Intrauterine abortion combined with tubal pregnancy rupture (draft)

obstetrics and gynecology paper I

Intrauterine abortion combined with tubal pregnancy rupture 

A Case Report

子宫内、外同时妊娠並均中止,临床上极为罕见。我们出诊遇到一例,现报告如下。

It is extremely rare to have both intra-uterine and extra-uterine pregnancies terminated simultaneously in clinic. We encountered a case of house call, which is now reported as follows. 

患者23岁,结婚两年未曾生育,平素月经尚属正常。停经52天,伴有恶心、偏食、嗜睡等早孕反应。79422日突然阴道流血伴下腹痛,继而排出胚胎组织,经检查证实为完全流产。俟后阴道流血停止及腹痛消失,一般情况尚好。尔后于第九天夜间,患者诉开始行房,当即感到右下腹疼痛伴头昏出汗等,急诊於当地医院被认为流产后感染或肠寄生虫症,给予四环素及止痛片,患者回家。翌晨再次剧烈腹痛並伴休克,於52日上午7时住入公社医院,检查血压60/30毫米汞柱,脈率112/分,面色苍白,大汗、烦燥,全腹压痛,右下腹肌紧张,扪之饱满感,有移动性浊音,诊断性腹穿,容易抽出不凝之暗红色血液,诊断为異位妊娠破裂。给以快速补液并输血400毫升,局麻下手术,腹腔积血和血块约2000毫升, 发现右侧输卵管壶腹部增粗如鸭蛋大。破裂出血,见3厘米长男性成形胎儿游离于腹腔。行右侧输卵管切除,其内见胎盘组织。对侧输卵管、卵巢均正常。子宫软而略增大,无粘连。收集腹腔积血350毫升回输无反应。术后10天痊愈出院。

A 23-year-old woman had not given birth after two years of marriage and her menstruation was normally normal. She stopped menstruating for 52 days, accompanied by nausea, partial eclipse, drowsiness and other early pregnancy reactions. On 22 April 79, sudden vaginal bleeding with lower abdominal pain and subsequent discharge of embryonic tissue were confirmed as complete abortion. After vaginal bleeding stopped and abdominal pain disappeared, the general situation was good. Later, on the night of the ninth day, the patient complained that he started to have sex, and immediately felt right lower quadrant pain with dizziness and sweating. In the emergency department, the patient was considered to have post-abortion infection or intestinal parasitic disease in the local hospital. He was given tetracycline and pain-killer tablets, and he went home. Rosty Yi again severe abdominal pain and shock, at 7 a.m. on May 2 in commune hospital, check the blood pressure of 60/30 mm Hg, pulse rate of 112/ minute, pale face, sweat, irritation, abdominal tenderness, right lower abdominal muscle tension, the feeling of fullness of ammon, mobile voice, diagnostic abdominal wear, easy to draw out the dark red blood coagulation, diagnosed as ectopic pregnancy rupture. After rapid fluid replacement and blood transfusion of 400 ml, the operation was performed under local anesthesia, and about 2000 ml of blood and clots were accumulated in the abdominal cavity. The ampulla of the right fallopian tube was found to be thickened as large as a duck’s egg. The rupture was bleeding, and a 3-cm-long male fetoprotein was found free in the abdominal cavity. A right salpingectomy was performed, which revealed placental tissue. The contralateral fallopian tube and ovary were normal. The uterus was soft and slightly enlarged without adhesion. There was no reaction after 350 ml of blood collected from abdominal cavity was transfused. He recovered and was discharged 10 days after surgery.    

By Yaogui Pan & Mingjie Li, Nanling County Hospital, 05/14/1979

Nanling Medicine, 1979; 1:21

obstetrics and gynecology paper II

Rivanol induction of labour by amnion cavity injection

Clinical Analysis of 120 Cases  

妊娠全程中,因某种原因随时需要终止妊娠,本是妇产科工作内容之一。在大力推行计划生育工作中,仍以此作为避孕、绝育的补救措施,更有增加趋势。除早孕以吸宫、刮宫一次处理完毕作为定型手术而获得较为满意的效果外,孕周在13周以后的中、晚期妊娠,则需要人工引产。虽方法众多,但均因各有利弊而不尽完善。近年来同道们正力图不断更新方法,以期求得安全、有效、少痛苦、缩短时间。我院在进行过程中,天花粉、芜花、羊水、高渗糖及羊水、高渗盐水交换等引产法之后,吸取国内外先进经验,于19804-10月又集中开展了一批利凡诺羊膜腔注入引产法。通过临床实践,感到效果良好,现就资料完整120例予以总结,并略加分析、讨论。

Pregnancy termination is required at any time during the whole pregnancy process for some reason, which is one of the tasks in obstetrics and gynecology department. In the vigorous implementation of family planning work, it is still used as a remedial measure for contraception and sterilization, and there is a growing trend. In addition to treating early pregnancy with one-off aspiration and curettage to obtain a satisfactory effect as a finalize the design operation, artificial induction of labor is required for the middle and late pregnancies with gestational weeks beyond 13 weeks. Although there are many methods, they are not perfect due to their respective advantages and disadvantages. In recent years, our colleagues are trying to constantly update the method, in order to obtain safe, effective, less pain, shorten the time. In the process of induction of labor in our hospital, after the induction of labor with trichosanthin, Wuhua, amniotic fluid, hypertonic glucose and amniotic fluid, hypertonic saline exchange, and drawing on the advanced experience in China and abroad, another batch of induction of labor with rivanol amnion implantation was carried out intensively from April to October 1980. Through clinical practice, we feel the effect is good. 120 cases with complete data are summarized, and slightly analyzed and discussed. 

适应症与禁忌症

118孕周以上,直至临产床前,因主动要求或因病被迫需妥终止妊娠,而又无禁忌症者。但妊娠34周以上,胎儿有可能成活。如因母子原因需提早分娩而又希望胎儿成活者除外。

2、生殖器炎症,若经阴道途径引产易致宫内感染者适于此法。

3、体质衰弱,心、肾、肝、肺功能不全。急性传染病等需积极治疗待改善后方可慎行。

4、急慢性泌尿系感染,需先行控制。否则易因上行感染而加重病情。

5、妊娠晚期若并有产道机械障碍或胎位不正。胎儿畸形,需在引流中适时给以助产或碎胎或放弃引产改行手术产。

Indications and contraindications 

1, more than 18 weeks of gestation, until before the delivery bed, due to active request or due to illness was forced to properly terminate the pregnancy, and no contraindications. However, after 34 weeks of gestation, the fetus may survive. Except in cases where early delivery is required due to mother-child reasons and the fetus is expected to survive. 

2, genital inflammation, if induced labor by vaginal route easily cause intrauterine infection is suitable for this method. 

3, weak constitution, heart, kidney, liver, lung dysfunction. Acute infectious diseases need active treatment and can be treated cautiously only after improvement. 

4, acute and chronic urinary infection, need to control. Otherwise, the disease is easily aggravated by ascending infection. 

5. If there is any mechanical disorder of the birth canal or abnormal fetal position during the third trimester of pregnancy. Fetal malformations, need to give timely midwifery or fetal fragmentation in drainage or give up induced labor to surgery. 

临庆资料

全组120例。年龄最小15岁,最大为48岁,初孕妇22人,经孕妇98人。孕期在18-38周。一次功成119例,成功率99.11%。作产时间: 初孕妇平均为40.3小时。经产妇为58.5小时,平均49.4小时。一次排出88例,胎盘残留者24例,有宫缩乏力行钳刮7例。失败一例,改用水囊引产而获成功。本组无二次注药。平均住院5天,住温66例正常,54例低热,最高为38℃,待胎儿排出后均自行下降正常。平均出血量约50毫升,全组无死亡。但有一例在钳刮中并发羊水栓塞经抢救成功。

Clinical materials 

There were 120 cases in this group. The youngest was 15 years old and the oldest was 48 years old. There were 22 primiparous women and 98 menstruating women. Pregnancy is between 18 and 38 weeks. One-off success was achieved in 119 cases, with the success rate of 99.11%. Labor time: the average duration of first trimester pregnancy was 40.3 hours. 58.5 hours, with an average of 49.4 hours. There were 88 cases of one-time discharge, 24 cases of retained placenta, and 7 cases of curettage with forceps due to uterine inertia. In the case of failure, the abortion was succeeded by using water bladder instead. There was no second drug injection in this group. The average hospitalization time was five days. Among the 66 cases with normal dwell temperature and 54 cases with low grade fever, the highest was 38℃, and all of them spontaneously declined to normal after the fetus was discharged. The average amount of bleeding was about 50 ml, and there was no death in the whole group. However, one case of complicated amniotic fluid embolism during curettage was successfully rescued. 

induction of labor effect: 

Among 119 cases of successful induction of labor, 112 cases of fetus were discharged by oneself, and all of them were stillborn. The remaining seven cases were 18–24 weeks pregnant. If the orifice of the uterus was opened due to uterine inertia or abnormal fetal position, curettage was performed with satisfactory results (Table 1) 

Table 1 relationship between drainage time and gestational week and cases   The drainage time mostly disappeared between 25 hours and 72 hours, reaching 88%, and the duration of labor was shorter as the gestational month became larger. There are many opportunities for natural childbirth, which shows that the uterus is relatively sensitive.   

() 引产效果:

引产成功的119例中,自行排出胎儿112例,全部死胎。余7例均为妊娠18-24周,因宫缩乏力或胎位不正,而宫口已开,则行钳刮术而获效满意(如表1)

1        引流时间与孕周关系及例数

孕周

例数

24小时内

25-48小时

49-72小时

> 73

小时

平均作产时间

18-21

38

2

15

18

5

56.1

22-25

35

0

11

21

3

48

26-29

22

1

8

12

1

45.3

30-34

16

7

3

6

0

44

> 35

8

3

3

2

0

42

合计

119

13

10.9%

40

33.0%

59

50%

7

5.9%

47.1

引流时间大多数在25小时至72消失之间,达88%,而孕约月愈大作产时问愈短。自然娩出机会多,显示子宫较为敏感。

References 

  1. Special summary of induced labor in second trimester pregnancy: materials from National Family Planning Experience Exchange Meeting 
  2. Department of Obstetrics and Gynecology, Bengbu Third Hospital, 1978: summary of 216 cases of induced labor in second and third trimester pregnancy by amnion cavity injection from Rever Woer. Family planning data compilation 1978 
  3. Liu Yong et al., amniotic fluid (review). Foreign Medical References, Gynaecology and Obstetrics fascicle 2:41 1975 
  4. Zhou Lijuan et al. Effect of rivanol on immune uterus. Data compilation of rivanol induced labor in second trimester 
  5. Wu Hanjing: 525 cases were treated with rivanol amnion injection. Analysis of the Effect of Induced Labor in Middle and Late Pregnancy (Internal Data) 1980 
  6. First Medical University: Gynaecology and Obstetrics. P: 61-541 people’s health press, 1978   September 1980 exchange of materials at the first academic conference on obstetrics and gynecology of anhui province by li mingjie, pan yaogui, nanling county hospital

 

参考资料

[1] 中期妊娠引产专题小结: 全国计划生育经验交流会资料 1978年[2] 蚌埠三院妇产科: 雷佛妇尔羊膜腔注射中、晚期妊娠引产216例小结。计划生育资料汇编 1978年[3] 刘庸等:羊水 (综述)。国外医学参考资料、妇产科分册  2:41 1975年[4] 周丽娟等: 利凡诺对免子宫作用的探讨。利凡诺中期妊娠引产资料汇编[5] 吴涵静:525例利凡诺羊膜腔注射。中晚期妊娠引产效果分析 (内部资料)  1980年[6] 上一医等: 妇产科学。P: 61-541 人民卫生出版社 1978年

 

一九八〇年九月 南陵县医院 李名杰 潘耀桂安徽省首届妇产科学术会议交流资料

发布者

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