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Abstract: This is the story of a 26-year-old woman who presented to the clinic with irregular abdominal pain for 6 hours, without vaginal bleeding or fluid flow and with normal fetal movement. Contractions, fetal heartbeat and fetal movement and progress of labor were observed. The woman was initially diagnosed as having primary uterine contractions and was subsequently treated with sedation and manual rupture of membranes.
Basic information】Female, 26 years old
Type of disease】Primary uterine contraction failure
Hospital】Suqian City People’s Hospital
Date of consultation】April 2019
Treatment plan] Intramuscular injection (pethidine hydrochloride injection) + intravenous injection (indocin injection) + surgical treatment (manual rupture of membranes)
Treatment period】1 week of hospitalization, 6 weeks of follow-up
Treatment effect】Uterine contraction weakness was corrected, labor progressed smoothly, and delivery was successful
-Initial consultation
The mother was admitted to the hospital with irregular abdominal pain for 6 hours. She reported that she had regular menstruation and was now 38+6 weeks menopausal. She had normal fetal movement, low risk of Down’s syndrome screening, no abnormal fetal system structure screening, normal OGTT, negative group B streptococcal test, good diet and sleep, normal bowel and stool.
Specialized examination: maternal uterine height 33cm; abdominal circumference 105cm; estimated fetal size 3500g; fetal orientation: occipital left anterior position; fetal heart sounds: 136 beats/min; previa: head; position: -2.5, semi-fixed, cervical soft, cervical canal length 0.5cm, uterine orifice not opened, fetal membranes not broken, contractions irregular, pelvic measurement no abnormalities.
Ultrasound examination showed maternal biparietal neck: 93.1mm, head circumference 338.7mm, abdominal circumference 354.2mm, femoral length 73.4mm, maximum depth of amniotic fluid 42mm, fetal heart sounds 142 beats/min. Umbilical artery: RI:0.5, S/D:2.0, placenta position attached to the anterior wall of uterine fundus, maturity grade II, placenta thickness about 38mm. singleton head position, normal blood test. Blood type O, positive RH blood group. Diagnosis: G1P0, preterm labor at 38+6 weeks of gestation.
II. Treatment history
The woman had normal fetal heartbeat and fetal movement, and after assessment, she had indications for vaginal trial of labor. After communicating with the woman and her family, she requested vaginal trial of labor, and was closely observed for contractions and labor progress, fetal heart sounds and fetal movement; then the contractions lasted for 20-30 seconds with intervals of 7-8 minutes, and were weak. On labor and delivery, the uterine opening was not opened, the cervical canal was flattened, the fetal membranes were not broken, and the fetal heart sounds were 140 beats/min. Consider the presence of primary uterine contraction weakness. Sedation was recommended and she was given pethidine hydrochloride injection intramuscularly. After communication with the family, the current treatment was agreed.
After sedation, the mother had regular contractions, which lasted for 30 seconds at 07:00, with an interval of 5-6 minutes, and were weak in intensity.
III. Treatment effect
The labor progressed smoothly after manual rupture of membranes, and a full-term mature newborn was delivered vaginally. During the hospitalization, no postpartum hemorrhage and infection occurred. After 6 days of hospitalization, the mother recovered well from the birth canal, and her respiration, blood pressure and heart rate were stable, without abdominal pain or other uncomfortable symptoms.
IV. Notes
I am very glad that the mother gave birth safely, but we need to remind the mother and her family to pay attention to the following points.
1. Pay attention to rest. Family members should increase the psychological and spiritual comfort for the mother to avoid postpartum depression. Enhance nutrition to be rich in nutrients, sufficient calories and water, maternal breastfeeding, should eat more protein and calorie-rich food, supplement vitamins and iron, supplement until 4 months after delivery.
2. pay attention to puerperal hygiene to avoid infection
3. abstain from sexual intercourse and bathing for 42 days, and contraception for six months
4, 42 days postpartum outpatient follow-up, perform ultrasound examination, pelvic floor muscle detection and repair.
5.Mothers with long labor and delivery are prone to puerperal infection and late postpartum hemorrhage. If fever, abdominal pain and vaginal bleeding are more than the amount of menstruation, go to the hospital for medical treatment in time.
V. Personal insight
The new mothers often have fear and anxiety about the delivery process, so the guided delivery can avoid the lack of contractions caused by mental tension. It can enhance the confidence of vaginal delivery. In this case, the cause of primary contraction weakness was considered to be related to psychological factors, and the coordination of uterine contractions was improved by sedation.