeding was considered. The patient and family were more anxious, and the patient had a painful expression. The patient was informed that there might be active bleeding in the pelvic and abdominal cavity and so far it was no longer suitable for medication, and it was suggested that surgical exploration and intraoperative tubal surgery would be decided according to the situation, and the patient and family informed and agreed to the surgery. The patient and her family informed and agreed to the operation. After emergency blood preparation, skin preparation and preoperative preparation, the operation was started soon, and intraoperative adhesion of the fallopian tube to the right ovary and broad ligament was seen.
III. Treatment effect
The patient was hospitalized and underwent emergency surgery, and her vital signs were stable after surgery.
IV. Notes
We are glad that the patient’s indexes are normal after active treatment, but after discharge, we still need to test the HCG level until it is negative, and pay attention to healthy diet and regular life, which is beneficial to the postoperative recovery.
1.Prohibit from bathing, sexual life, swimming, etc. for 3 months.
2.Monitoring of blood HCG until negative.
3.Follow up if there is vaginal bleeding, abdominal pain, poor wound healing, etc.
4, abdominal surgery incision pay attention to cleanliness and hygiene, strengthen nutrition, balanced diet to promote the speed of recovery of the patient’s body.
5. Take oral iron supplements and eat iron-rich food to correct mild anemia, and recheck blood count after 1 week.
V. Personal insight
The main factors for the development of ectopic pregnancy include tubal inflammation, a history of tubal pregnancy and an increased probability of ectopic pregnancy in a second pregnancy, tubal dysplasia or poor development, endocrine disorders, assisted reproductive technology, etc. The patient was found to have intraoperative pelvic adhesions, especially in the right fallopian tube, and the patient’s history of previous cesarean section may be the cause of inflammatory adhesions. The patient’s previous history of cesarean section may be the cause of inflammatory adhesions.
If ectopic pregnancy ruptures, the patient must be highly alert to the possibility of ectopic pregnancy in early pregnancy, especially in patients with high-risk factors, and must be highly alert when vaginal bleeding with abdominal pain occurs.
Ectopic pregnancy may be accompanied by anemia due to rupture, which should be corrected in a timely manner and treated with blood transfusion if necessary. Ectopic pregnancy is an emergency, so don’t get hung up on whether conservative treatment is possible or not, because conservative treatment requires certain indications and not every patient is suitable for conservative treatment; surgical treatment is a way to avoid serious complications and even save lives.