(Disclaimer: This article is for general use only, and the information in the following content has been processed to protect patient privacy)
Abstract: A 23-year-old female presented with a 50-day menopause and hemorrhagic shock due to incomplete abortion with massive vaginal bleeding and severe anemia, while incomplete abortion mainly refers to the fact that most of the pregnancy products have been expelled and a small amount of tissue remains in the cavity, which affects the uterine contraction and therefore causes massive bleeding, thus requiring clinical clearance and anti-shock treatment as soon as possible. In this case, the patient had a rapid onset of bleeding within a short period of time, and was clinically resuscitated to safety.
Basic information】Female, 23 years old
Type of disease】Incomplete abortion
Hospital】Guangzhou Huadu District People’s Hospital
Date of consultation】March 6, 2020
Treatment plan】Emergency uterus removal + blood transfusion + medication (cefuroxime tablets + ferrous sulfate slow-release tablets + Wujia biochemical capsules) + vulva care (iodophor scrubbing)
Treatment Period】5 days of hospitalization
Treatment effect] The patient’s condition was stable
I. Initial consultation
A 23-year-old female was wheeled into the consultation room for 50 days of menopause, 1 day of vaginal bleeding, and 1 hour of dizziness. The patient was pale, could answer questions correctly, and had normal development in appearance. The patient’s last menstruation was on January 18, 2020, with normal volume and cleared in 5 days. Germ tissue can be seen. This morning, she had lower abdominal pain and vaginal bleeding after slipping and falling in the bathroom. She thought she had injured the embryo and rested in bed, but the abdominal pain did not decrease. Examination showed T: 36.6°C, P: 98 beats/min, R: 22 beats/min, Bp: 84/56 mmHg, severe anemic appearance, clammy and cold skin, but answered questions correctly, no abnormality was heard on cardiopulmonary auscultation, whole abdomen was flat and soft, lower abdominal pressure pain (±), no rebound pain, enlarged uterus was not yet palpated at the pubic symphysis. Gynecologic examination: normal vulvar development, fresh blood in the vagina with high discharge, smooth cervical area, no tissue filling at the cervical orifice, enlarged horizontal uterus, spherical shape, soft texture, no obvious pressure pain, no mass or pressure pain in the bilateral adnexal area. Emergency vaginal ultrasound examination: uterus 8×7×7 cm in size, disorganized echogenic masses were seen in the uterine cavity, and blood flow signals were seen, no abnormalities were seen in the myometrium and bilateral adnexal areas. Routine blood test showed WBC: 6.02×10＾9/L, HGB: 65g/L, and normal coagulation time. Clinical diagnosis: incomplete abortion.
II. Treatment history
After laboratory and gynecological examinations and comprehensive analysis of clinical history, the initial diagnosis was incomplete miscarriage, so the uterus was cleared under emergency surgery, the uterus was 8 cm long, about 4 g of chorionic tissue and meconium were removed and sent for pathological examination. 200 ml of whole blood was transfused during the operation. On the second day of the operation, the patient was given oral Wukka biochemical capsules, and local care of the vulva was strengthened by scrubbing the vulva with iodophor twice a day to reduce the possibility of infection. One week after the operation, the pathology results were sent for villi tissue and decidualized tissue.
III. Treatment effect
After active correction of shock and the operation of uterine clearance, the patient’s condition was stable, her general condition was good, her facial pallor was better than before, her blood pressure was 110/70 mmHg, her skin temperature was normal, her breathing was stable, there was no abnormality in cardiopulmonary auscultation, there was no lower abdominal pain, a small amount of vaginal bleeding, dark red, no odor, before discharge, the uterus was of normal size in ultrasound examination, there was no fluid in the uterine cavity, no abnormal echogenicity, bilateral adnexal area No abnormality was seen, and the hematocrit rose to 85g/L. The patient was discharged after 5 days of hospitalization and recovered.
IV. Notes
We are glad that the patient’s symptoms have been relieved after treatment. After discharge, the patient should continue to rest in bed for 10 days, and strengthen nutrition in diet, mainly light diet, and eat more blood-supplementing foods, such as red dates, pork liver, lean meat, peach, cherry, spinach, etc. During the period of vaginal bleeding, it is not allowed to eat ginseng, antler and other tonic products, which may lead to increased vaginal bleeding. It is recommended to keep the vulva clean, change sanitary napkins and underwear regularly, not to take a sitz bath for 1 month, not to have sex in the bath, and if you plan to get pregnant, it is better to do so after 6 months, and pay attention to pregnancy safety after getting pregnant again.
V. Personal insight
Incomplete miscarriage is very dangerous once it occurs, and the patient’s life was saved only by timely resuscitation in this case. Therefore, in case of incomplete abortion with a lot of bleeding, the patient is in shock and emergency, the first choice is to remove the uterus and at the same time correct the anemia to protect the life.