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Abstract: Colds during early pregnancy should be taken seriously, and once a cold or fever develops, prompt medical attention should be sought to avoid abnormal embryo development. The patient in this article is a senior pregnant woman with consistently low progesterone levels after pregnancy. She developed fever after accidentally catching a cold, which then affected the embryonic development and was finally diagnosed with indolent miscarriage. The patient listened to the doctor’s examination and underwent a timely operation to clear the uterus. She recovered well after the operation without serious complications and was discharged successfully.
Basic information】Female, 38 years old
Type of disease】Abortive miscarriage
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Date of consultation】March 2022
Treatment plan】Uterine removal surgery + medication (contraction injection, cefuroxime tablets, deoxyprogesterone ethinyl estradiol tablets)
Treatment period】10 days in hospital, 5 days after outpatient review
Treatment effect】The patient recovered well after surgery, no serious complications occurred, and was discharged successfully.
I. Initial consultation
A patient came to our hospital and reported that she had one early pregnancy abortion in the past and one normal delivery in 2015, and the process was smooth. She had a regular menstrual cycle of 27-29 days, each lasting 4-5 days, and her last menstrual period was on January 30, 2022, and she had not prepared for pregnancy. The patient tested herself positive for urine HCG on March 5 and went to the hospital outpatient clinic on March 6 for three pregnancy tests, the results indicated that the blood HCG was 6844mIU/ml and progesterone was 17.25ng/ml. At that time, the patient was asked to take oral progesterone capsules and folic acid tablets and was instructed to follow up in 5 days. On March 10, the patient had a small amount of vaginal bleeding and mild abdominal pain, accompanied by nausea, vomiting and other early pregnancy reactions, and went to the outpatient clinic again for three pregnancy tests. The results indicated that the patient’s blood HCG was 23110mIU/ml, progesterone 15.25 ng/ml, and ultrasound indicated “early intrauterine pregnancy, equivalent to 6 weeks of pregnancy”, which was clinically diagnosed as preterm abortion with upper respiratory tract infection, and she was an advanced maternal age, so she was admitted to hospital for further treatment.
II. Treatment history
Immediately after admission, the patient was given routine blood tests, ultrasensitive C-reactive protein, electrocardiogram and other relevant tests, and progesterone injection for fetal preservation, as well as Yu Ping Feng granules for upper respiratory tract infection. After 2 days of admission, the patient developed fever and the temperature reached up to 38.5℃, and was given anti-inflammatory treatment with cefuroxime sodium for injection and physical cooling with external ice packs, and the temperature returned to normal after 2 days of treatment and the symptoms were relieved. The ultrasound examination indicated early intrauterine pregnancy, equivalent to 6 weeks of pregnancy, but no embryonic heart tube pulsation was seen. In comparison with the previous findings, it was considered that the embryo was in abortion at this time and the diagnosis was an indolent abortion. The patient and her family were informed of the final diagnosis and it was explained to the patient that because she was of advanced maternal age, she was prone to low progesterone due to luteal insufficiency and high fever due to upper respiratory infection, which affected the development of the embryo, resulting in an indolent abortion. It was recommended to perform a curettage operation to terminate the pregnancy as soon as possible, which was performed on March 18 after the patient’s consent.
III. Treatment results
The patient was operated gently and meticulously without perforation of the uterus because of the tight adhesion of the aborted tissue to the uterus during the curettage operation. After the operation, the patient was promptly given intramuscular injection of contractin to promote uterine contraction and reduce postoperative bleeding, and oral cefuroxime tablets were given to prevent infection. Since the patient was prone to sadness and self-blame after the operation of uterine clearance, and negative emotions are not conducive to physical recovery, adequate communication and encouragement were provided to the patient after the operation. After 10 days of hospitalization, the patient’s vital signs were normal, no fever or abdominal pain, less vaginal bleeding, and her mood improved, so she was discharged. The patient was asked to come to the outpatient clinic for a follow-up ultrasound in 5 days.
IV. Notes
Unfortunately, the baby in the patient’s abdomen was not saved in the end, but thankfully, the patient recovered well after the operation without serious complications and was eventually discharged successfully. However, the patient still needs to pay attention to the following after discharge.
1. patients should go to the outpatient clinic for a follow-up ultrasound 5 days after discharge to find out if the uterus is clean and the uterus is recovering.
2.Patients should rest in daily life, do not go to work too early, and at the same time strengthen supplemental nutrition, which is conducive to body recovery.
3.Since the endometrial surgery can easily lead to damage to the endometrium, it is recommended that patients take dexprogesterone ethinyl estradiol tablets as prescribed by the doctor after discharge from the hospital, which can promote endometrial repair and play a contraceptive effect, but it should be noted that patients should not have intercourse too early after discharge.
4, maintain a positive and optimistic attitude, do not blame yourself too much for losing this pregnancy, a good attitude is conducive to another pregnancy.
5. It is recommended to go to the hospital for relevant pregnancy preparation examination before the next pregnancy and take folic acid early to prevent fetal neural tube malformation.
V. Personal insight
If the embryo has stopped developing but still remains in the uterine cavity and does not expel itself, this is an indolent abortion. Pregnant women are a special group of people, and there are more cases of abortion during early pregnancy, such as chromosomal abnormalities, hyperthermia, luteal insufficiency, and history of bad contact. Therefore, when uncomfortable symptoms appear during early pregnancy, you should go to the hospital without delay, and you should not use medication on your own. The patient in this case is of advanced maternal age, and her hormone level is lower than normal after pregnancy, so she did not seek medical attention in time when she developed upper respiratory tract infection, and by the time she came to the hospital, she had already missed the best period of fetal preservation, which eventually led to the occurrence of indolent abortion. Therefore, it is important to strengthen maternity checkups and pay attention to personal protection during pregnancy to reduce the incidence of indolent miscarriage.