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Abstract: This is a case of a primiparous woman who did not pay enough attention to her maternal examinations after her pregnancy and did not have regular maternal examinations as required, resulting in an overdue pregnancy. The patient was found to have low amniotic fluid during ultrasound examination at 42 weeks of gestation, and the fetal monitoring results were not satisfactory, so she failed to initiate contractions spontaneously and was given a cesarean section to terminate the pregnancy.
Basic information】Female, 22 years old
Type of disease】Low amniotic fluid
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Date of Consultation】January 2022
Treatment plan】Surgical treatment (cesarean delivery)
Treatment Period】6 days in hospital
Effectiveness】Fetus was delivered successfully by cesarean section and the treatment effect was good
I. Initial consultation
Patient’s description: Her last menstrual period was on April 3, 2021, and the ultrasound examination at 7 weeks of menopause indicated early intrauterine pregnancy, and the expected delivery date was January 10, 2022. On January 10, 40 weeks of pregnancy, the ultrasound indicated intrauterine pregnancy, late pregnancy, single live fetus, cephalic position, amniotic fluid index 82mm, normal fetal monitoring, no abdominal pain, vaginal bleeding, fluid flow and other discomforts, and the patient was advised to go home for observation for 3 days and then follow up. However, the patient did not follow the doctor’s advice and went back home. On January 24, she developed irregular lower abdominal distension before returning from home and went to the hospital on January 25.
II. Treatment
The ultrasound indicated intrauterine pregnancy, late pregnancy, single live fetus, cephalic position, low amniotic fluid, amniotic fluid index of 34 mm, fetal monitoring indicated irregular contractions and no acceleration of fetal heartbeat. On examination: the patient’s uterine orifice was not opened and the cervical canal was not eliminated. The doctor explained to the patient that the patient was currently in a late pregnancy, with the possibility of hypoplasticity, which led to a significant decrease in amniotic fluid and fetal distress. By assessing the current situation, it was difficult to deliver vaginally in a short period of time and a cesarean delivery was recommended to terminate the pregnancy. The patient agreed to cesarean delivery after discussion with her family and was given a cesarean section on the same day to terminate the pregnancy. Intraoperatively, only 100 ml of amniotic fluid was seen with a degree II turbidity, and the fetus had an Apgar score of 8 at 1 minute, and a score of 10 at 5 minutes after the administration of suction and oxygen, and the operation went smoothly.
(Color ultrasound)
III. Treatment results
The operation went smoothly, and the patient was informed of the low amniotic fluid volume seen intraoperatively and diagnosed with hypohydramnios. Postoperatively, the patient’s vital signs were normal, and postoperative anti-inflammatory treatment with sodium chloride injection + ceftriaxone sodium for injection was given, and uterine contraction was promoted with indocin injection. On the 6th day of hospitalization, the patient had no fever, good uterine regeneration, little vaginal bleeding, the patient’s gastrointestinal function had recovered, no intestinal distension and intestinal obstruction, normal blood count on recheck, good abdominal wound healing, and was discharged on the same day.
IV. Notes
We are glad that the patient had a successful pregnancy. After surgery, the main thing is to prevent puerperal infection and abdominal wound infection, so we should pay attention to personal hygiene habits, change sanitary napkins or pads regularly and pay attention to washing. After delivery, it is recommended to perform pelvic floor rehabilitation treatment as early as possible, especially within 1 year after delivery, to avoid postpartum leakage and uterine prolapse. Attention should be paid to rest after surgery, and patients’ families are advised to help share the task of bringing up children. In addition, postpartum patients are prone to postpartum depression and other psychological disorders, and patients’ families should be understanding and pay attention to patients’ emotional protection. Encourage breastfeeding after delivery, pay attention to contraception, and another pregnancy must be at least 18 months apart.
V. Personal insight
Do regular obstetric checkups and drink herbal medicine during pregnancy, especially in late pregnancy, because the doctor will make specific arrangements for hospitalization according to the fetal condition, contractions, amniotic fluid, pregnancy complications, etc. Because this patient did not follow the doctor’s prescription for regular obstetric checkups, she missed the best time for hospitalization to induce labor and had too little amniotic fluid due to hypoplasticity of her overdue pregnancy, which even triggered mild fetal hypoxia, and the doctor gave a timely cesarean section to terminate the pregnancy to ensure the safety of mother and child. Therefore, the above case reminds us to have regular maternity checkups during pregnancy and to seek medical attention immediately if there is any discomfort.