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Abstract: This is the case of a 25-year-old pregnant woman who presented to the hospital with 11+1 weeks of menopause and 2 hours of vaginal bleeding. The patient had no history of dysmenorrhea and had undergone ultrasound examination at a local hospital, which showed that embryonic tissue and heart tube pulsation were visible, suggesting early pregnancy, embryonic survival, and uterine cavity effusion of 1.1 cm×0.8 cm. After consultation, intracavitary 3D ultrasound examination was performed, suggesting subchorionic hemorrhage, consistent with the diagnosis of preterm abortion, and treatment was performed to preserve the fetus.
Basic information】Female, 25 years old
Type of disease】Pre-eclampsia miscarriage
Hospital】Huangshi Central Hospital
Date of Consultation】May 2022
Treatment plan】Medication (methotrexate injection + diphenhydramine tablets)
Treatment Period】Hospitalization for 4 days, rechecked after 1 week
Effectiveness of treatment】Vaginal bleeding was controlled, and subchorionic hemorrhage was not significantly increased.
I. Initial consultation
The patient came to our hospital accompanied by her family, complaining of 11+1 weeks of menopause. 2 hours ago, while resting at home, she had a sudden onset of vaginal bleeding, which was small and bright red in color and not accompanied by abdominal pain. During the examination, we learned that the patient had regular and normal menstruation in the past, no history of dysmenorrhea, and had nausea, vomiting, fatigue and other early pregnancy reactions during pregnancy. After the examination, the patient underwent physical examination and intracavitary three-dimensional ultrasound, and the results of the comprehensive examination and examination were considered: the bleeding originated from the uterine cavity, and the ultrasound indicated the accumulation of subchorionic blood, so the patient was recommended to be hospitalized for fetal preservation treatment.
II. Treatment process
After the patient was admitted to the hospital, the relevant tests were completed, i.e. blood routine, liver and kidney function, coagulation function, urine routine, ECG, HCG test and progesterone test. We communicated with the patient and her family about her condition and advised that there was currently subchorionic hemorrhage, which was consistent with the diagnosis of preterm abortion. If the vaginal bleeding increases further and the subchorionic hemorrhage expands further, there is a possibility of leading to inevitable miscarriage. She was advised to use methotrexate injection to suppress contractions and to take oral dydrogesterone tablets to supplement progesterone for fetal preservation. During the course of treatment, she needed to review the ultrasound periodically to check the fetal survival status and whether the subchorionic hemorrhage had expanded or absorbed on its own.
III. Treatment effect
After the treatment of suppression of contractions and progesterone supplementation, the patient’s vaginal bleeding symptom was significantly relieved, and the ultrasound was repeated after 3 days of treatment, which showed that the subchorionic hemorrhage did not increase significantly. The patient was discharged from the hospital with subchorionic hematoma and was advised to observe vaginal bleeding at home after discharge and to return to the hospital immediately if there was a possibility of vaginal bleeding, and to return to the hospital one week after discharge for a follow-up ultrasound, regular obstetric examination and attention to abdominal pain and vaginal bleeding.
IV. Precautions
I am happy that the patient’s fetus in the womb was preserved through treatment. The patient should also pay more attention to vaginal bleeding and lower abdominal pain after discharge. Pay attention to the cleanliness of the vulva and avoid sexual intercourse; at the same time, pay attention to rest, strengthen nutrition, and stay up less. Keep your bowels open, eat more fresh fruits and vegetables, coarse grains, cereals, such as spinach, broccoli, tomatoes, corn, peanuts, etc. Milk, soy products, shellfish and other seafood are rich in calcium and can be consumed by pregnant women. During home if abdominal pain worsens or bleeding increases as well as odorous discharge, it is recommended to seek immediate medical attention.
V. Personal insight
1. If, like this patient, there is a case of pre-eclampsia, but the symptoms are relieved after rest and fetal preservation treatment, the pregnancy can be continued, but if the symptoms continue to worsen, there is a possibility of leading to inevitable miscarriage. Therefore, such cases need to be taken seriously by patients and their families, and they should go to the hospital promptly when they become uncomfortable. Patients with prolonged vaginal bleeding also need to pay attention to perineal hygiene to avoid intrauterine infection, and antibiotics can be used to prevent infection treatment if necessary.
2. there are very many possible causes of miscarriage in early pregnancy, such as uterine malformation, fetal chromosomal abnormalities, rheumatic immune diseases, easy embolism, etc. Treatment according to the cause can improve the success rate of fetal preservation and avoid the development of inevitable miscarriage.
3. Subchorionic hematoma or hematoma, usually need to be diagnosed by ultrasound, if the subchorionic hematoma exceeds 1/2 of the size of the gestational sac, the success rate of fetal preservation will be reduced. Therefore, for patients with subchorionic hemorrhage found after vaginal bleeding, the cause should be actively investigated, closely followed and treated in a timely manner.