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Abstract: Postpartum hemorrhage is the leading cause of maternal death in China. In this case, the patient delivered a live female infant by surgical cesarean section, and a large amount of blood gushed out after delivery of the fetus, and the placenta was also delivered immediately. Resuscitation measures for postpartum hemorrhage were immediately initiated, and treatment was given to promote uterine contraction + ligation of bilateral superior uterine artery branches, and continuous static dosing of uterine contraction, and the operation was completed. After the operation, the uterus contracted well, the wound healed at grade A, and she was discharged from the hospital.
Basic information】Female, 36 years old
Type of disease】Postpartum hemorrhage
Hospital】General Hospital of Heilongjiang Agricultural Reclamation Bureau
Date of consultation】March 2022
Treatment plan】Medical treatment (uterine contraction injection, carboprost aminotriol injection) + surgical treatment (bilateral ligation of superior uterine artery branches) + blood transfusion treatment
Treatment period】7 days of hospitalization
Treatment effect】Good uterine contraction, Grade A wound healing, and recovery discharge
I. Initial consultation
The patient was 39+6 weeks pregnant and was prepared to be hospitalized one day in advance for termination of pregnancy. The patient’s hands were slightly swollen, so she was first arranged to be hospitalized, and was hospitalized to improve relevant examinations in preparation for delivery, and she also needed to monitor her blood sugar, and after hospitalization, she improved relevant examinations and underwent lower uterine segment cesarean section at 40 weeks. She was given treatment to promote uterine contraction + ligation of bilateral superior uterine artery branches. The total intraoperative bleeding was about 1200 ml, and the diagnosis was postpartum hemorrhage.
II. Treatment history
After the patient was admitted to the hospital, the relevant examinations including routine blood, urine routine, biochemistry, coagulation, infectious disease, blood group, electrocardiogram, ultrasound, etc. were completed, and the blood glucose was monitored and controlled stably. Since the patient was successfully conceived through in vitro fertilization and was an advanced primigravida, the estimated fetal size was about 3800g, which allowed for a vaginal trial of labor, but the patient and her family discussed and decided not to consider a vaginal trial of labor, fearing that the trial of labor would fail and that the fetus would have symptoms such as hypoxia and refuse to have a trial of labor. There were no obvious contraindications to the operation, and the cesarean section was performed at 40 weeks. Just after delivery of the fetus, a large amount of blood was seen and the placenta was delivered at the same time, and the umbilical cord was immediately cut. The placenta and fetal membranes were found to be intact. The uterus was found to be indistinct and soft, and hemorrhage was considered to be caused by weak contraction of the uterus, and the resuscitation procedure for postpartum hemorrhage was started immediately. Input crystalloid and colloid fluid to maintain blood volume, prepare blood for timely transfusion. Massage the uterus + contractin injection intermuscular wall injection + contractin injection continuous static point, the uterus contraction is poor, still visible bleeding, immediately give carboprost aminotriol injection + 5ml saline in diluted intermuscular wall and lower uterine segment respectively, visible bleeding decreased, massage the uterus, still bleeding, give blood transfusion, at the same time perform bilateral uterine artery superior branch ligation, bleeding significantly reduced, iodophor The uterine cavity was cleared, sutured layer by layer, and the abdomen was closed. The intraoperative bleeding was about 1200 ml, and routine blood count, blood gas analysis and coagulation test were given during the operation, and blood transfusion guidance and observation were given according to the corresponding values to avoid complications such as DIC, infection and thrombosis due to blood loss.
III. Treatment effect
The patient’s hemoglobin was 126 g/L before admission, and hemoglobin was 90 g/L during the intraoperative examination, indicating that the patient was bleeding heavily intraoperatively. The uterine bleeding decreased after ligation of the superior branch of the uterine artery, which was obviously effective, and uterine massage and continued intravenous injection of uterine constrictor were given to promote uterine contraction treatment, and the uterus contracted well without significant bleeding. Because of the large fetus, postoperative indocin injection was given continuously to prevent the recurrence of postpartum hemorrhage and corresponding complications due to poor uterine contraction. Five days after the operation, the ultrasound of the adnexa was repeated, and the uterus was enlarged after delivery, and the uterus was waiting to be restored. The patient had good contraction of the uterus 7 days after surgery, a small amount of bloody vaginal malignant fluid, normal urine and stool, and good movement of the extremities. Blood glucose monitoring was in the normal range and newborn monitoring was in the normal range. The surgical incision healed at grade A and was discharged from the hospital.
(Pre-admission blood count)
(Intraoperative blood routine)
IV. Notes
We are glad that after treatment, the patient’s uterus contracted well, the wound healed at grade A and was discharged from the hospital. After discharge, the patient should pay attention to the following points.
1. pay attention to a well-ventilated living environment, keep warm and avoid catching cold.
2, pay attention to personal hygiene during the puerperium, keep the vulva clean, avoid bacterial infection, closely observe the amount and nature of malignant dew, and prevent late postpartum hemorrhage.
3, balanced nutrition, more intake of food with high iron, protein and vitamins, including dairy products, eggs, meat, vegetables, etc., to promote postpartum recovery.
4, appropriate pelvic floor functional exercises to promote postpartum uterine rejuvenation.
5, after delivery, observe the condition of the malignant dew, including the amount, taste, color, etc., observe the caesarean section incision for abnormalities, monitor blood sugar, control the intake of sugary foods, and seek medical consultation promptly if abnormalities occur.
6. Review the blood routine and blood sugar 1 week after discharge, and review and glucose tolerance test 42 days after delivery.
V. Personal insight
1, the high-risk factors of postpartum hemorrhage include gestational diabetes, huge baby, advanced maternal age, obesity, etc. In this case, the patient was of high age, primiparous and in vitro, and also had gestational diabetes combined during pregnancy, all these factors increase the risk of postpartum hemorrhage, advanced maternal age is a factor of high-risk pregnancy, and it is necessary to strengthen management during pregnancy test and delivery to prevent complications.
2, severe postpartum hemorrhage may lead to shock and infection, which may seriously lead to maternal death, once postpartum hemorrhage occurs to actively and quickly take effective ways to stop bleeding, and the possibility of removal of the uterus may be necessary in women with difficult hemostasis, which is a variable factor in the process of diagnosis and treatment of postpartum hemorrhage. Postpartum hemorrhage is prone to complications such as anemia, infection, thrombotic tendency, coagulation disorders, electrolyte disorders, etc. Active prevention of complications is also an important element of postpartum hemorrhage. This case patient was given intraoperative blood routine, coagulation, blood gas analysis examination, timely correction of anemia and electrolyte disorders.
3. Prevention of postpartum hemorrhage requires strict management of high-risk pregnancies, and the need to enhance early warning of possible comorbidities during labor. Make adequate preparation, including psychological preparation of family members and pregnant women, and do not panic.
4, postpartum hemorrhage is not terrible, as long as active and timely measures are taken, it can be cured.