Pregnant woman admitted to hospital with 36+2 weeks of menopause and 1+ days of decreased fetal movement.
Current medical history: she has regular menstruation, last menstruation: June 16, 2020, expected date of delivery: March 23, 2021. The pregnancy was planned, 1+ months after menopause, she tested positive on the early pregnancy test, ultrasound confirmed the diagnosis of intrauterine twin pregnancy, early pregnancy reaction was obvious, nausea, vomiting, anorexia of oil, etc., which was tolerable and resolved on its own after 2+ months of pregnancy. She had no history of cold and fetus during early pregnancy and no history of drug exposure. 3+ months of pregnancy, she established a pregnancy health card at the local maternal and child health center and had regular maternity checkups. OGTT, obstetric 4D ultrasound, fetal heart ultrasound, ECG and fetal monitoring showed no significant abnormalities. She has no history of cat or dog contact, no history of toxic, harmful, radioactive and chemical exposure during pregnancy. She had no dizziness, headache, fever, palpitation, chest tightness, skin itching, abdominal pain, vaginal bleeding and other symptoms during pregnancy. 3.90mg/L of D-D dimer on Feb 14, 2021. 4000u of enoxaparin was given subcutaneously once a day. 1+ days ago, the pregnant woman felt a decrease in fetal movement and did not pay attention to it. Today, the ultrasound showed that the fetus was in cephalic position with no abnormality in the umbilical artery and middle cerebral artery, while the fetus was in breech position with no fetal heartbeat and fetal movement, and the umbilical cord was wrapped around the neck for two weeks. She has a normal urine output and a 10 kg weight gain during pregnancy.
Her past history was not special. At admission, T:36.5, P:91 beats/min, R:20 beats/min, BP:110/69 mmHg, height: 162 cm, weight: 69.2 kg, uterine height: 38 cm, abdominal circumference: 109 cm, fetal position: one end and one buttock, fetal previa: high floating, fetal heart rate: 145/0 beats/min. The cervical position is medium, soft, 50% tolerance, the opening is not open, the membranes are not broken, cervical score Bishop 4, no contractions.
Blood count on 02/20/02/02:WBC count 8.55X 10^9/L, neutrophil ratio 76.4 %, hemoglobin 112.00 g/, platelet count 246.00X 10^9/L. Leukocyte cleanliness grade III. Coagulation five: fibrinogen 4.09 g/L, D-D dimer 3.47 mg/L. Liver and kidney function, electrolytes, random blood glucose did not show significant abnormalities. The fetus was in a cephalic position with no abnormalities in the umbilical artery and middle cerebral artery.
Admission diagnosis: 1. G1P0 36+2 weeks intrauterine pregnancy (ROA/LSA) twin fetus. 2. twin pregnancy one fetus dead in utero. After admission and completion of relevant investigations, cesarean section was performed. fetus A was stillborn, weight 2655 g, amniotic fluid II contaminated, umbilical cord wrapped around the neck for two weeks, tighter. fetus B was a live baby girl, weight 2720 g, length 46 cm, no obvious deformity in appearance, clear amniotic fluid, volume about 300 ml. live baby girl was transferred to neonatal unit with heavy anemia and infection.
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