Patient's question:
Ms. Chen, 25 years old, was admitted to the hospital due to amenorrhea for 392 weeks and intermittent abdominal pain for 5 hours. Chief complaint: Pregnancy at 392 weeks, intermittent abdominal pain for 5 hours. Current medical history: The patient has regular menstrual cycles, with a cycle of 135/30 days, moderate flow, and no dysmenorrhea. Gravida 0-0-1-0 (abortion at 23 years old), LMP (last menstrual period) April 28, 2016, amenorrhea for 40 days, urine β-hCG tested negative, and early pregnancy symptoms (nausea, vomiting) reappeared, lasting for one month. At 4.5 months of pregnancy, fetal movement reappeared and has continued to this day. Fetal movement is good, no dizziness or lower extremity edema, no vaginal bleeding. At 3:00 AM on January 28, 2017, intermittent abdominal pain reappeared, lasting for 30-35 seconds with intervals of 4-5 minutes. She was admitted to the hospital at 8:00 AM on January 28, 2017. Menstrual history: Regular menstrual cycles, 135/30 days, moderate flow, no dysmenorrhea, normal leukorrhea, LMP April 28, 2016. Fertility history: Married at 23 years old, Gravida 0-0-1-0 (abortion at 23 years old). Past medical history: No history of chronic diseases such as heart, lung, or kidney disease; no history of infectious diseases such as tuberculosis or hepatitis; vaccination history is unknown; no history of trauma or intravenous fluid administration. Personal history: Born and raised in her hometown, married at 23 years old, generally healthy, no history of residence in epidemic areas or water; no history of smoking, alcohol, or drug addiction; no special occupation, no history of exposure to toxic substances; no history of promiscuity. Family history: All family members are healthy, no history of hereditary diseases or mental illness in the family; no history of tuberculosis, hepatitis, or sexually transmitted diseases; no history of hereditary diseases or genetic diseases; no history of diabetes or hemophilia. Allergies: No history of penicillin, sulfonamide drugs, streptomycin, or other drug allergies; no history of food allergies. Physical examination: General condition is good, vital signs: T: 36.6°C, P: 78 beats/min, R: 20 breaths/min, BP: 110/70 mmHg. Obstetric examination: Uterine height 33 cm, abdominal circumference 98 cm, fundus palpation is wide, soft, and irregular, with a soft fetal mass; left abdominal wall palpation is wide and soft, right abdominal wall palpation is uneven and mobile, and a round, hard fetal mass is palpated above the symphysis pubis, which is active but not moving. Fetal heart auscultation: Fetal heart sounds can be heard in the lower left abdominal wall: 144 beats/min. External pelvic measurement: 24 cm, 26 cm, 19 cm, 9 cm. Vaginal examination: Cervix dilated to 2 cm, membranes intact, fetal presenting part at S1 below the sacrum, uterine contractions weakened. At admission, contractions were 6-8 times per hour, lasting 20-30 seconds. Medical advice: 5% Dextrose 500 ml with oxytocin 2.5 U IV infusion (adjust drip rate as needed). The patient naturally went into labor at 7:00 AM on January 29, 2017, delivering a male neonate weighing 3200 g, with a red body and blue extremities. The extremities were relaxed; the airway was cleared, with some movements; HR: 80 beats/min; breathing was shallow, slow, and irregular. The placenta was naturally delivered, with a 5x6 cm scar observed. Vaginal bleeding was significant, with more than 500 ml of blood collected, containing clots, and intermittent tearing. The patient's BP was 60/40 mmHg, with pale complexion. She reported dry mouth and was alert but indifferent.Doctor's answer:
According to the condition, it is predicted that the second stage and third stage of labor for the mother will be without issues, and the delivery will be smooth. After the placenta is delivered in the second stage, vaginal bleeding reappears. It is paroxysmal, and it is considered to be due to uterine atony and tearing. Blood pressure is 60/40, with pale complexion, dry mouth, and indifferent expression, indicating that hemorrhagic shock has reoccurred. There is also placental residue. It is recommended to urgently call for help and form a treatment team. Report to the medical department. Emergency surgery and fluid resuscitation for shock treatment are necessary. Cold plasma and platelets may be administered if necessary. At the same time, uterine contractions should be enhanced. Vital signs should be closely monitored. Oxygen should be administered, and the patient and family should be informed of the condition. If strict treatment cannot be applied, hysterectomy should be performed. Antibiotics should be used to prevent infection. Protect the function of vital organs.