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Abstract: The patient had several pregnancies and deliveries. After menopause again, she developed early pregnancy reaction, tested positive for urine HCG, and thought she was pregnant. Almost 2 months after menopause, she developed irregular vaginal bleeding, and ultrasound examination indicated that the uterus was slightly large without a gestational sac, and the uterine cavity was filled with heterogeneous dense falling snow-like echoes. The patient was treated with medication after the curettage, and her condition was controlled with a significant decrease in blood HCG.
Basic information】Female, 43 years old
Type of disease】Complete gravida
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Date of consultation】June 2021
Treatment plan】Surgical treatment (curettage) + oral medication (cefuroxime tablets, blood flow breaking granules)
Treatment period】Hospitalization for 6 days, weekly rechecking of blood HCG until it returned to pre-pregnancy level
Treatment effect】Clean uterus, blood HCG decreased significantly
I. Initial consultation
The patient reported that she had 2 abortions and 2 normal deliveries in the past, and the process was smooth. On June 3, she started to have a small amount of vaginal bleeding without abdominal pain, and the bleeding stopped on its own after resting, and then she repeatedly had similar symptoms in the following days. The ultrasound showed that the uterus was slightly large without a gestational sac and the uterine cavity was filled with heterogeneous and dense snow-like echoes.
Treatment
After admission, we improved blood HCG, coagulation function, liver and kidney function, chest X-ray, CT and other examinations, blood HCG 18056.2mIU/ml, and explained to the patient that this pregnancy was not a normal pregnancy, and according to the ultrasound and blood HCG results, the possibility of staphyloma was considered to be high, and it was suggested to perform a curettage, and scraping out the intrauterine tissue for pathological examination could clarify the diagnosis. The patient agreed to the operation and underwent surgery in the afternoon of June 10. After the operation, she was given oral cefuroxime tablets to prevent infection and granules to stop the bleeding.
III. Treatment effect
After the operation, the patient’s vital signs were normal, no fever and abdominal pain, and a small amount of vaginal bleeding, which was normal, and the pathological examination result on June 15 showed chorionic edema and diffuse trophoblastic hyperplasia, suggesting complete staphyloma. The repeat uterine ultrasound indicated clean clearance, indicating that the treatment was effective. The patient was generally in good condition and was given discharge after 6 days of hospitalization, and it is recommended to review the blood HCG situation at the outpatient clinic every week after discharge until it returns to the pre-pregnancy level.
IV. Notes
We are glad that the patient’s condition is under control after treatment, but it is important to review the blood HCG at the outpatient clinic weekly after the clearance procedure, because once the HCG becomes abnormal, there is a possibility that new treatment will be required according to the condition. After surgery, pay attention to personal hygiene to avoid infection, change sanitary napkins regularly during the period of vaginal bleeding, and do not have intercourse too early. Complete staphyloma is a benign disease. Patients are advised to relax, not to be overly worried and anxious, to keep a good attitude, to face the disease correctly and to do regular follow-ups. Patients must do a good job of contraception, at least six months, and if an unwanted pregnancy is found, it is recommended to seek medical attention as soon as possible.
V. Personal insight
The patient is now 43 years old, which is an advanced age pregnancy and prone to staph. However, the patient did not pay attention to it because she had several pregnancies and deliveries and thought she was pregnant again until she had symptoms of irregular vaginal bleeding. Staphyloma is a benign lesion and the treatment is mainly to give clearance. After the operation, pay attention to the regular rechecking of blood HCG, which is gradually decreasing under normal circumstances. If abnormal or elevated blood HCG is found after clearance, there is a possibility of gestational trophoblastic tumor and further treatment is needed.