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Abstract: Placental abruption is one of the more serious complications of pregnancy and often occurs in patients with gestational hypertension, but it can also occur if a normal pregnant woman suffers violent abdominal impact. This patient was diagnosed with placental abruption due to the impact on her belly although the labor and delivery process went well, and the pregnancy was immediately terminated surgically. After timely surgery and medication, the mother and child were discharged safely.
Basic information】Female, 29 years old
Type of disease】Placental abruption
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Date of consultation】April 2022
Treatment plan】Cesarean section + drug treatment (contraction injection, carboprost aminotriol injection
(cefuroxime sodium for injection, blood production)
Treatment period】6 days in hospital, 42 days postpartum follow-up
Treatment effect】Mother and child were safe and discharged successfully.
I. Initial consultation
The patient reported that she had two previous abortions and her last menstrual period was on August 9, 2021, and she had an ultrasound examination when she had stopped menstruating for more than 2 months. At 10:30 on April 7, 2022, the patient and her husband were driving out in the car when they were rear-ended, and the patient’s abdomen struck the front seat. The patient was in shock during the rear-end collision, but did not go to the hospital because she did not experience abdominal pain or vaginal bleeding. About 4 hours later, the patient felt an increase in fetal movement and mild pain in the lower abdomen, which was persistent, and soon developed a small amount of vaginal bleeding, so she came to our hospital accompanied by her family. Ultrasound examination was performed in the outpatient clinic, suggesting intrauterine pregnancy, single live fetus, equivalent to 34 weeks of pregnancy, and a dark area between the uterine wall and the placenta.
II. Treatment history
The patient was admitted to the hospital with normal vital signs, but she felt nausea and vomiting, and her abdomen was hard with obvious pressure pain. Although the fetus was not yet full term, the patient and her family agreed to perform a cesarean section immediately to terminate the pregnancy. One minute after delivery, the Apgar score was 4, which was considered as severe asphyxia, and the patient was immediately given warmth, airway cleaning and positive pressure oxygen. The patient was transferred to the neonatal unit for further treatment because of prematurity. Shortly after delivery, the placenta was delivered, and the examination revealed about 80 ml of bruises and clots between the placenta and the uterine wall, and the placenta showed signs of abruption in nearly a quarter of the area, which was consistent with the clinical diagnosis of placental abruption.
III. Treatment effect
The patient had a smooth cesarean section with intraoperative blood loss of about 550 ml. Immediately after delivery of the placenta, contractin injection and carboprost aminotriol injection were given to promote uterine contraction and reduce bleeding. The patient returned to the ward after the operation and was given cefuroxime sodium for injection to prevent infection and continued to be given contraction-promoting uterine injection. The patient’s preoperative routine blood test indicated that the hematocrit was 101g/L. The hematocrit was 85g/L on the day of the postoperative recheck, and he was given oral hematopoietic combination for hematopoietic treatment. The patient recovered well 5 days after the operation, the wound healing was good, the hematocrit was 89g/L on the recheck, and the malignant fluid was not too much, so the mother and child were discharged after 6 days of hospitalization. The patient was instructed to follow up 42 days after delivery.
IV. Notes
We are glad that after a series of emergency treatment, the mother and child were discharged safely. However, the following points still need to be noted after discharge.
1. Due to blood loss both before and after delivery, which subsequently led to the development of hemorrhagic anemia, but not to the indication of blood transfusion, therefore, blood replacement therapy is needed. Even after discharge from the hospital, it is still necessary to follow the doctor’s prescription to apply the blood production treasure combination, and to eat appropriate blood and nutritious food in daily life, which is conducive to the recovery of the body after delivery.
2. Since newborns are preterm babies, they should be regularly followed up by the pediatric department after discharge, and rehabilitation treatment should be performed when necessary.
3.After discharge from hospital, pay attention to strengthen wound care, once there are symptoms such as wound dehiscence, fever and infection, go to the hospital as soon as possible.
4. Pay attention to contraception and avoid premature sexual intercourse. Patients should go to the outpatient clinic for postpartum examination and pelvic floor rehabilitation treatment at 42 days after delivery.
V. Personal insight
Placental abruption is usually seen in pregnant women with gestational hypertension, but it is less common in normal pregnant women, but it may be induced in normal pregnant women in case of abdominal impact, such as car accident, fall and sexual intercourse. The patient in this case did not suffer from gestational hypertension, but the impact on her abdomen caused placental abruption, which was a dangerous situation. You should always pay attention to external impact and other adverse factors during pregnancy, and once there is an accidental impact, you should go to the hospital as soon as possible to improve the ultrasound examination, do not take it lightly. Once the diagnosis of placenta abruptio is made, active treatment should be given, especially for severe placenta abruptio, emergency cesarean delivery should be performed.