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Abstract: The patient in this case was a 33-year-old woman who had an emergency delivery during labor and a large fetus, resulting in a lack of uterine contractions after delivery, causing a large amount of vaginal bleeding in a short period of time and postpartum hemorrhage. In the face of the crisis, the experienced obstetrics staff gave emergency resuscitation, including conventional treatment + symptomatic treatment, and the condition was finally controlled and the fetus was delivered successfully.
Basic information】Female, 33 years old
Type of disease】Postpartum hemorrhage
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Time of consultation】April 2022
Treatment plan】Symptomatic treatment: abdominal pressure on the uterus combined with vaginal two-handed method + application of uterine shrinker injection + uterine cavity water sac filling + application of hemostatic drugs (carboprost aminotriol injection); conventional treatment: anti-infection (ceftriaxone sodium for injection, metronidazole injection) + blood replenishment treatment (Yixin Sheng capsule)
Treatment period】5 days of hospitalization
Treatment effect] The condition was controlled, and the rescue was timely and effective
I. Initial consultation
Patient’s description: 2 previous abortions, stillbirth in April pregnancy, 1 induced labor, 1 normal delivery at 40 weeks of pregnancy in 2016, with a smooth process. The last menstrual period was on July 6, 2021, and the ultrasound for 2 months indicated early intrauterine pregnancy. The outpatient fetal monitoring indicated that the contractions were regular, about once every 7 minutes, and the opening of the uterus was not opened during the negative examination, but it was recommended to hospitalize the patient for observation considering that she was a transwoman.
II. Treatment
After completing routine blood tests, coagulation function, electrocardiogram, ultrasound and other relevant tests, and after assessing the size of the fetus and the condition of the birth canal, the patient and her family were informed that since the patient was currently 40+ weeks pregnant, the fetal weight was estimated to be close to 4000g according to the uterine height, abdominal circumference and ultrasound results, and there was a possibility of a huge baby, but the patient had delivered a 3700g baby before, so she could try to have a vaginal delivery this time. The patient and her family understood and agreed to try vaginal delivery first. At 20:30 that night, the patient’s contractions strengthened significantly, and the opening of the uterus was 2 cm, and the labor progressed rapidly. The postpartum hemorrhage was caused by the lack of contraction of the uterus after delivery due to the large fetus. The uterus was immediately pressed with abdominal pressure combined with the vaginal two-handed method to reduce the hemorrhage, and carboprost aminotriol injection was given through the vagina.
III. Treatment effect
The patient had postpartum hemorrhage due to lack of contraction, after giving symptomatic treatment such as pressure on the uterus, application of uterine constrictor injection and uterine water sac filling, the vaginal bleeding stopped and the texture of the uterus became hard, indicating that the treatment was effective. The patient’s condition was controlled and resuscitation was active and effective. After successful resuscitation, antibiotic treatment was given, including injectable ceftriaxone sodium and metronidazole injection to prevent infection; oral blood replenishment drug, Yixin Sheng capsule was administered. After 4 days of postpartum checkup, the patient’s vital signs had returned to normal, the uterus had recovered well, the postpartum malignant fluid was less, and the hematocrit was 88g/L on recheck, and the patient was discharged successfully.
IV. Notes
We are glad that the patient recovered after treatment, and the patient should pay attention to the following points after discharge.
1. Continue to take medication for blood tonic treatment, eat more blood tonic food appropriately and actively correct anemia, which is beneficial to postpartum recovery.
2, pay attention to more rest, do not work too hard, increase nutrition appropriately, avoid eating spicy, cold and blood-activating foods, and eat more fresh vegetables, fruits, milk, eggs, meat, etc..
3, postpartum patients are weak, coupled with anemia, which can easily lead to a decrease in body immunity and resistance, so pay attention to personal hygiene to avoid puerperal infections.
4.Patients are advised to relax and maintain a good state of mind, and family members are advised to give more care to avoid the occurrence of postpartum depression due to postpartum bleeding.
5. It is recommended to follow up with the obstetrics and gynecology clinic 42 days after delivery to improve the pelvic floor function assessment and postpartum examination and perform pelvic floor rehabilitation treatment.
V. Personal insight
Postpartum hemorrhage caused by weak uterine contraction is very common. In the case of postpartum hemorrhage, first of all, medical and nursing staff should carefully find the causes of postpartum hemorrhage in order to effectively deal with the symptoms. For postpartum hemorrhage caused by weak uterine contraction, it can be quickly judged by pressing the uterus, so it is necessary to give timely treatment to promote uterine contraction and stop bleeding, often one method of stopping bleeding is difficult to achieve quick results, so several methods are often used simultaneously in the clinic to achieve the treatment purpose faster and more effectively. As in the case of this patient, the combination of manipulation and medicine to help stop the bleeding will have twice the effect with half the effort!