What to do if there is bleeding around the gestational sac

Although many pregnant women are happy during pregnancy, they are sometimes very worried, fearing that they will be hurt and affect the growth of the baby in their belly. Many pregnant women are worried about bleeding around the gestational sac during pregnancy, because this may mean that the baby in the belly is hurt. But once such a situation occurs, what should we do?

Let’s first popularize a term: paroxysmal nocturnal hemoglobinuria (PNH). The cause of this disease is a defect in the red blood cell membrane structure, which causes the complement system of the patient's immune system to launch an attack on red blood cells, followed by red blood cell destruction (hemolysis), which further induces hemoglobinuria and anemia. Due to the defect in the red blood cell membrane structure, the blood is in a hypercoagulable state at the same time. The diagnosis of this disease relies on bone marrow smear via bone marrow puncture. The treatment mainly focuses on immunosuppression, alkalization of urine, avoiding fatigue, and preventing thrombosis. The incidence of this disease is 4/1,000,000. Patients who pay attention to current affairs probably still remember a rare disease called "amyotrophic lateral sclerosis", with an incidence rate of 2/100,000. So, in terms of rarity, PNH is 50 times rarer than ALS. Perhaps, many obstetricians and gynecologists may never encounter such a patient in their lifetime, and this patient is pregnant, not to mention that she is pregnant, and she also has recurrent miscarriage...

This patient had a history of recurrent spontaneous abortions. Looking at her examination results, all immune-related items were negative and her blood hypercoagulable state was not obvious, so there was no direction for preserving the fetus. The first pregnancy preservation treatment ended in failure. Large doses of immunoglobulin and low molecular weight heparin were used. The HCG level was only about 30,000U/L at around 9 weeks, and severe immune hemolysis occurred. Looking back at previous treatments and considering his underlying disease, it is possible that the immunoglobulin injection caused the immune system to lose balance. Although high-dose immunoglobulin suppresses immunity, it mainly inhibits B cells and NK cells and has no significant inhibitory effect on T cells that mediate complement cytotoxic reactions. Therefore, this immunoglobulin injection may be the cause of poor prognosis. In addition, overly conservative use of glucocorticoids is also a reason.

The patient was hospitalized actively to preserve the fetus. During the hospitalization, hemolysis indexes, coagulation indexes and immune abnormality indexes were monitored. Even though the patient had severe subchorionic and peri-gestational sac bleeding during this pregnancy, and even the hematoma around the gestational sac was larger than the gestational sac itself, we insisted on using large doses of glucocorticoids and low-molecular-weight heparin as the main treatment for preserving the fetus.

There are several things worth recalling during this pregnancy:

First, the patient's blood cells are extremely susceptible to damage, especially during repeated blood draws and tests, which can cause hemolysis of the specimens. However, HCG testing must use serum to complete the experiment. Therefore, it is impossible to obtain accurate data from hemolyzed specimens. Taking into account the particularity of the disease itself, Guo Zhongjie's medical team consulted a lot of literature and consulted many experts. In the end, they could only finalize a more troublesome method, which is to use a syringe to draw blood, then send it to the laboratory in a warm state and immediately process the specimen to extract serum. This greatly increased the difficulty of the work of nurses and the laboratory, but through our repeated adjustments, we finally reached a tacit understanding of cooperation. He thought that such special treatment for special diseases would be impossible in public hospitals.

Second, the patient suffered repeated hemolysis during hospitalization and needed blood transfusion three times. The blood she needed was relatively precious washed red blood cells. In particular, the first blood transfusion occurred during an important political and economic event in the region. In order to ensure the emergency needs of the related event, the blood center had extremely strict control over the blood source and was unwilling to provide blood. Elizabeth contacted the clinical blood use management department and made emergency coordination with the blood center. She obtained the blood quota on the same day and transfused life-saving blood to the patient.

Our female friends must pay special attention during pregnancy, especially we must not do some dangerous actions, and we should not do some dangerous work at this time. Once you find yourself experiencing symptoms of gestational sac bleeding, you must pay attention and take the pregnant woman to the hospital for examination as soon as possible, perform necessary fetal preservation work, and ensure the baby is born smoothly.