(Disclaimer: This article is for scientific use only, and the relevant information in the following content has been processed to protect patient privacy)
Abstract: In this article, the patient thought she had experience of multiple pregnancies and deliveries, so she did not go to the hospital in time after the occurrence of menopause and successful pregnancy test, and only sought medical attention after the occurrence of abdominal pain and vaginal bleeding. Ultrasound examination suggested a mixed echogenic mass in the left adnexal region and pelvic effusion, and posterior fornix puncture extracted non-coagulated blood, which led to the diagnosis of ruptured ectopic pregnancy, and emergency surgical treatment was given. The patient’s condition was controlled after timely surgical removal of the lesion and avoidance of ectopic hemorrhage.
Basic information】Female, 30 years old
Type of disease】Ectopic pregnancy
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Date of consultation】May 2022
Treatment plan】Surgical treatment (laparoscopic ectopic pregnancy lesion removal) + MTX embryo killing (methotrexate for injection) + intravenous infusion (cefuroxime sodium for injection + metronidazole for injection)
Treatment period】Inpatient treatment for 4 days, outpatient review after 1 week
Treatment effect】Surgical removal of the lesion and control of the disease
I. Initial consultation
The patient, Ms. Kang, reported that she had two early abortions and two normal deliveries, and the births were smooth. She reported that her last menstrual period was on April 7, 2022, and her urine HCG was positive on May 15, when she had no abdominal distension, no vaginal bleeding, no nausea and vomiting, and no anal swelling. On the morning of May 20, she came to our outpatient clinic and was diagnosed with ectopic pregnancy (a mixed echogenic mass with a size of about 22mm×20mm was detected in the left adnexal area), a small amount of fluid in the pelvis, blood HCG: 7961mIU/mL, progesterone: 16.86ng/mL, and was admitted to the hospital.
II. Treatment history
She was admitted to the hospital with a temperature of 36.5℃, pulse rate of 85 beats/min, respiration of 20 breaths/min, systolic blood pressure of 95mmHg, diastolic blood pressure of 75mmHg, clarity, mild abdominal pressure and rebound pain, mild painful cervical elevation on gynecological examination, normal size uterus, thickened left adnexa and pressure pain, posterior fornix puncture was performed and about 2ml of non-coagulated blood was withdrawn, the patient was informed of her condition and based on her medical history, gynecological examination and ultrasound results, she is now On the afternoon of May 20, the patient was sent to the operating room for laparoscopic removal of the left tubal ectopic pregnancy under general anesthesia, together with local injection of MTX (methotrexate for injection) to kill the embryo. After the operation, she returned to the ward and was monitored by cardiac monitoring, given cefuroxime sodium for injection and metronidazole injection for intravenous anti-inflammatory treatment, and regular blood tests for routine blood, blood HCG and electrolytes.
III. Treatment effect
After the operation, the patient was depressed and often cried because she was worried that her next pregnancy would be an ectopic one due to pregnancy failure. After 4 days of hospitalization, the patient recovered well, abdominal pain did not recur, all vital signs were normal, no fever, no abdominal distension, small amount of vaginal bleeding, blood HCG was rechecked: 1948mIU/mL, which was significantly lower than before, the patient’s mood improved, and she was discharged from the hospital and asked to be rechecked in 1 week.
IV. Notes
We are glad that the patient found ectopic pregnancy in time and took measures to terminate the pregnancy without causing any serious harm, but we still need to advise the patient to go to the clinic for weekly postoperative rechecking of blood HCG until it turns negative, and to go to the clinic for tubal lavage 3-7 days after the next menstrual period; pay attention to reasonable rest in daily life, avoid staying up late and straining, do not have intercourse too early and pay attention to contraception for six months; at the same time, increase nutrition appropriately and avoid eating Avoid eating spicy, cold and blood-activating foods, and eat more fresh vegetables, fruits, eggs, meat, etc.; also pay attention to personal hygiene to avoid infection.
V. Personal insight
After menopause and successful pregnancy test, women must go to the hospital as soon as possible to improve the blood HCG and ultrasound examination to understand the development of embryo on the one hand, and to determine whether the pregnancy is intrauterine or ectopic on the other. Most ectopic pregnancies occur in the fallopian tubes, which are tiny and therefore prone to rupture and heavy bleeding after rupture, so ectopic pregnancies at risk of bleeding from rupture should be treated with surgery as soon as possible. Therefore, for ectopic pregnancy with the risk of bleeding after rupture, surgery should be performed as soon as possible. The chance of ectopic pregnancy occurring again after ectopic pregnancy is relatively high, and patients are prone to worry and fear, so doctors and family members should give more guidance and care.