(Disclaimer: This article is for scientific purposes only. To protect the patient’s privacy, the relevant information in the following content has been processed) Abstract: In this case, the patient presented with irregular contractions with redness on a day in November 2021, and her family immediately brought the patient to our hospital. Outpatient fetal monitoring suggested that the patient was having irregular contractions, and she was diagnosed with preterm labor at 37 weeks in a live fetus, hypoplastic placenta, and uterine anomalies, and was admitted to the hospital. After a brief conversation with the patient and her family, we suggested a vaginal trial of labor, but bleeding occurred during the trial of labor, and a cesarean section was urgently performed, and the mother and child were safely discharged from the hospital after the operation. [Basic information] Female, 28 years old [Type of disease] Prolonged labor with preeclampsia, low lying placenta, uterine anomaly [Hospital] Jiangbin Hospital, Guangxi Zhuang Autonomous Region [Date of consultation] November 2021 [Treatment plan] Surgical treatment (cesarean section) + medication (ceftriaxone sodium for injection, metronidazole injection, uterotonin injection, yihaosheng capsule) [Treatment period] Hospitalization for 7 days [Treatment effect The fetus was successfully delivered, and the patient was discharged without any obvious discomfort I. Initial interview Patient’s self-report: in 2018, 1 early pregnancy spontaneous miscarriage, went to the hospital and found bicornuate uterine deformity, and after that, there has been no contraception, and there has been no conception. Last menstrual period on March 12, 2021, menopause for more than 1 month, check ultrasound suggests early intrauterine pregnancy, the expected date of delivery is December 19, 2021. She was hospitalized in February for fetal preservation; at 10 weeks of pregnancy, she was admitted to our outpatient clinic and underwent regular obstetric examination; at 22 weeks of pregnancy, the systematic ultrasound indicated placenta previa; at 36 weeks of pregnancy, the ultrasound indicated intrauterine pregnancy, single live fetus, cephalic position, which was equivalent to 35 weeks and 2 days of pregnancy, and low lying placenta. In addition, there was no vaginal bleeding during pregnancy, but on November 29, 2021, the patient experienced irregular contractions with redness, and her family immediately brought her to the hospital. The outpatient fetal monitoring indicated irregular contractions, and she was diagnosed as: pregnancy 2 labor 0, 37 weeks of gestation with live fetus with preterm labor, low placenta, and uterine anomaly, and was admitted to the hospital. After being admitted to the hospital, the patient and her family were informed that despite the presence of hypoplastic placenta and uterine anomalies, there was no obvious abnormality in the results of the current examination, and she could have a vaginal trial of labor, and that hypoplastic placenta was not an indication for cesarean section, and that although there was a risk of hemorrhage during labor with hypoplastic placenta, the healthcare staff would closely observe the progress of the labor process, and that once hemorrhage occurred, immediate treatment could be provided. The patient and her family understood and asked for a trial of vaginal delivery. The patient started regular contractions on the second day of admission, and the labor progressed quickly. When the uterine opening was dilated close to 6cm, there was a burst of bright red vaginal bleeding of about 120ml, and the fetal heart rate appeared to be slowing down, so the patient was considered to be hemorrhaging from a low lying placenta. Therefore, it was decided to change the surgical treatment, immediately arrange cesarean section and contact the neonatologist to the operating room to prepare for neonatal resuscitation. During the cesarean section, the placenta was seen to be attached in a low position and partially detached, the operation went smoothly with about 500 ml of surgical bleeding, and the mother and child were safe. After cesarean section, ceftriaxone sodium injection and metronidazole injection were given for anti-inflammatory treatment, and hysteronin injection was applied to promote uterine contraction treatment to reduce postpartum hemorrhage. Third, the therapeutic effect The surgical process was smooth, and the patient delivered the newborn without any other abnormalities. Postoperative examination of the patient’s hematocrit was 98g/L, which was lower than 111g/L at the time of admission, but it was not yet an indication for blood transfusion, and oral Yixueisheng capsule was given to replenish blood. Meanwhile, the newborn’s development was normal and no different from normal babies. At the postoperative checkup 5 days later, the patient’s vital signs were normal, no fever, good uterine regrowth, little post-partum discharge, good healing of abdominal wounds, no infection, no need to remove the stitches for cosmetic suture, and was discharged from the hospital. The patient said she was very satisfied with the treatment result. The patient and her newborn baby were very happy. It is recommended that the patient should strengthen nutrition after discharge, avoid spicy stimulation, cold and blood-activating food, eat more fresh vegetables, fruits, milk, eggs, meat, etc., which can help to strengthen the body; pay attention to rest, don’t be too tired, and relax the mood to avoid postnatal depression; pay attention to personal hygiene, and diligently take care of the abdominal wounds, to avoid infections; moreover, she should go to the Obstetrics and Gynecology clinic for follow-up on the 42nd day after delivery, and improve the postpartum examination and the pelvic floor function assessment. In addition, 42 days after delivery, the patient should go to the obstetrics and gynecology clinic for follow-up, improve the postpartum examination and pelvic floor function assessment, and perform pelvic floor rehabilitation therapy if necessary. Low lying placenta means that the placenta is attached close to the cervical opening at the time of pregnancy. Since it does not cover the cervical opening, hypoplastic placenta is not an indication for cesarean section and can be delivered vaginally. However, because the low lying placenta is located very close to the endocervical os, during dilatation of the cervical os, it may lead to premature detachment of the placenta and hemorrhage, triggering fetal distress, which requires immediate cesarean section to terminate the pregnancy, or else the lives of the mother and child will be jeopardized. In this case, the active cooperation of the patient as well as her family, the close cooperation of medical and nursing staff from various departments, and the effective communication during and after delivery were the only way to make the correct judgment and treatment of the unexpected situation, and to avoid the patient’s psychological burden due to the low lying placenta, which would give up the chance of a normal delivery.