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Abstract: Ms. Li had a history of multiple abortions and pelvic inflammatory disease, and her placenta was retained due to placental adhesions induced by roughness of the uterine wall, resulting in placental abruption after normal delivery. A small amount of placental tissue remained in the uterine cavity after placental ablation, and the residual tissue could not be expelled by itself even after pro-uterine contraction treatment, so she underwent uterine evacuation, and after the operation, Ms. Li had no residual placental tissue and recovered well.
Basic information】Female, 30 years old
Type of disease】 Retained placenta
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Date of consultation】November 2021
Treatment plan】Intravenous infusion (indocin injection) + surgical treatment (placenta abruptio + curettage)
Treatment period】7 days in hospital
Effectiveness】No residual placental tissue, good treatment effect
I. Initial consultation
The patient is 30-year-old Ms. Li, who reported that she had 3 previous abortions and was treated in the outpatient clinic for pelvic inflammatory disease 1 year ago. Her last menstrual period was on February 10, 2021, and her menopause was over 1 month. She started to have irregular lower abdominal distension at 5:00 on November 10, which gradually intensified and became red when she woke up. The outpatient fetal monitoring examination suggested regular contractions, and after sterilization, gynecological examination was performed, the cervical canal was receding and the uterine opening was 2cm. Diagnosis: 1. 4 pregnancies and 0 births (i.e. 4 pregnancies and 0 births), live birth at 39 weeks of gestation; 2. history of adverse pregnancy and delivery, and hospitalization.
II. Treatment history
After admission, the relevant investigations were completed, and assessment of the birth canal and fetal size was given. No indication for cesarean section was found, and the patient was advised to have a trial of vaginal delivery, to which she agreed. After delivery of the fetus, the patient was given an injection of contractin to promote uterine contraction. 15 minutes later, there was no sign of placenta abruption, the uterus was well contracted by massage, and there was little vaginal bleeding, and catheterization was given. After 30 minutes of delivery, the placenta was still not aborted, so the right hand was extended into the uterine cavity and the placenta was examined for tight adhesion to the uterine wall. After the placenta was removed, the placenta lobules were seen to be missing and rough, and a little placental tissue was considered to remain in the uterine cavity, but there was not much bleeding at present.
3 days after delivery, the patient’s general condition was good, no fever, good uterine regeneration, not much malignant dew, ultrasound examination was given, suggesting abnormal echogenicity of about 5cm×3cm in the uterine cavity, there was still residual placental tissue not discharged, which was considered as retained placenta. We explained to the patient that the placenta residual tissue might expose the uterine vessels and cause hemorrhage in the process of detachment, so we suggested that we should perform a cervical clearance before discharge, and the patient agreed to perform a cervical clearance on November 15, and a small amount of placenta-like tissue was scraped out.
III. Treatment effect
On the seventh day of treatment, the patient’s ultrasound showed no obvious abnormality in the uterus, so the patient was discharged after considering the good effect of uterus removal, and the patient’s vital signs such as respiration, blood pressure and heart rate were stable. The patient came to the hospital for review 42 days after delivery, and her body did not show any abnormalities and recovered well, and all the examination indexes were normal.
IV. Notes
We are glad that the patient’s retained placenta was detected and treated in a timely manner without other adverse events. However, after the patient was discharged from the hospital, the patient and her family should be advised to pay attention to the following points.
1, pay attention to personal hygiene, change sanitary napkins regularly, never have intercourse too early to avoid puerperal infection, and pay attention to contraception.
2, do not stay up late, keep enough sleep, increase nutrition appropriately, and scientifically match the diet, which is conducive to physical recovery.
3. Patients who have experienced childbirth and postpartum surgical operations are prone to adverse emotions, and it is suggested that family members should care more about the patients, encourage them, and share the pressure of taking care of the newborn to avoid their postpartum depression.
V. Personal insight
This patient experienced 3 abortions and uterine inflammation, so she is prone to placenta-uterine wall adhesions, which leads to postpartum placenta retention. Generally, the adhesions between the retained placenta and the uterus can be solved by the doctor’s freehand detachment of the placenta and the operation of uterine evacuation, but an experienced doctor is needed to perform the operation. This patient has increased the number of uterine surgeries after purging, which may aggravate the postoperative damage to the endometrium and uterine wall, so she can go to the outpatient clinic for endometrial repair treatment after delivery.