Zhang Xin team of the Obstetrics and Gynecology Department of the Emergency General Hospital is the success of "scar pregnancy" women successfully "disassemble"

Author:Emergency Hospital Time:2022.07.27

Experts remind: "scar pregnancy" should be diagnosed early and ended early

Recently, Ms. Wan, who was pregnant unexpectedly, came to the obstetrics and gynecology department of the Emergency General Hospital because of the "6 weeks of pregnancy". Dr. Niu Xiumin who took the consultation realized that this was not a simple manual abortion after seeing the ultrasound result in the patient's hands. Instead, it is a case of pregnancy. Because of the difficulty of "scar pregnancy" treatment and high risk, local hospitals have no power, and patients came to the emergency hospital for medical treatment.

So what is scar pregnancy? Scar pregnancy is a special type of ectopic pregnancy. Normally fertilized eggs are bed in the uterine cavity, and the fertilized eggs of scar pregnancy are at the cesarean section of the uterus before.邂. And this situation will almost develop into placenta implantation, such as continuing pregnancy. During childbirth, the mother is facing a lot of blood loss, uterine rupture, even uterine resection, and life -threatening. Prevention should be stopped immediately. However, the termination of pregnancy during early pregnancy is also facing the possibility of removal of uterus when severe bleeding. Therefore, the bomb of the scar pregnancy is not left, and it is not dismantling.

Dr. Niu reported the case to Director Zhang Xin of the obstetrics and gynecology department. Director Zhang Xin understood the situation and immediately interrupted the patient: immediately incorporated the patient to the hospital. Ms. Wan, who has been in a cesarean section twice, has been admitted to the obstetrics and gynecology department of the Emergency Hospital. She told the doctor that since she was diagnosed with "scar pregnancy", the doctor of the local hospital told her risks, and the pressure was huge. Difficult to settle. Director Zhang Xin quickly organized everyone to discuss before surgery: pregnancy of scar parts, whether it was immediately terminated or continued pregnancy, there was a risk of hemorrhage, just like a "bomb" was placed in the patient's body. The judgment of the current imaging science should be type I. The drug treatment takes longer and there is a risk of hemorrhage during the observation process; contact the intervention department as soon as possible, and first go to the bilateral uterine arterial embolism, which is equivalent to cutting off the bomber's quilt and then the Qing Dynasty surgery. Remove the bomb is the best treatment for the patient.

Director Zhang Xin led the team's inspection room

Under the coordination of Director Zhang Xin, on the afternoon of the patients in the hospital, the bilateral uterine arterial embolism was performed as scheduled. The surgery was very smooth and successfully cut off the "bomb" queries. On the next day, 24 hours after embolism, Director Zhang Xin led the team to perform the Qing Dynasty surgery for Ms. Wan in the operating room. Due to the superb medical skills and rich experience, the "bomb disassembly" was successful. The post -patient was resumed well and was discharged as scheduled.

Emergency hospital is a three -level comprehensive hospital with complete professional settings. At the beginning of the establishment of the hospital, obstetrics and gynecology are set up. Obstetrics and gynecology technology is strong and clinical experience is rich.

Science time

Scar pregnancy belongs to a special ectopic pregnancy. It refers to the scar incision of fertilized eggs at the previous section or other surgery during pregnancy. The pregnancy (CSP) is most common in the scar of scarring section. There may be no special abnormalities in the early stage. With the development of pregnancy, dangerous situations such as placental implantation, placental penetration or uterine rupture may occur. The incidence of CSP to normal pregnancy is about 1: 2216 ～ 1: 1800, occupying 1.15%of women in the history of cesarean section, and 6.1%of women's ectopic pregnancy in the history of cesarean section. Scar pregnancy is divided into type I, type II, and III based on ultrasound characteristics. Clinicians can adopt different treatment plans according to different types of types.

Treatment goals: Avoid major bleeding, retain the uterus, and treat moderate treatment.

Treatment principles: early diagnosis, early termination, early removal.

Treatment: Drug treatment, surgical treatment and joint treatment.

1. Drug treatment can avoid surgical trauma, but the decrease in absorption of drugs and blood HCG for pregnancy tissues requires long -term follow -up, and there is still the possibility of uterine bleeding and removal of uterus during the treatment process. Simple drug treatment is not the preferred plan for the treatment of CSP.

2. Uterine embolism (UAE) is an important means used to assist therapy. It is an involved in vascular intervention. It has the advantages of minimally trauma, accurate positioning, safety and effectiveness, and less complications. It is often jointly used with other treatments. Not only can he bleeding, but also the risk of major bleeding during treatment.

3. CSP pregnancy removal and uterine scar repair can be completed by opening abdomen, laparoscopy, and vaginal vagina. The surgeon can choose the appropriate surgical pathway according to the patient's condition and their own surgical technical level.

(1) Ultrasonic surveillance surgery: Type Ⅰ CSP suitable for stable life signs, gestational week <8 weeks. Type II, Type III, and type I of the pregnancy weeks ≥8 weeks. CSPs are underwriting. Doctors need pre -treatment pre -treatment, such as UAE or MTX treatment to reduce bleeding during surgery.

(2) Pregnancy removal of uterine hysteroscopy: This surgery requires higher requirements for the surgeon. If combined with ultrasound surveillance during surgery, the risk of surgical complications can be reduced.

(3) Local lesions of uterine lesions and uterine scar repair: Some patients have large lesions, thin uterine muscle layers, and re -fertility requirements and hope to repair uterine defects at the same time. The risk of re -pregnancy in scars.

(4) Uterine resection: Including all -uterine or sub -uterine resection, it is suitable for vaginal bleeding without fertility requirements, difficulty resection of local lesions, ineffective drug treatment, and difficult to control. Most of the cases are misdiagnosed as a normal position of pregnancy -oriented artificial flow or clearing the palace surgery, and even when the uterine rupture is used, it is an emergency measure to save patients' lives. The above treatment methods can be carried out by the obstetrics and gynecology department of the Emergency General Hospital.

understand us

Obstetrics and Gynecology Medical Team

At the beginning of the establishment of the Emergency General Hospital (formerly Coal General Hospital), the Department of Obstetrics and Gynecology was established. There are currently 28 medical staff and 14 doctors, including 3 chief physicians, 5 deputy chief physicians, 4 attending physicians, residents Two people, including 3 doctoral students and 8 graduate students.

There are 21 beds in the department, and the ward and delivery room are redesigned and decorated, which is comfortable and quiet. At present, laparoscopic whole uterine resection, yin -type uterine division, laparoscopic auxiliary yin -type uterine division, uterine fibroid removal, attachment resection, ovarian cyst peeling, ovarian wedge resection, endometrium endometriosis Routine gynecological surgery such as septic removal, fallopian tube pregnancy lesions, fallopian tube umbrella ending, fallopian tubal reinforcement, pelvic adhesion and other conventional gynecological surgery; also conducts surgery and ovarian cancer surgery and ovarian cancer surgery and ovarian cancer surgery and ovarian cancer Chemotherapy. Various hysteroscopic surgery: diagnosis of uterine laparoscopic diagnosis of abnormal uterine hemorrhage, exotic, breeding ring residue/incarceration, endometrial polyps and submucosal fibroids of uterine mucosal fibroids.

The department has a standardized maternal management system, and carries out eugenics, fetal custody, analgesic delivery, newborns bathing and touching, blue light radiation treatment, etc., so that the mother will give birth and childbirth in safety and comfort to ensure the safety of mothers and children's safety Like health.

Department of diagnosis and treatment characteristics:

Gynecological:

1. Ordinary gynecological: Frequently gynecological reproductive system inflammation, uterine fibroids, ovarian cysts, endometrial polyps, submucosal fibroids, reproductive system malformations and other diseases. Ordinary gynecological surgery is mainly minimally invasive surgery, especially good at uterine muscle muscle muscle muscles. Diagnosis and treatment of tumor and uterine adenoma.

2. Gynecological tumor: Gynecological malignant tumors such as cervical cancer, endometrial cancer, ovarian cancer can be accurately applied and comprehensive treatment.

3. Diagnosis and treatment of vaginal mirror and cervical cancer: scientific management of patients with HPV infection, through the screening of cervical cancer and vagoscopy, and implementing standard treatments such as LeEP or cervical cold knife cone in patients with cervical lesions. Cervical cancer early detection, early diagnosis, and early treatment.

4. Gynecological endocrine: Anechetic clinic for menopausal clinics, for patients such as menstrual abnormalities, premature ovarian failure, abnormal reproductive function, and perimal period diseases, formulate a reasonable and effective treatment plan to improve the living standards of patients.

5. Pot bottom dysfunctional diseases: diagnosis and treatment of postpartum pelvic floor relaxation, uterine prolapse, vaginal wall swelling, stress urinary incontinence, various genital tract fistula, cesarean section scar diverticulum, vaginal relaxation, labia abnormal diagnosis and treatment have the diagnosis and treatment. Rich clinical experience.

family planning:

Carry out early pregnancy, painless abortion, visual flow, medium -term pregnancy induction of labor, upper ring, ring, sterilization, etc.; laparoscopic falloposcopy, fallopian tubal reinstation, and fallopian tubes are carried out to relieve trouble for infertile patients.

obstetrics:

1. Pre -pregnancy health care and pre -pregnancy consultation.

2. Conventional prenatal examination and health care; have rich experience in the treatment of normal delivery, dystocia, pregnancy complications, pregnancy complications, and complications during childbirth.

Our obstetrics outpatient clinics: Outpatary of obstetric nutrition management, outpatient medical clinic, prenatal consultation clinic.

3. Postpartum rehabilitation: Rehabilitation treatment of breast dredging, uterine recovery, rectus abdominis, and back pain after giving birth, and postpartum back pain during postpartum hospitalization. Patients with dysfunction of pelvic foundation after discharge can be treated with pelvic floor rehabilitation.

Emergency General Hospital Obstetrics and Gynecology Consultation Telephone