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Abstract: The patient had an abnormal miscarriage, usually had irregular menstruation, and conceived again without being prepared for pregnancy. She was examined at the hospital for low blood HCG and progesterone levels and had a small amount of bleeding, and the patient strongly requested hospitalization for fetal preservation. Although she was given aggressive fetal preservation treatment during hospitalization, the result was not satisfactory and eventually developed into spontaneous miscarriage. It is recommended that patients who present with miscarriage should not rush to conceive, but should fully evaluate all physical indicators before preparing for pregnancy to obtain a good pregnancy outcome.
[Basic information] Female, 23 years old
Type of disease】Spontaneous miscarriage
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Date of consultation】April 2022
【Treatment plan】Medication for fetal preservation (progesterone injection + estradiol valerate tablets + uterine contraction injection)
Treatment period】7 days in hospital
Effectiveness】Fetal preservation failed, but no need to remove the uterus, and the patient recovered well
I. Initial consultation
The patient reported that she had a previous abortion in February 2021 and had one ablation. Her last menstrual period was on February 11, 2022, and she stopped menstruating until April 2 when she tested positive for urine HCG. On April 7, the blood HCG result was 1832.55mIU/ml and progesterone: 12.67pmol/L. Because the HCG result was too low, no ultrasound examination was performed, and there was a little vaginal bleeding without abdominal pain, and the patient was told that this pregnancy still had the possibility of abortion, but she wanted to continue the pregnancy and strongly requested hospitalization for fetal preservation treatment, and was diagnosed with preterm abortion and admitted to the hospital.
II. Treatment history
The patient denied having a history of hyperthyroidism and asked the doctor whether hyperthyroidism could cause miscarriage. The doctor explained that there are many causes of spontaneous miscarriage, including endocrine diseases such as hyperthyroidism, which may affect The doctor explained that there are many causes of spontaneous miscarriage, among which endocrine diseases such as hyperthyroidism may affect embryonic development, but in early pregnancy, due to the increase of hormone level in pregnant women, it may cause abnormal thyroid function, but this change is relatively short-lived, not true hyperthyroidism, and will not affect the embryo. At the same time, progesterone injection and estradiol valerate tablets were given after admission to the hospital for fetal preservation. After 5 days of fetal preservation treatment, blood HCG: 9144.30mIU/ml, progesterone: 16.02pmol/L, ultrasound suggested intrauterine dark area. The patient had been having a small amount of irregular bleeding. On April 15, the patient suddenly developed abdominal pain with increased vaginal bleeding, such as the amount of menstruation, and the repeat ultrasound indicated no abnormality in the uterus.
III. Treatment effect
After admission, the patient was given fetal preservation treatment, but the effect of fetal preservation was not good. The patient’s blood HCG and progesterone levels did not rise satisfactorily, and there had been a small amount of irregular vaginal bleeding, and the ultrasound only indicated a dark intrauterine area. The patient had no abnormality in the uterus on ultrasound after heavy bleeding, which means that the pregnancy tissues had been expelled cleanly and the abortion was complete, so there was no need to clear the uterus. The patient had little vaginal bleeding and no abdominal pain, and was discharged at 7 days of hospitalization.
IV. Notes
Unfortunately, the patient failed to keep the fetus, but still need to pay attention to the following matters.
1. The patient is advised not to have intercourse too early after discharge and to pay attention to contraception to avoid premature re-pregnancy.
2. Although the patient did not undergo uterine evacuation, she should pay attention to hygiene to avoid vaginitis and pelvic inflammatory infections.
3. advise the patient to go to the endocrinology clinic to review thyroid function, and if hyperthyroidism is diagnosed, to treat it before pregnancy.
4, the patient has accumulated two bad pregnancies, it is recommended to improve the chromosomal examination of both spouses at the Reproductive Medicine Clinic to further find the cause.
5. The patient has had two consecutive miscarriages, which may have a negative impact on the patient’s psychology. It is suggested that the family members should show more care and understanding, and help the patient actively find the cause and relieve the psychological pressure.
V. Personal insight
Spontaneous miscarriage in early pregnancy is often related to embryonic abnormalities, especially embryonic chromosomal abnormalities. Therefore, after two consecutive adverse pregnancy miscarriages, the couple should go to the hospital as soon as possible to improve chromosomal examination and then have related consultation. The patient in this case had an unplanned pregnancy after an auditory miscarriage and failed to prepare for the pregnancy, resulting in a spontaneous miscarriage. Patients with spontaneous abortion should not rush to get pregnant again, firstly, they should actively look for the causes that triggered the miscarriage to avoid recurrence, and secondly, they should prepare for pregnancy checkups that are more conducive to conceiving quality embryos and reducing the occurrence of spontaneous abortion.