Li Xiang is 30 years old this year. She usually has regular menstruation, which usually lasts about 5 days. The menstrual flow is moderate, and the cycle is usually 28 days. She has no history of dysmenorrhea. It has been 35 days since the last menstruation, and the menstruation has not come yet. Li Xiang is secretly thinking that she may be pregnant, so she just keeps it. Unexpectedly, she has been having vaginal spotting and pain in the lower abdomen for the past few days, as well as mild nausea and vomiting. This is also Li Xiang’s first pregnancy, so she thought it was a normal reaction, and it was relieved after she rested in bed. One night, her vagina started bleeding again, the color was dark red, and she also had pain in the lower abdomen. , anus and lumbosacral pain, so she came to the hospital accompanied by her husband. Physical examination: body temperature 36.9℃, heart rate 81 times/min, respiration 17 times/min, blood pressure 110/80mmHg. Blood HCG is 214.0IU/L; B-ultrasound showed that there was no gestational sac in the uterus, no obvious abnormality in the left adnexa, 3.6cm×2.5cm mixed echo in the right adnexa, and 2.0cm×1.7cm liquid dark area in the uterine rectal fossa, and it was confirmed to be an ectopic pregnancy. Because the patient has fertility requirements and hopes to be treated conservatively, methotrexate intramuscular injection and mifepristone oral administration were given, and rescue and surgical preparations were made. The abdominal pain improved significantly on the second day after admission, and vaginal bleeding stopped on the fourth day. Urine HCG was negative one week later. B-ultrasound showed no abnormalities in the uterus and left adnexa, and low echo in the right adnexa area. Blood HCG was 58.5IU/L three days later. The patient was in general good condition, with stable vital signs, and was discharged.Conservative treatment is mostly suitable for women who want to have children. During conservative treatment, we should communicate more with the patients, strengthen psychological care, closely observe the patients' abdominal pain and vaginal bleeding, prevent infection, and prepare for surgery and rescue. After discharge, we should pay attention to rest, ensure sleep, avoid strenuous exercise and heavy physical labor, avoid abdominal pressure, and seek medical attention at any time if there are any discomfort symptoms. |
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