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Abstract: This patient was 23 weeks pregnant and was found to have excessive amniotic fluid and abnormal fetal development during ultrasound examination. According to the findings, the fetus was found to have congenital diaphragmatic hernia, and termination of pregnancy was recommended because it had seriously affected the development of the fetal lungs and other organs. With the consent of the patient and her family, she was treated with medication and uterine evacuation, and was rechecked one month later.
Basic information】Female, 30 years old
Disease Type】Congenital diaphragmatic hernia
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】August 2020
Treatment】Induction of labor + Misoprostol tablets to soften the cervix + Cleansing surgery + Cefuroxime sodium for injection to fight infection
Treatment Period】1 week in hospital, review after 1 month
Treatment effect】Better recovery of uterus
I. Initial consultation
The patient is 23 weeks pregnant and had a routine delivery today. During the ultrasound examination, she found excessive amniotic fluid, abnormal fetal development, unclear display of the left diaphragm, and partial liver and intestinal echogenicity in the left thoracic cavity. If it is a simple congenital diaphragmatic hernia, it can be treated surgically after birth, but if it is combined with other diseases and malformations, the prognosis is usually not good and further pregnancy is not recommended and abortion needs to be induced.
(At 23 weeks of gestation, the fetus has an indistinct left diaphragmatic surface, discontinuous signals of the left diaphragm, herniation of the stomach, most of the small intestine and colon into the left thoracic cavity, significant upward displacement of the left lung by pressure, and significant reduction in the volume of the left lung tissue by pressure; congenital diaphragmatic hernia is considered)
II. Treatment history
In fetal congenital diaphragmatic hernia 50% is related to chromosomal abnormalities, combined with neurological malformations as well as cardiovascular malformations. From the eugenic point of view, it is recommended to terminate the pregnancy as early as possible, and if the fetus can develop normally until about 40 weeks, it can be treated surgically after birth. However, according to the test results, the development of the fetus’ lungs and other organs had been severely affected, and after discussion with the patient and her family, and after several reviews, the decision was made to end the pregnancy. The patient was first induced and the cervical cervix was softened with oral misoprostol tablets, and then cleared after the embryo was delivered, which was followed by anti-infection treatment with cefuroxime sodium for injection.
III. Treatment effect
After the termination of pregnancy, the patient could not calm down for a long time. I reassured her that she must adjust her mind and get well in order to prepare for the next pregnancy, and she was discharged after 1 week of hospitalization. The ultrasound examination showed that the uterus had returned to normal size and there were no abnormalities such as residue or blood accumulation in the uterine cavity, so the next pregnancy can be prepared when the body recovers. Therefore, it is recommended that both spouses should have chromosome examination before pregnancy preparation, avoid contact with teratogenic substances during pregnancy and have regular maternity checkups.
IV. Precautions
It is unfortunate that the patient’s pregnancy was interrupted, but fortunately, after treatment such as uterus removal, the uterus has returned to normal and the body has recovered, so the patient can actively prepare for the next pregnancy. It is recommended that the patient should adjust her mind and body and give enough nutrition to help her body recover faster. Before the next pregnancy preparation, it is recommended that both spouses should undergo chromosome examination, maintain a healthy lifestyle and stay away from high-intensity radiation, toxic and harmful chemicals, etc., which can reduce the incidence of congenital septal hernia in the fetus.
V. Personal insight
It was not easy for this patient to conceive, but the pregnancy had to be ended because the fetus had a congenital diaphragmatic hernia combined with other congenital malformations that could be severely lethal. It is recommended that couples who are preparing for pregnancy must pay attention to reproductive health examination to clarify whether there are chromosomal abnormalities in both spouses, and to avoid smoking, alcohol and drug abuse during the preparation period to avoid increasing the chance of congenital diseases in the fetus.