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Abstract: A 31-year-old woman who had regular obstetric checkups after pregnancy was found to be in malposition at 23 weeks of gestation; at 34 weeks of gestation, the fetus was found to be in transverse to breech position and the umbilical cord was wrapped around the neck for 2 weeks; at 37 weeks of gestation, she suddenly developed a small amount of vaginal fluid without abdominal pain or vaginal bleeding and was seen in our hospital. The pregnancy was terminated by cesarean section. The fetus was delivered successfully.
Basic information】Female, 31 years old
Type of disease】Fetal malposition
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Date of consultation】March 2022
Treatment plan】Surgical treatment (cesarean section)
Treatment Period】5 days in hospital
Effectiveness】Good results, the fetus was delivered successfully
I. Initial consultation
The 31-year-old woman described herself as having had one abortion and one spontaneous miscarriage. Her last menstrual period was on July 1, 2021, and the ultrasound showed early intrauterine pregnancy at 6 weeks of menopause, and her expected delivery date was April 8, 2022. On February 23rd, the ultrasound of 34th week of pregnancy indicated “single live fetus in late pregnancy, breech position, equivalent to 33 weeks of pregnancy, the umbilical cord is wrapped around the neck for 2 weeks”. Although the fetal position was found to be incorrect, no instruction was given to correct the fetal position because the umbilical cord was rounded for two weeks.
On March 18, just after reaching 37 weeks of gestational age, the mother felt an increase in fetal movement and suddenly developed a small amount of vaginal fluid without abdominal pain or vaginal bleeding, so she went to the hospital. She was diagnosed as “1. 3 weeks of gestation and 37 weeks of gestation with live fetus awaiting delivery; 2. breech position (i.e. fetal malposition); 3. premature rupture of fetal membranes; 4. umbilical cord encirclement.” She was admitted to hospital immediately.
II. Treatment history
After admission, the mother was given routine blood tests, coagulation function, fetal monitoring and fetal ultrasound, etc. The ultrasound indicated “single live fetus in late pregnancy, breech position, equivalent to 36 weeks of gestation, two weeks of cord encirclement, low amniotic fluid”. “The vaginal examination showed a small amount of amniotic fluid in the vagina, the opening of the uterus was not opened, and the fetal breech was floating high. The mother was advised to rest in bed and given elevation of the breech. The doctor explained the condition to the mother, that at present the mother had no contractions, the opening of the uterus was not opened, and it was estimated that she would not be able to deliver in a short time. At the same time, the fetal position was not correct, the fetal monitoring was not ideal, the amniotic fluid was low, and there were indications for cesarean delivery, so the mother was advised to terminate the pregnancy by cesarean delivery as soon as possible. The woman agreed to have a cesarean section after discussion with her family, so she performed a cesarean section on the same day with perfect preoperative preparation. Postoperatively, analgesic drugs were given to help relieve pain, and uterine contraction was promoted by using contraction injections and anti-inflammatory treatment was given with ceftriaxone sodium for injection.
III. Treatment results
The postoperative vitals were normal, and the mother felt painful uterine regeneration, so postoperative analgesia was given to relieve the pain. After 5 days of postoperative checkup, the mother had no fever, had defecation, normal blood count, good lactation of both breasts, good uterine regeneration, good healing of the abdominal wound, no wound bleeding, and little postpartum malignant dew, and was successfully discharged after 5 days of hospitalization.
IV. Notes
We are glad that the mother was able to consult the doctor in time when the fetal malpresentation was accompanied by premature rupture of membranes and umbilical cord winding, and the mother and child were safe after the cesarean delivery.
However, the mother should be advised to observe whether there is fat liquefaction, infection, cracking and other conditions in the wound after the operation, and to seek medical follow-up for poor healing. After delivery, ensure sufficient sleep and increase nutrition to help the body recover. At 42 days after delivery, go to outpatient clinic for postpartum examination and pelvic floor rehabilitation treatment to avoid premature leakage and pelvic organ prolapse. In addition, you need to pay attention to contraception when having intercourse, and if you want to have another pregnancy, it is better to have an interval of 18 months, which can reduce the risk of uterine rupture.
V. Personal insights
In most women, the fetus is relatively small in the middle of pregnancy and the amniotic fluid area is large, so the fetus does not need to be treated even if the fetal position is not correct. In late pregnancy, as the fetus grows, the space for fetal movement in the uterus decreases, so the fetal position becomes relatively fixed. When the fetal position is not correct, the doctor can generally instruct the mother to correct the fetal position in the chest and knee position, but in the case of a woman in breech position with the umbilical cord wrapped around the neck for two weeks, it is not advisable to forcefully correct the fetal position, which may cause fetal hypoxia and placental abruption, which cannot be corrected even after the full-term pregnancy. Therefore, it is crucial to terminate the pregnancy by cesarean section in a timely manner.