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Abstract: A pregnant woman was found prenatally to have vulvovaginal pseudomelanosis, a clinically common vaginitis, but without thorough and effective treatment, the inflammation eroded the fetal membranes at the cervical os, resulting in brittle membranes and thus premature rupture of the fetal membranes. As the conditions for vaginal trial of labor were available, she was given an intravenous injection of indocin to induce labor and antibiotics to prevent infection.
Basic information】Female, 32 years old
Type of disease】Premature rupture of membranes
Hospital】Guangxi Zhuang Autonomous Region Jiangbin Hospital
Date of Consultation】May 2022
【Treatment plan】Operative labor treatment (contraction injection) + anti-infection treatment (ceftriaxone sodium for injection + gynecologic spray)
Treatment period】5 days of hospitalization and 42 days of postpartum review
Effectiveness】Smooth labor and safe mother and child
I. Initial consultation
The patient reported that her last menstrual period was on August 17, 2021, and her menopause was over 1 month. She had a low risk of Down’s syndrome screening and no significant abnormalities on systemic ultrasound. At 36 weeks of pregnancy, she was diagnosed with vulvovaginal pseudomycosis and was given nifurtimox vaginal soft capsule for vaginal plugging, which she stopped using after 3 days. She was diagnosed with premature rupture of fetal membranes and was admitted to hospital immediately.
Treatment
The patient was admitted to the hospital and was given an elevation of the buttocks, the vaginal examination revealed that the cervical canal was semi-eliminated and the opening of the uterus was not yet opened. At 15:20, we started to induce labor, and at 20:00, we checked the cervical canal, but the opening of the uterus had not yet opened, so we suspended labor and let the patient rest. The labor progressed smoothly, and a live baby was delivered at 11:18.
III. Treatment effect
The patient’s vital signs were normal, vaginal bleeding was not much, and the uterus was well regenerated, and she returned to the ward to rest after 2 hours. Because the patient had severe vulvovaginal pseudomicrobial disease before delivery, and the premature rupture of fetal membranes increased the chance of vaginal lateral wound, uterine and pelvic infections, the patient was advised to pay attention to personal hygiene, change sanitary napkins and pants regularly, and give gynecological spray to clean the vulva. The patient had no fever, no abdominal pain, little postpartum malignant dew, good healing of the lateral vaginal incision wound, and normal neonatal indicators, so she was discharged on the 5th day of hospitalization.
IV. Notes
We are glad that the patient was discharged from the hospital after timely treatment and the mother and child were safe, but we still need to pay attention to the following matters.
1. Pseudomonal vaginal yeast disease is prone to recurrence. It is recommended that the patient should go to the outpatient clinic for leucorrhoea tests after the malignant dew is cleared, and active treatment should be given if the disease is not completely cured.
2. In case of vaginitis, the vaginal lateral incision wound is more difficult to heal, so care should be taken to avoid infection and also to avoid being sedentary.
3.It is recommended to breastfeed after delivery and drink more nutritious soup to promote milk secretion.
4. It is recommended to go to the obstetrics and gynecology clinic for pelvic floor function assessment and pelvic floor rehabilitation treatment 42 days after delivery.
5.Postpartum rest is the main focus, do not have intercourse and do strenuous exercise too early, ensure quality sleep, keep a happy mood, and avoid postpartum depression.
V. Personal insight
Due to the change of hormone level in pregnant women, vaginitis can easily occur due to the dysbiosis of vaginal flora. In case of serious vaginitis, it is easy to infect the vagina, which leads to the brittle quality of the fetal membranes at the cervical opening, and the local tension becomes poor, and premature rupture of fetal membranes can easily occur. In this case, the maternal condition was not thoroughly treated for vulvovaginal pseudomelanosis, which increased the chance of premature rupture of membranes. Because the barrier protecting the uterine cavity is destroyed after premature rupture of membranes, pathogenic bacteria can easily enter the uterine cavity and cause uterine infections and fetal infections in the pregnant woman, which are detrimental to the pregnant woman and the fetus. Therefore, it is necessary to terminate the pregnancy as soon as possible, to actively induce labor for pregnant women who are eligible for vaginal trial of labor, to perform cesarean section as soon as possible for pregnant women with indications for cesarean section, and to apply antibiotics prophylactically to reduce the chance of infection.