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Abstract: A young woman with 3 previous abortions was diagnosed with partial placenta praevia, a relatively common type of placenta praevia, after ultrasound examination of her current pregnancy, and she sought urgent medical attention because of heavy vaginal bleeding in late pregnancy. She was treated with emergency cesarean section and positive pressure oxygen for neonatal tracheal intubation, which successfully saved the life of mother and child.
Basic information】Female, 24 years old
Type of disease】Partial placenta praevia
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Date of consultation】June 2022
Treatment plan】Maternal surgical treatment (cesarean section, hydrocystic cavity tamponade) + medication (cefuroxime sodium for injection, metronidazole injection, indocin injection, carboprost aminoglutethimide injection, Yixin Sheng capsule) and fetal tracheal intubation with oxygen
[Treatment period] 6 days in hospital, review after 42 days
Effectiveness of treatment】The surgery was timely and effective, saving the life of mother and child.
I. Initial consultation
She is a 24-year-old woman with 3 previous abortions, her last menstruation was on September 15, 2021, and her menopause was over 1 month. She was pregnant at 12 weeks and had a regular checkup at our clinic. At 30 weeks of pregnancy, she developed a small amount of vaginal bleeding after exertion and went to the hospital for emergency ultrasound, which indicated “intrauterine single live fetus, equivalent to 29 weeks and 2 days of pregnancy, partial placenta praevia”, and was hospitalized for 5 days. On June 1, she had more vaginal bleeding during sleep, but she found it only when she got up at 6:00 a.m. without abdominal pain, so she called 120 and was rushed to the obstetrics department, where she was diagnosed with partial placenta praevia and was admitted immediately.
II. Treatment
Due to the large amount of vaginal bleeding and the fact that the fetus was alive, the mother and her family were informed of her condition and that an immediate cesarean section was necessary to save the life of the mother and child, and they agreed to the operation. The patient was given blood, opened double intravenous infusion, sent to the operating room immediately, and notified the anesthesiologist, ICG, and neonatologist to prepare for joint resuscitation. The neonatologist gave positive pressure oxygen after tracheal intubation, with a score of 8 at 5 minutes and 10 at 10 minutes, and the resuscitation was effective. The uterus was contracting well, but there was obvious bleeding at the placental abruption, so sutures were given to stop the bleeding plus hydrocolloid cavity tamponade, and the bleeding was significantly reduced. Intraoperative blood count showed hemoglobin of 81g/L, and transfusion was not necessary. After the operation, the mother was sent back to the ward for observation, blood pressure was measured at 88/55 mmHg, heart rate was 98 beats/min, and her face was slightly pale. She was given sodium chloride glucose injection to enhance rehydration treatment, and at the same time, she was treated with contraction of the uterus by intramuscular injection of cefuroxime sodium for injection and metronidazole injection for anti-inflammatory treatment. Preoperative and intraoperative blood loss were all present, resulting in maternal anemia, and postoperative blood supplementation with Yixin Sheng capsules was given to correct the anemia.
III. Treatment effect
Due to the timely administration of oxygen therapy to the newborn after surgery, the newborn’s skin regained its redness and oxygen saturation increased. In the postoperative checkup, the maternal organism recovered well, the vital signs were normal, the wound healed well, no postoperative infection occurred, no concomitant bleeding, and less postpartum malignant dew, and after 6 days of hospitalization, the routine hemoglobin rose to 88g/L and was discharged. The mother was instructed to review after 42 days to assess the recovery of the incision and uterus.
IV. Notes
We are glad that this woman was treated promptly by cesarean section and the life of mother and child was not threatened, but still pay attention to the wound healing after discharge and follow up promptly in case of redness, blood oozing, exudate and pain. Pay attention to strengthen blood replenishment treatment, you can continue to take blood replenishment capsule, and also eat more blood replenishing food, such as pig blood and pig liver. Increase nutrition and rest in daily life. Breastfeeding is recommended to help promote uterine regeneration. Pay attention to contraception for 18 months after cesarean section, don’t have intercourse too early and don’t get pregnant again too early, otherwise there is a risk of uterine rupture.
V. Personal insight
There are more reasons for the occurrence of anterior placenta. Multiple abortions can lead to roughness of the uterine wall, which can easily affect the attachment of the placenta. When the placenta is too low, especially complete placenta praevia and partial placenta praevia which are closely related to the cervical opening, it is easy to bleed repeatedly and many times in late pregnancy, just like the patient in this case. Therefore, it is important to have a family member with you in late pregnancy, and once vaginal bleeding occurs, go to the hospital in time and give a cesarean section in time for pregnant women with heavy bleeding.