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Abstract: The patient had 2 previous cesarean deliveries, and this time she had an unexpected pregnancy and was of advanced age, and had a spontaneous abortion. Due to the scarred uterus, the ultrasound showed that there was still tissue remaining in the lower uterine cavity, suggesting that an incomplete abortion had occurred. After standardized treatment, the residual intrauterine tissue was completely expelled without abdominal pain, vaginal bleeding and signs of infection.
Basic information】Female, 47 years old
Type of disease】Incomplete miscarriage
Hospital】Guangxi Zhuang Autonomous Region Jiangbin Hospital
Date of Consultation】May 2022
Treatment plan】Uterus rejuvenation instrument + medication (uterine contraction injection, motherwort granules)
【Treatment cycle】7 days of treatment, re-check after 3 months if you plan to get pregnant again
Effectiveness of treatment】The residual intrauterine tissues were completely expelled by ultrasound examination, no abdominal pain, no vaginal bleeding and no signs of infection.
I. Initial consultation
The patient reported that she had one abortion and two cesarean deliveries in the past and had irregular menstruation after the age of 45, with a menstrual cycle of 32-40 days and a menstrual period of 3-5 days. She did not use contraception during sexual intercourse, and her last menstrual period was on March 20, 2022. On May 3, she tested positive for urine HCG, and on May 5, she went to the outpatient clinic to draw HCG results of 10554.86 mIU/ml and 20.05 nmol/L of progesterone, and ultrasound indicated “early intrauterine pregnancy, equivalent to 5+ weeks of pregnancy”. On May 9, she had abdominal pain and a small amount of vaginal bleeding, no flesh-like tissue was seen, and she went to the hospital for ultrasound examination, which indicated “early intrauterine pregnancy, equivalent to 6 weeks of pregnancy, with fluid in the uterine cavity”, and diagnosed “1. pre-eclampsia, 2. advanced maternal age, 3. She was admitted to the hospital.
Treatment history
After admission, we rechecked blood HCG 26334.46mIU/ml and progesterone 15.41nmol/L. We explained to the patient that her pregnancy was of advanced age and the quality of eggs and sperm would decrease, resulting in a higher possibility of poorly developed fertilized eggs. The patient was given progesterone injection and Fertility Pill for fetal preservation treatment. Four days after the treatment, the patient suddenly had more vaginal bleeding, and after an obvious abdominal pain, a mass of flesh-like tissue was discharged, and the doctor immediately arranged an ultrasound, which showed that “the strong echogenic mass in the lower part of the uterine cavity is 13×3mm”. The patient asked for outpatient treatment with a uterine revitalization device. On May 14, the patient was discharged from the hospital, and from the day she was discharged, she was treated with a uterine rejuvenation device in the outpatient clinic, which promoted uterine contraction through electrical stimulation of lower abdominal acupuncture points.
(Ultrasound result of inpatient department on May 13)
III. Treatment effect
The patient’s ultrasound was repeated after 7 days of outpatient treatment with the uterine rejuvenation device, and the results indicated that “no significant abnormality was seen in the uterine cavity”, indicating that the residual intrauterine tissue had been expelled by itself. The patient’s vital signs were normal, there was no abdominal pain, no vaginal bleeding, and no signs of infection, indicating that this regimen was effective, and she was discontinued. If the patient intends to conceive again, it is recommended to visit the outpatient clinic for a pregnancy preparation examination in 3 months.
IV. Precautions
We are glad that the patient’s residual embryonic tissue was successfully expelled after the treatment with the uterine revival device. Although the patient did not undergo uterine evacuation, the following precautions should be taken after abortion.
1. Pay attention to rest, do not overwork, stay up late and have sex too early.
2. Patients are advised to pay attention to contraception after miscarriage and not to get pregnant again prematurely; if they plan to get pregnant again, they can go to the clinic for pregnancy preparation and physical conditioning 3 months after miscarriage.
3.Patients are advised to develop good personal hygiene habits after abortion to avoid infection.
4. Patients with spontaneous abortion have a greater psychological impact, and some may even experience depression and guilt, etc. It is recommended that family members should understand and guide the patients to relax.
V. Personal insight
Women who are too old will experience a decline in ovarian function, resulting in abnormal hormone levels and a decrease in egg quality, so it is important for senior women to have a good pregnancy preparation test when planning another pregnancy. When an older woman conceives unexpectedly, she should go to the hospital as soon as possible for examination and treatment of fetal preservation according to her condition, but in the case of poor quality embryo itself, there is no point in preserving the fetus and spontaneous abortion is likely to occur. In this case, because of the scarred uterus, the patient is prone to incomplete abortion, the residual tissue is small and close to the lower part of the uterus, and uterine perforation is likely to occur with uterine clearance, while treatment by uterine revival instrument can avoid the risk of clearance surgery and also effectively stimulate uterine contraction and expel the residual tissue.