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Abstract: A 32-year-old woman was planned for a full-term cesarean delivery after the presence of an anterior vessel was detected by ultrasound during labor and delivery. However, premature rupture of the membranes occurred before full term, with massive vaginal fluid and bleeding, and a significant drop in blood pressure and hematocrit. She was given an emergency cesarean section and blood transfusion, and the mother and child were eventually discharged safely.
Basic information】Female, 32 years old
Type of disease】Anterior vessel
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Date of consultation】August 2021
Treatment plan】Oxygen absorption + surgical treatment (cesarean delivery, bilateral uterine artery ligation, uterine backstrap suture) + medication (contraction injection, ceftriaxone sodium for injection, metronidazole sodium chloride injection, carboprost aminobutriol injection) + blood transfusion treatment
[Treatment period] 11 days of hospitalization and follow-up after 42 days
Treatment effect】Rescued in time, effective, mother and child safe
I. Initial consultation
She is a 32-year-old woman who reported that she had one cesarean section and one abortion in the past, and her last menstruation was on November 19, 2020. The ultrasound indicated “intrauterine pregnancy, single live fetus, breech position, equivalent to 35 weeks and 1 day of gestation, anterior vessels, low lying placenta”, no vaginal bleeding during pregnancy, normal fetal monitoring, planned to be hospitalized at 37 weeks of pregnancy for elective cesarean delivery. In the morning of August 2, 2021, the mother woke up with vaginal fluid, like urine, wetting her inner and outer pants, which soon turned red and became bright red vaginal bleeding, greater than the amount of menstruation, without abdominal pain, and her family immediately sent her to the hospital. The fetal heart rate was 110 beats per minute, and the diagnosis was: 1) 3 pregnancies and 1 delivery, 36+ weeks of pregnancy with live fetus awaiting delivery; 2) ruptured anterior vessels and bleeding; 3) premature rupture of membranes; 4) low lying placenta; 5) scarred uterus, and she was admitted to hospital immediately.
II. Treatment history
The mother and her family were informed that due to the high amount of vaginal bleeding and the fact that the fetus was currently alive, an immediate cesarean section was recommended to save the life of the mother and child, and the mother and her family agreed. Afterwards, the mother was given oxygen and pushed to the operating room, while preoperative blood routine, coagulation function and electrocardiogram were improved, the transfusion department was notified to dispense blood, and the neonatologist was contacted to prepare for neonatal resuscitation in the operating room. The mother showed signs of hemorrhagic shock, and a cesarean section was performed immediately, and the fetus was delivered with an Apgar score of 3 minutes, and neonatal asphyxia resuscitation was performed. After delivery of the placenta, the uterus contracted poorly, the uterus became soft, and the lower part of the uterus where the original placenta was attached leaked a lot of blood.
After the cesarean section, the mother was sent to the ICU ward for continued observation and treatment, and the newborn was resuscitated and transferred to the pediatric department for treatment. Postoperative examination of the placenta showed abnormal placental morphology and a thick anterior vessel rupture over the middle fetal membrane rupture, i.e. rupture of the anterior vessel occurred. Due to the high maternal blood loss, transfusion therapy was continued. At the same time, postoperative anti-inflammatory treatment with injectable ceftriaxone sodium and metronidazole sodium chloride injection was given, and uterine contraction promotion treatment with contractin injection and carboprost aminotriol injection was continued to reduce postpartum bleeding.
III. Treatment effect
The maternal blood volume was maintained, the hematocrit gradually returned to normal level, and the anemia was corrected after the cesarean delivery. At 10 days postoperative checkup, the maternal vital signs had returned to normal, and no abnormalities were found in respiration, heart rate, body temperature and blood pressure. The mother’s uterus was well regenerated, the postpartum malignant discharge was small, the wound healed well, and no infection or bleeding occurred.
IV. Notes
We are glad that the mother was treated in time and the life of the mother and child was saved, but after discharge, we need to tell the mother to pay attention to the following points.
1. Continue to take medication to correct anemia.
2, pay attention to more rest, avoid cold, exertion, relaxation, and promote physical recovery.
3, diet appropriate to increase nutrition, pay attention to personal hygiene, diligent care of abdominal wounds to avoid wound infection.
4. Follow up with the obstetrics and gynecology department 42 days after delivery to check the recovery of the uterus, assess the function of the pelvic floor, and perform pelvic floor rehabilitation therapy if necessary.
V. Personal insight
The occurrence of anterior vascularity is mostly related to low placental position and abnormal placental morphology. Since it is very rare in clinical practice, only some anterior vascularity can be detected during pregnancy and labor by ultrasound and vaginal examination by doctors. Once anterior vessels are detected, it is important to intensify the labor and delivery and choose to terminate the pregnancy by cesarean section at 37-38 weeks of gestation without any special circumstances. In this case, because the anterior vessels were attached to the fetal membranes and close to the cervical os, premature rupture of the membranes occurred along with the rupture of the vessels, and due to timely treatment, the woman recovered well after surgery. Therefore, mothers with anterior vessels must pay more attention to physical changes and seek medical attention in time if there is any abnormality to avoid serious consequences.