It is important to follow the natural course of life and to terminate the pregnancy if necessary in case of a dangerous pregnancy, not to force it, as a healthy life is more important. Stop1 Ectopic Pregnancy When the fertilized egg formed by the sperm and egg does not follow the established “procedure” and wanders back to the uterine cavity, or stops halfway, or wanders from the other end of the fallopian tube (umbrella) to the pelvic and abdominal cavity of the mother to lay and grow, it is called ectopic pregnancy, which is often referred to as ectopic pregnancy. Don’t underestimate the fact that ectopic pregnancy, which has an incidence of only 1 in 1, can even endanger a woman’s life if it is not treated promptly and if internal bleeding occurs. Clinical manifestations (1) The clinical manifestations of ectopic pregnancy are particularly non-specific, generally manifesting as menopause, irregular vaginal bleeding and abdominal pain, etc. When rupture of ectopic pregnancy occurs, sudden acute abdominal pain will occur. When the bleeding volume is large, blood pressure drops, heart rate increases, and even syncope appears, which can lead to death if not treated properly. (2) The time of rupture varies depending on the location, for example, tubal pregnancy occurs earlier, mostly around 6 to 8 weeks after menopause. (3) If you have menopause and positive urinary enzyme immunity but have symptoms such as bleeding and abdominal pain, you will be alerted to the possibility of ectopic pregnancy, especially if you are using an intrauterine device, have a history of pelvic inflammatory disease, a history of ectopic pregnancy, or a history of uterine or tubal surgery. (4) Your clinician will recommend you to do pelvic ultrasound, blood HCG dynamic monitoring (blood HCG will double every 48 hours in normal early pregnancy), etc. Treatment If ectopic pregnancy is diagnosed, the pregnancy must be terminated. At present, there can be two methods of treatment: conservative treatment, which refers to the use of small doses of short courses of chemotherapy drugs, and surgical treatment, which is divided into open surgery and minimally invasive surgery (if diagnosed in time, minimally invasive surgery is currently the least invasive treatment method). Stop2 low amniotic fluid If the amniotic fluid is less than 300 ml in the middle and late stages of pregnancy, it is called low amniotic fluid, but at this time it is already a diagnosis made by measurement after delivery. Before delivery, it will be based on ultrasound, and low amniotic fluid is suspected when the amniotic fluid index is less than 5 cm or the single amniotic level is less than 2 cm. Causes If low amniotic fluid occurs, there are two reasons for this: a decrease in production, which includes fetal malformations (most often urinary malformations), placental hypoplasia, etc., and a loss of amniotic fluid due to rupture of the fetal membranes, which can occur at any stage of pregnancy. Management Low amniotic fluid is a red flag. The doctor will take a careful history, especially if there is a history of vaginal fluid, and will recommend ultrasound (mainly to rule out serious malformations), fetal heart monitoring for fetal hypoxia, and in the case of ruptured membranes, observation of amniotic fluid properties, odor, and infection indicators. (1) If there is a serious malformation, the pregnancy can be terminated, but it is recommended to do fetal chromosomal examination in order to find the cause, which can be a guide for future pregnancies. (2) If the placenta is hypoplastic and shows signs of hypoxia, the pregnancy should also be terminated. (3) If the fetal membranes rupture and the pregnancy is not yet full term, antibiotics can be applied if infection is excluded, while actively promoting the maturation of the fetal lung and closely expecting observation, and also terminate the pregnancy once signs of infection appear or if the fetus is estimated to be viable. If the rupture of fetal membranes occurs after 35 weeks of gestation, unless there is an indication to promote fetal lung maturation, termination of pregnancy is usually chosen without expectation. Stop3 Placental abruption The placenta is an important organ between the mother and the fetus. Generally, abruption of the placenta occurs after the fetus is delivered from the mother, if all or part of the placenta has separated from the uterine wall before the fetus is delivered, it is called placental abruption. Hazards (1) It is one of the critical obstetric conditions that can cause fetal hypoxia and even death due to the interruption of blood flow; on the other hand, when placental abruption occurs, certain substances are released that cause maternal coagulation dysfunction, which in turn can lead to severe bleeding. (2) Sometimes, the central part of the placenta is detached but the edges have not yet separated from the uterine wall, forcing blood to penetrate into the myometrium (called uterine stroke) due to continuous bleeding, affecting uterine contraction and in severe cases requiring uterine removal to save maternal life. Signs (1) Placental abruption generally still has some signs to draw attention to, such as vaginal bleeding, abdominal pain, low back pain, etc., examination reveals uterine sensitivity, failure to return to a sluggish state after contraction, slowing down or even disappearance of fetal heartbeat, etc. Laboratory tests can show signs of decreased hematocrit and coagulation dysfunction. In severe cases, shock symptoms may appear. (2) Some cases are prone to placental abruption, such as trauma, severe pre-eclampsia, when the membranes are broken with excessive amniotic fluid, or after the delivery of the first twin fetus. Treatment After the diagnosis of placental abruption, most of the pregnancies need to be terminated urgently. Sometimes, although the fetus has died, a cesarean section may even be performed to save the life of the mother. The termination of pregnancy needs to be accompanied by intensive life support. Continuation of pregnancy under close observation may be resorted to only when exceptional circumstances occur. For example, when old placenta abruptio is detected on ultrasound and the mother and fetus are evaluated to be stable. Stop4Severe pre-eclampsia Pre-eclampsia is a type of hypertensive disorder of pregnancy with an incidence of 6% to 9%. It is mainly characterized by elevated blood pressure and proteinuria after 20 weeks of gestation, mostly accompanied by edema, which can cause organ damage in severe cases and endanger the safety of mother and fetus. Pre-eclampsia is likely to occur in mothers of advanced age, history of pre-eclampsia, chronic hypertension, and gestational diabetes mellitus. Clinical diagnosis Pre-eclampsia is divided into mild and severe, the latter mainly refers to those with blood pressure above 160/110mmHg, 24-hour urine protein quantification above 2g, or persistent urine protein characterization above ++. Severe preeclampsia can even occur before full term, which is called early onset severe preeclampsia, and the earlier the week of gestation, the more severe the condition. (1) Since the mechanism of preeclampsia is not yet clear, only symptomatic treatment is available, such as the use of magnesium sulfate to prevent convulsions (eclampsia), hypotension, sedation, diuresis and reasonable volume expansion when necessary. In addition to monitoring blood pressure and urine protein, liver and kidney function, cardiopulmonary function, and the presence of central nervous system symptoms should be monitored. Those who are not full term should also take the time to promote the maturation of fetal lungs. (2) In 24 to 48 hours of severe preeclampsia, if the condition is not controlled or even worsened, the pregnancy should be terminated, regardless of the small gestational age. It is worth reminding that although termination of pregnancy is the ultimate choice for the treatment of preeclampsia, there will be a small number of patients whose condition still worsens after termination of pregnancy, so the treatment of severe preeclampsia should be continued until after delivery, usually 2 to 3 days mostly. (3) Pregnant women with severe preeclampsia usually need to be referred to a general hospital for treatment of delivery to maximize the safety of the mother and child. (4) Pregnant women with preeclampsia, especially those with severe preeclampsia, should be followed up after delivery to observe the time of blood pressure regression, disappearance of urine protein, and the time of recovery of the function of the involved organs. Stop5 Severe fetal malformations By severe fetal malformations, we generally refer to compound malformations, mostly associated with genetic abnormalities (such as chromosomal abnormalities, genetic abnormalities or metabolic diseases), which cannot yet be effectively treated due to the limitations of the current medical level. Moreover, the chances of intrauterine fetal death, neonatal death and distant disability of such fetuses are significantly higher, which brings a certain burden to families and society. Therefore, after rigorous high-level prenatal diagnosis (including imaging, genetics, etc.), joint multidisciplinary evaluation (including obstetrics, imaging, neonatology, pediatric surgery, geneticists, etc.), pregnant women and husbands are fully informed of the prognosis of severe malformations, as well as the risks and effects of treatment, while the religious beliefs and wishes of pregnant women and their families are respected, and the choice of whether to terminate or continue the pregnancy is made, with the latter seeking Extended medical services and social welfare guarantee support. Warm tips Life is precious and irreducible, therefore it is not mandatory to terminate a pregnancy once an abnormality is detected, respecting the right to life. If genetic anomalies are excluded, in many cases, the level of orthopedic pediatric surgery continues to develop, with fetal surgery, intrauterine surgery, and surgery in the neonatal period, improving to a large extent the quality of life of children born with birth defects in the long term. In conclusion, don’t forget to consult with a senior professional doctor once a fetal anomaly is detected.