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Abstract: Ms. Feng, 30 years old, tested strongly positive with her own early pregnancy test because of the presence of nausea and vomiting, and was found to have a significantly higher HCG value after 2 months of pregnancy, which was tentatively judged to be a staph in combination with ultrasonography. The cause of partial gravida was not completely clear and could be related to chromosomal abnormalities and malnutrition. After discussion with the patient, she was given surgery to remove the gravida and recovered well after surgery.
Basic information】Female, 30 years old
Type of disease】Partial gravida
Hospital】Obstetrics and Gynecology Hospital of Fudan University
Date of consultation】March 2021
Treatment plan】Surgical treatment (ultrasound-guided uterine removal surgery) + general care (maintaining hygiene in the vulva area)
Treatment period】4 days of inpatient treatment and 6 months of outpatient follow-up
Results】The condition was basically controlled and the staph was removed from the body.
I. Initial interview
When we first saw the patient, she looked difficult, with anxious and nervous expression. She reported that she gave birth to a baby girl at full term a year and a half ago, and her mother and daughter were in good health. The results were significantly higher than normal, and the ultrasound showed a mixed echogenic mass in the uterine cavity and a partial gravidity awaiting elimination. The patient came to our hospital for further diagnosis and treatment, and agreed to undergo further examination after explaining her condition to us.
II. Treatment process
Firstly, the patient’s ultrasound was repeated and showed an enlarged uterus with sonographic changes consistent with staphyloma, with clear borders and increased peripheral blood flow signal, but no germ or yolk sac was seen. The HCG level was still high, and the diagnosis of partial gravidity was confirmed by the patient’s previous examination and clinical symptoms. After discussion with the patient and her family, it was agreed to perform ultrasound-mediated curettage, indicating that the risk of postoperative bleeding was relatively high. The procedure was performed by first observing the uterus using ultrasound, dilating the cervical area using a cervical dilator, placing a cervical aspirator into the uterine cavity without negative pressure, and repeatedly scratching to completely remove the embryo as well as the fetal sac. The postoperative pathology showed early chorionic villus tissue, significant chorionic edema with central pool formation, and mild trophoblast hyperplasia, suggesting no significant abnormal changes. The condition was stable 4 days after the operation, and he was advised to go home and keep the vulva clean, and was discharged.
III. Treatment results
The procedure was relatively smooth, with little bleeding, and the patient returned to the ward safely after the operation. In the first 2 days after surgery, the patient had slight abdominal pain and a small amount of vaginal bleeding, which were normal. The abdominal pain and vaginal bleeding decreased gradually on the third day after the operation, and the symptoms disappeared completely on the fourth day after the operation without any other discomfort, and the patient was discharged from the hospital. The patient’s HCG level was monitored weekly after the procedure and after 3 consecutive normal levels, the follow-up interval could be extended, i.e. 1 month or even 2 months for 6 months. Repeat HCG as well as ultrasound without abnormalities suggest a good treatment effect.
IV. Precautions
The patient actively cooperated with the clinical treatment and recovered well after the operation, I am also happy for the patient, but still recommend the patient to pay attention to the following matters.
1.After the operation, it is necessary to keep the vulva area clean and hygienic, and it is necessary to wash the vulva regularly and avoid taking a tub bath to avoid infection.
2, after surgery, it is recommended to give a light, nutritious diet, such as spinach, shrimp, etc.. It is also necessary to eat high-protein foods, such as milk and eggs, to promote recovery, and avoid spicy and stimulating foods, such as chili peppers, to avoid local irritation.
3. bed rest is needed after surgery, and leg massage can be given to promote blood circulation when lying in bed to avoid lower limb vein embolism.
4.Regular review on time.
V. Personal insight
Partial gravida is a disease caused by gestational trophoblast hyperplasia, not a real fetus. If diagnosed as gravida, it needs to be treated with timely clearance. Although it is understandable to feel the loss of a pregnancy that is not real, it is recommended that we still need to give priority to our own health, and we can still choose to continue the pregnancy after we have taken care of our body. In addition, it is recommended that people with partial gravidity need to follow up on a regular basis to avoid serious damage to the body from malignancy.