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Abstract: The patient, Ms. Wang, was admitted to the hospital with menstrual irregularities after 6 weeks of menopause with a small amount of vaginal bleeding for 3 days without symptoms such as nausea and vomiting, and an ultrasound was performed after admission, suggesting an ectopic pregnancy with a significantly elevated HCG value. After the operation, the patient’s HCG decreased significantly and she was discharged from the hospital.
Basic information】Female, 38 years old
Type of disease】Ectopic pregnancy, cesarean scar pregnancy
Hospital】Huangshi Central Hospital
Date of Consultation】May 2022
Treatment plan】Surgical treatment (uterine artery interventional embolization, uterine evacuation)
Treatment Period】Hospitalization for 4 days, rechecked after 1 week
Results】The patient’s HCG value decreased significantly, her condition was controlled, and her body improved
I. Initial consultation
The patient, Ms. Wang, came to our hospital accompanied by her family, complaining of delayed menstruation, and now the bleeding volume after menstruation is significantly less than the usual menstrual volume. The patient came to the hospital after the menopause because the amount of bleeding was significantly less than the amount of menstruation, and she thought she had irregular menstruation, and at present there was no pain in the abdomen. After examination of the patient and ultrasound examination, it was found that the patient’s HCG value reached 12,886.5 mIU/ml, and the ultrasound suggested that the pregnancy was ectopic due to the cesarean incision, and the patient was considered to be a cesarean scar pregnancy, so the patient was recommended to be hospitalized for immediate termination of pregnancy, and the patient and her family actively cooperated with The patient and her family actively cooperated with the treatment.
II. Treatment process
After admission to the hospital, the relevant examinations were completed, namely physical examination, liver function, kidney function, blood routine, urine routine, ECG, HCG test, ultrasound, etc., which were consistent with the characteristics of cesarean scar pregnancy, and then we communicated with the patient and her family about the patient’s situation, and informed them that the cause of the disease was due to the fertilized egg implanted in the original cesarean incision site, and that the HCG was currently rising significantly, the embryo was alive under ultrasound, and there was a risk of hemorrhage and uterine rupture if the pregnancy continued. The risk of haemorrhage and uterine rupture is high. It is recommended that uterine artery embolization be performed first to temporarily reduce the blood supply to the uterus, and then perform a curettage to reduce the risk of hemorrhage. The patient and her family agreed to perform uterine artery interventional embolization and uterine debridement, and the procedure was successful.
III. Treatment results
After the operation, the patient had a small amount of vaginal bleeding and no pain in the abdomen, which was considered normal after the operation, without other obvious discomfort.
IV. Notes
Unfortunately, the patient was diagnosed with cesarean scar pregnancy and could not continue the pregnancy. Fortunately, the risk of uterine rupture was relieved after treatment, and it is suggested that the following points should be noted in subsequent life.
1. pay attention to vaginal bleeding and lower abdominal pain, pay attention to vulvar cleanliness and hygiene, avoid sexual intercourse, 2 weeks rest is recommended.
2.After discharge home, a light diet should be taken, do not over-eat spicy and stimulating food, and stay up less.
3. 1 week after discharge, we should go back to the hospital to recheck whether the blood HCG is elevated again, and also recheck the gynecological ultrasound.
V. Personal insight
Cesarean scar pregnancy can be asymptomatic in the early stage and prone to rupture, which may cause abdominal bleeding, uterine rupture, shock, syncope or even death. If you want to avoid the harm of this disease, you should pay special attention to the ultrasound examination of the early pregnancy bed site, to achieve early detection and early treatment, and only by controlling the disease as soon as possible, you can reduce the harm to your body and thus protect your health. For pregnant women with cesarean scar pregnancy, it is important to develop an individualized treatment plan. In this case, the patient’s ectopic pregnancy resulted in a significantly elevated HCG value. It is good to see that after treatment, the HCG value decreased significantly, the condition was controlled and the body improved, and a good treatment result was obtained.