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Abstract: This young woman presented with abnormal fetal monitoring results from the 35th week of gestation, which improved with the administration of oxygen, but the situation was recurrent. She began to experience a decrease in self-counting fetal movements at 39 weeks of gestation, and went to the outpatient clinic for abnormalities in fetal monitoring and maternal-fetal blood flow tests, and was admitted to the hospital for further improvement of the contractin provocation test, which resulted in frequent late decelerations. The fetal distress was found to be caused by a knotted umbilical cord, and was effectively resuscitated with neonatal resuscitation.
Basic information】Female, 27 years old
Type of disease】Fetal distress
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Time of consultation】April 2022
Treatment plan】Surgical treatment (cesarean section) + intravenous injection (cefuroxime sodium for injection) + intramuscular injection (indocin injection) + oral medication (lactulose oral solution)
[Treatment cycle]: 6 days in hospital, 42 days to review
Effectiveness of treatment】Cesarean section helped the fetus get out of the hypoxic environment, and neonatal resuscitation was given effectively.
I. Initial consultation
She is a 27-year-old woman who reported that she usually has regular menstruation and her last menstruation was on July 20, 2021. She had a low risk of Down’s syndrome during pregnancy and no significant abnormality on ultrasound at 22 weeks of pregnancy. On April 21, the mother’s self-counting fetal movement decreased for 2 days, and she went to the outpatient clinic to check the atypical response of fetal monitoring, and the ultrasound of maternal-fetal blood flow test indicated that the pulsatility index and resistance index of the right uterine artery were increased, and the diagnosis: pregnancy 1 labor 0 pregnancy 39+ weeks live fetus awaiting delivery, fetal distress, admitted to hospital.
II. Treatment history
After admission, the relevant tests were completed and the fetus and birth canal were evaluated, and no significant abnormalities were found. We explained the condition of the mother, and based on the results of fetal monitoring and maternal-fetal blood flow test, we considered the possibility of fetal distress, and now the mother was at full term, so in order to make a definite diagnosis, we suggested the mother to perform OCT test (contractin provocation test). The OCT test was given in the morning of the second day of admission and resulted in frequent late decelerations after regular contractions, which led to the diagnosis of fetal distress, and as the contractions could not be tolerated, cesarean delivery was recommended to terminate the pregnancy. Emergency cesarean section was performed in the afternoon of the same day, and the operation went smoothly. The fetus had an Apgar score of 5 at 1 minute, and was successfully resuscitated with a score of 8 at 5 minutes and 10 at 10 minutes after treatment with positive pressure oxygen and warmth. There was a true knot in the umbilical cord on examination, and the placenta was normal. Fetal distress was considered to be caused by the knotted umbilical cord.
The cesarean section was successful, and the mother returned to the ward after the operation to continue the postoperative treatment. Cefuroxime sodium for injection with saline was given to prevent infection, and contractin injection was also given to promote uterine regeneration. On the second postoperative day, the mother showed obvious abdominal distension and was advised to get out of bed appropriately and given lactulose oral solution to promote defecation.
III. Treatment effect
On the third postoperative day, the mother successfully defecated and her abdominal distension was significantly relieved. On the 5th day after surgery, the mother’s uterus was well restored, the basic vital signs were normal, the abdominal wound was well healed, there was no bleeding, no postoperative infection occurred, no abnormalities were found in the breathing, heart rate and blood pressure of the newborn, the blood oxygen saturation was normal, the general condition was good, and the newborn was also normal, the mother was discharged after 6 days of hospitalization, and the mother was instructed to come to the hospital to review the recovery of the uterus after 42 days.
Notes
We are glad that the fetal distress was detected and corrected in time, but we need to advise the mother to breastfeed the newborn, which is good for promoting uterine recovery, giving the child good nutrition, and increasing the relationship between mother and child; ensuring sufficient rest after surgery is very good for physical recovery, and we suggest that the family members help to take care of the newborn, so that the mother can have enough rest time; in addition, in order to increase the amount of milk, we suggest In addition, in order to increase the amount of breast milk, it is recommended that the mother increase her diet and nutrition, drink more chicken soup, fish soup and vegetable soup to increase the amount of breast milk; at the same time, pay attention to contraception, and it is recommended to go to the obstetrics and gynecology clinic for pelvic floor rehabilitation 42 days after delivery.
V. Personal insight
In late pregnancy, pregnant women must pay attention to counting fetal movement every day, because most of the fetuses in fetal distress will have abnormal fetal movement, such as a significant increase or decrease in fetal movement, especially if you can’t feel fetal movement for a long time, you must go to the hospital in time. Fetal monitoring and maternal-fetal blood flow test in late pregnancy can help doctors to detect fetal distress earlier. Mild fetal distress will be relieved quickly with symptomatic treatment such as oxygen, left lateral position and rehydration, but severe fetal distress, like the case, requires immediate cesarean section to terminate the pregnancy.