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Abstract: This woman had several spontaneous miscarriages and also underwent hysteroscopic surgery for uterine cavity polyps. She became pregnant shortly after surgery and again showed signs of miscarriage in early pregnancy and was given fetal preservation treatment. Ultrasound examination during pregnancy revealed partial placenta previa with marginal cord insertion and placental abnormality leading to fetal growth restriction, and treatment was given to preserve the fetus and nourish the fetus. Sudden vaginal bleeding and fetal distress occurred at 36 weeks of gestation, and a cesarean section and neonatal resuscitation were given to save the life of the newborn.
Basic information】Female, 30 years old
Type of disease】Placental malformation, partial placenta praevia, marginal cord insertion, fetal growth restriction
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Date of consultation】April 2022
【Treatment plan】Surgery (cesarean section) + intravenous injection (Ceftriaxone sodium for injection + metronidazole injection + indocin injection + carboprost aminotriol injection + Yisheng capsule) + neonatal resuscitation and rescue
Treatment period】6 days in hospital
Effectiveness】The fetus was delivered successfully after timely surgery.
I. Initial consultation
A 30-year-old woman reported two previous spontaneous miscarriages and underwent hysteroscopic surgery for uterine cavity polyps in May 2021, with last menstruation on August 14, 2021 and expected delivery on May 21, 2022. After discharge from the hospital, she was admitted to our outpatient clinic to establish a card and had regular obstetric checkups. 22 weeks of pregnancy, she had a system ultrasound indicating intrauterine pregnancy with a single live fetus, equivalent to 21 weeks and 2 days of pregnancy, with a low lying placenta and marginal cord insertion. She was hospitalized for 7 days and given magnesium sulfate injection for fetal preservation and amino acid injection (18AA) for nutritional treatment. on April 23, vaginal bleeding occurred again with no obvious cause, such as the amount of menstruation, without abdominal pain, and was sent to the obstetrics department by 120 emergency, with the diagnosis of pregnancy 3 She was admitted to the hospital with a diagnosis of 3 weeks’ gestation, live fetus at 36 weeks’ gestation, partial placenta praevia, marginal cord insertion and placental abnormality resulting in fetal growth restriction.
II. Treatment history
The fetal heart rate was fast at the baseline, fluctuating between 165 and 180 beats per minute, and the fetal movement was frequent, so the possibility of fetal distress was considered. The fetus was removed by cesarean section. The fetus was seen to have pale skin color and Apgar score of 3 at 1 minute. The neonatologist gave first aid such as tracheal intubation, positive pressure oxygen and cardiac compressions. Intraoperatively, the placenta was seen to be located in the posterior wall of the uterus, the placenta covered part of the internal cervical opening, the placenta was lobulated with a quarter defect, the entrance of the umbilical cord was located at the edge of the placenta, there was blood oozing from the placental abruption, sutures were given to stop bleeding, and the estimated bleeding during surgery was 650 ml.
III. Treatment effect
Postoperative cardiac monitoring was given, blood pressure: 92/57 mmHg, heart rate: 92 beats/min. Anti-inflammatory treatment with injectable ceftriaxone sodium and metronidazole injection was given, while uterine contraction was promoted with contractin injection and carboprost aminotriol injection to reduce postpartum bleeding. The postoperative routine blood test was repeated and the hemoglobin: 95g/L was given oral blood supplementation with Yixinsheng capsule to correct anemia. On the 6th day of hospitalization, the maternal general condition was good, with normal vital signs, no fever, good uterine regeneration, little postpartum effusion and good wound healing, and she was discharged.
IV. Notes
We are glad that the life of the newborn was saved by timely surgical treatment. It is recommended that the mother should actively correct anemia after surgery, and it is recommended to continue to take oral blood supplementation with blood capsules and pay attention to scientific increase of diet and nutrition. It is recommended to do postpartum examination and pelvic floor rehabilitation treatment 42 days after delivery to reduce the chance of pelvic floor dysfunction. It is important to pay attention to contraception after cesarean delivery, as premature pregnancy is prone to scar pregnancy, uterine rupture, etc. Breastfeeding is recommended after surgery, as it can stimulate uterine contraction and reduce postpartum bleeding, as well as increase the nutrient supply of newborns and promote physical development.
V. Personal insight
Repeated spontaneous abortions and uterine surgical operations in this woman can easily damage the endometrium, which in turn affects the placenta’s implantation and differentiation, leading to placental abnormalities, abnormal morphology and position, formation of placenta praevia and marginal cord insertion, resulting in repeated vaginal bleeding, fetal growth restriction and fetal distress during pregnancy, which can threaten the life of the fetus in more serious cases and require timely delivery by cesarean section Termination of pregnancy and effective neonatal resuscitation are needed to save the life of the newborn.