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中华医学会北京分会妇产科学会于1985年10月31日组织北京市城郊妇产科医务人员,讨论了软产道损伤造成的产后大出血病例,与会者对此问题极为重视,积极发言交流经验,现将病例及讨论情况摘要绍介如下: 病例摘要患者27岁,宫内孕40~(-2)周,产妇于1977年7月17日8∶30因破水2小时入院。产前检查未发现异常,末次月经1976年10月13日,预产期1977年7月20日。入院检查,一般情况良好,血压140/106mmHg,尿蛋白(-),下肢浮肿(-),胎心144次/分,ROA,肛查宫口开指尖,先露为S—O,胎膜已破,骨盆正常,血色素10g％,胎儿体重估计3000g。入院后宫缩20″/10′,因血压高肌肉注射50％硫酸镁7ml,宫缩一直不好。14∶40宫缩30″/5′,16∶35肛查宫口开1~+cm,先露为S—O,血压150/100mmHg,稍感头晕,再肌肉肉注射5％硫酸美7ml,17∶55宫缩35″/3′肛查宫口开大9cm,先露为S+1,18∶19产母用力,阴道口见头发,肛查宫口开全,先露已达盆底,18∶53以右枕前位自然娩出一女婴,体重3,100g,生后即哭。当婴儿肩娩出时常规静脉注射50％萄葡糖10ml加催产素10单位。19∶09胎盘自然娩出,完整,随后一股鲜血流出约350ml,会阴Ⅱ°裂伤常规缝合,在裂伤缝合中阴道仍有活动出血,宫底注射麦角0.2mg,同时1∶1,000催产素静脉点滴,手揉宫底子宫时软时硬,阴道出血时多时少。20∶20血压90/60mmHg,脉104次/分,快速点滴催产素。20∶35血压
The Chinese Society of Obstetrics and Gynecology, Beijing Branch of Obstetrics and Gynecology Society organized the subordinate obstetrics and gynecology medical staff in Beijing on October 31, 1985 to discuss cases of postpartum hemorrhage caused by soft birth canal injury. Participants attached great importance to this issue and actively spoke to exchange experiences. Summary of the cases and discussion are summarized as follows: Case Summary 27-year-old woman, intrauterine pregnancy 40 to (-2) weeks, at 8:30 on July 17, 1977, the mother was admitted to hospital for 2 hours due to broken water. Prenatal examination found no abnormalities, the last menstrual October 13, 1976, the expected date of July 20, 1977. Admission examination, generally good, blood pressure 140 / 106mmHg, urinary protein (-), lower extremity edema (-), fetal heart rate 144 beats / min, ROA, anal inspection cervix open fingertips, Broken, pelvic normal hemoglobin 10g%, estimated fetal weight 3000g. Uterine contractions after admission 20 “/ 10 ’, due to high intramuscular injection of 50% magnesium sulfate 7ml, contractions have been bad .14:40 Contractions 30” / 5’, 16:35 anal check cervix 1 ~ + cm , First exposed to the S-O, blood pressure 150 / 100mmHg, slightly dizzy, and then intramuscular injection of 5% sulfuric acid 7ml, 17:55 contractions 35 "/ 3 ’anal check cervix open large 9cm, first exposed to S + 1,18:19 Productive force, see the vagina mouth hair, cervix open the cervix, first revealed the pelvic floor, 18:53 to the right of the former natural delivery of a baby girl, weight 3,100g, cry after birth When the baby is delivered when the shoulder routine intravenous injection of 50% glucose 10ml plus oxytocin 10 units.19:09 placenta naturally delivered, complete, and then an outflow of about 350ml of blood, perineum Ⅱ ° laceration conventional suture, laceration and suture The vagina is still active bleeding, intrauterine injection of ergot 0.2mg, at the same time 1: 1,000 oxytocin intravenous drip hand rubbing the uterus at the time of the soft and hard, vaginal bleeding for more time less.20:20 Blood pressure 90 / 60mmHg, pulse 104 / Min, rapid drip oxytocin .20: 35 blood pressure